Although bladder drainage is widely used for general surgical patients undergoing laparotomy, there is little consensus on whether suprapubic or transurethral catheterization is better.
A systematic database search was undertaken to find all studies of suprapubic catheterization. Randomized controlled trials were identified for inclusion. Endpoints for analysis were bacteriuria, patient satisfaction and recatheterization rates. A meta-analysis was performed using fixed-effect or random-effect models as appropriate, depending on heterogeneity.
After abdominal surgery, transurethral catheterization is associated with significant bacteriuria (relative risk (RR)=2.02, P<0.001, 95 percent confidence interval (c.i.) 1.34 to 3.04) and pain or discomfort (RR=2.94, P=0.004, 95 percent c.i. 1.41 to 6.14). Recatheterization rates using the transurethral method were not increased significantly (RR=1.97, P=0.213, 95 percent c.i. 0.68 to 5.74) with heterogeneity between studies.
The suprapubic route for bladder drainage in general surgery is more acceptable to patients and reduces microbiological morbidity.
"Other authors have hypothesized that urethral catheterization may play a role in exacerbating postoperative inflammation at the urethrovesical anastomosis, promoting development of bladder neck or urethral strictures . In a meta-analysis of patients undergoing abdominal surgery (but not RP), postoperative discomfort was significantly higher in patients with urethral versus suprapubic catheterization . "
[Show abstract][Hide abstract] ABSTRACT: Patients undergoing radical prostatectomy (RP) traditionally require urethral catheterization for adequate bladder drainage in the postoperative period. However, many patients have significant discomfort from the urethral catheter.
To describe a technique of percutaneous suprapubic tube (PST) bladder drainage after robotic-assisted laparoscopic radical prostatectomy (RALP) and to evaluate patient discomfort, complications, continence, and stricture rate after this procedure.
Two hundred two patients undergoing RALP were drained with a 14F PST instead of a urethral catheter. The PST was placed robotically at the conclusion of the urethrovesical anastomosis and secured to the skin over a plastic button. Beginning on postoperative day 5, patients clamped the PST, urinated per urethra, and measured the postvoid residual (PVR) drained by PST. The PST was removed when residuals were <30 cm(3) per void. The control group consisted of 50 consecutive patients undergoing RALP with urethral catheter drainage.
The primary end point was catheter-associated discomfort as measured with the Faces Pain Score-Revised (FPS-R). Secondary end points included use of anticholinergics, complications related to the PST, urinary continence, and urethral stricture.
When compared with urethral catheter patients, PST patients had significantly decreased catheter-related discomfort on postoperative days 2 and 6 (p<0.001). Anticholinergic medication was required by one PST and four urethral catheter patients (p<0.001). Ten patients required urethral catheterization for PST dislodgement (n=5) or urinary retention (n=5). No patient has developed a urethral stricture at a mean follow-up of 7 mo.
PST provides adequate urinary drainage following RALP with less patient discomfort and no increased risk of urethral stricture.
European Urology 04/2009; 56(2):325-30. DOI:10.1016/j.eururo.2009.04.018 · 13.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The most common site of nosocomial infection, involving more than 400 000 patients in this country annually, is the catheterized urinary tract. These infections cause significant morbidity, prolong hospital stay, increase hospitalization costs, and contribute to mortality caused by Gram-negative septicemia. Strict adherence to appropriate infection control procedures is necessary if the incidence and sequels of catheter-related infections are to be reduced. Based upon current understanding of the epidemiology of nosocomial urinary tract infections, guidelines for the prevention of catheter-associated urinary tract infections are presented.
Annals of internal medicine 04/1975; 82(3):386-90. DOI:10.7326/0003-4819-82-3-386 · 17.81 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This paper is concerned with aspects of the analysis, design and implementation of an Electric Power-Assisted Steering (EPAS) system. In particular, it presents a number of innovative areas of the design characterised by the fact that in some sense they lie outside the usual constrained 'feedback loop design' view of the Control Systems discipline, but whose underlying and unifying theme is that their origins can be traced to specific control objectives and/or dynamic systems analysis or approach. The paper commences by introducing the EPAS system concept where both the technical and commercial benefits are compared with existing technologies. The remainder of the paper is then focused on detailed examples which link control and systems analysis to innovative areas of the design.
American Control Conference, 2002. Proceedings of the 2002; 02/2002
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