BACKGROUND Urologists are commonly consulted regarding difficult and traumatic urethral catheterizations.Complications surrounding Foley catheterizations represent a significant burden to the healthcare system.AIM To ...BACKGROUND Urologists are commonly consulted regarding difficult and traumatic urethral catheterizations.Complications surrounding Foley catheterizations represent a significant burden to the healthcare system.AIM To assess the demographic and patient characteristics surrounding urological consultation for difficult and traumatic Foley catheterizations at our institution across multiple hospitals.METHODS This is a single-institution,multi-hospital,263 patient,retrospective chart review from Jan 2020–December 2023.RESULTS The majority of consultations(80.2%)did not require heroic measures by the urology service.A Foley catheter placement was determined not difficult in the majority 191(72.6%)of patients.Sub-group analysis of“difficult by urology”vs“not difficult by urology”,showed a significant difference between those with zero attempts,one attempt,and greater than one attempts(P=0.004).Those patients specifically with greater than one attempts were more likely to be seen as a difficult insertion by urology assessment(60.6%)compared to not difficult(38.6%).Likewise,those patients with a history of difficult urethral catheter(DUC)/traumatic urethral catheterization(TUC)(25.8%)were more likely to be difficult compared to those without a history of DUC/TUC(14.2%)(P=0.038).CONCLUSION The study found that majority of consultations received did not require heroic measures by the urology service to place a catheter.Patients who had a history of DUC/TUC and those who had greater than one catheter attempts were statistically more likely to be a DUC based on urology assessment.At our institution we hope to propose a protocol in which nursing staff and non-urologic clinicians will utilize a troubleshooting checklist and an algorithm when difficult or traumatic urethral catheters are encountered in order to improve patient care and decrease healthcare costs.For example,this protocol would ideally address complications of multiple catheter attempts such as urethral trauma,development of urethral strictures,and infection risk.Additionally,future trainings and availability of additional resources will be provided and assessed with a goal of reducing healthcare cost surrounding these complications.展开更多
<strong>Background:</strong> Postpartum haemorrhage is the leading cause of maternal deaths worldwide, the majority of which occur in low resource settings. Uterine atony is the commonest cause of postpart...<strong>Background:</strong> Postpartum haemorrhage is the leading cause of maternal deaths worldwide, the majority of which occur in low resource settings. Uterine atony is the commonest cause of postpartum haemorrhage. Uterine balloon tamponade (UBT) is an effective method of treating refractory postpartum haemorrhage.<strong> Aim:</strong> Commercial UBT devices are often not affordable and not readily available in rural settings. The aim of this paper is to report on three cases of postpartum haemorrhage successfully managed with uterine balloon tamponade using Foley catheters. <strong>Case Reports:</strong> We report on three patients with major obstetric haemorrhage from uterine atony who were successfully managed with uterine balloon tamponade using Foley’s urethral catheter. The first two patients had primary postpartum haemorrhage while the third patient had significant bleeding during the surgical evacuation of the uterus for a molar pregnancy. In each case, uterine bleeding was refractory to pharmacologic uterotonics. They all had uterine tamponade with a Foley catheter with the dramatic resolution of their bleeding. <strong>Conclusion:</strong> In well-selected patients, uterine balloon tamponade with Foley catheter is cheap, arrests bleeding and prevents clinical deterioration among women with refractory postpartum haemorrhage, especially in low resource settings where commercial balloon tamponade may not be available or affordable.展开更多
The present study was conducted to evaluate minimally invasive tube cystostomy technique in goats and calves suffering from obstructive urolithiasis having intact and ruptured urinary bladder. This clinical study was ...The present study was conducted to evaluate minimally invasive tube cystostomy technique in goats and calves suffering from obstructive urolithiasis having intact and ruptured urinary bladder. This clinical study was carried out on 84 clinical cases （61 goats and 23 calves） based on the history, clinical signs and physical examination along with common laboratory techniques at the Chittagong Veterinary and Animal Sciences University during January 2015-December 2016. Physical parameters like heart rate, respiratory rate, rectal temperature and dehydration status of animals were noted and corrected abnormality before surgery. Some cases had slightly higher haemoglobin （Hb）, packed cell volume （PCV） and uric acid and epithelial casts in urine. The study revealed that abnormal calcium-phosphorus ratio was predisposing the animals to urolithiasis. It was found that young ruminants （3-5 months） were most commonly affected in both species. All affected animals were male in this study, in which calves were not castrated but in goats 95.08% animals were castrated. Rupture of bladder was more common in calves as compared to goats. Postoperatively all cases were administered with broad-spectrum antibiotic, anti-inflammatory agent and caliculolytic agents like ammonium chloride. Tube cystostomy with Foley’s catheter was the most satisfactory technique for the management of obstructive urolithiasis in small ruminants. Postoperative complications were recorded only in four animals and remaining 80 animals had a normal recovery from tube cystostomy. Tube cystostomy is a simple, inexpensive and very effective procedure for the treatment of urolithiasis in ruminants.展开更多
文摘BACKGROUND Urologists are commonly consulted regarding difficult and traumatic urethral catheterizations.Complications surrounding Foley catheterizations represent a significant burden to the healthcare system.AIM To assess the demographic and patient characteristics surrounding urological consultation for difficult and traumatic Foley catheterizations at our institution across multiple hospitals.METHODS This is a single-institution,multi-hospital,263 patient,retrospective chart review from Jan 2020–December 2023.RESULTS The majority of consultations(80.2%)did not require heroic measures by the urology service.A Foley catheter placement was determined not difficult in the majority 191(72.6%)of patients.Sub-group analysis of“difficult by urology”vs“not difficult by urology”,showed a significant difference between those with zero attempts,one attempt,and greater than one attempts(P=0.004).Those patients specifically with greater than one attempts were more likely to be seen as a difficult insertion by urology assessment(60.6%)compared to not difficult(38.6%).Likewise,those patients with a history of difficult urethral catheter(DUC)/traumatic urethral catheterization(TUC)(25.8%)were more likely to be difficult compared to those without a history of DUC/TUC(14.2%)(P=0.038).CONCLUSION The study found that majority of consultations received did not require heroic measures by the urology service to place a catheter.Patients who had a history of DUC/TUC and those who had greater than one catheter attempts were statistically more likely to be a DUC based on urology assessment.At our institution we hope to propose a protocol in which nursing staff and non-urologic clinicians will utilize a troubleshooting checklist and an algorithm when difficult or traumatic urethral catheters are encountered in order to improve patient care and decrease healthcare costs.For example,this protocol would ideally address complications of multiple catheter attempts such as urethral trauma,development of urethral strictures,and infection risk.Additionally,future trainings and availability of additional resources will be provided and assessed with a goal of reducing healthcare cost surrounding these complications.
文摘<strong>Background:</strong> Postpartum haemorrhage is the leading cause of maternal deaths worldwide, the majority of which occur in low resource settings. Uterine atony is the commonest cause of postpartum haemorrhage. Uterine balloon tamponade (UBT) is an effective method of treating refractory postpartum haemorrhage.<strong> Aim:</strong> Commercial UBT devices are often not affordable and not readily available in rural settings. The aim of this paper is to report on three cases of postpartum haemorrhage successfully managed with uterine balloon tamponade using Foley catheters. <strong>Case Reports:</strong> We report on three patients with major obstetric haemorrhage from uterine atony who were successfully managed with uterine balloon tamponade using Foley’s urethral catheter. The first two patients had primary postpartum haemorrhage while the third patient had significant bleeding during the surgical evacuation of the uterus for a molar pregnancy. In each case, uterine bleeding was refractory to pharmacologic uterotonics. They all had uterine tamponade with a Foley catheter with the dramatic resolution of their bleeding. <strong>Conclusion:</strong> In well-selected patients, uterine balloon tamponade with Foley catheter is cheap, arrests bleeding and prevents clinical deterioration among women with refractory postpartum haemorrhage, especially in low resource settings where commercial balloon tamponade may not be available or affordable.
文摘The present study was conducted to evaluate minimally invasive tube cystostomy technique in goats and calves suffering from obstructive urolithiasis having intact and ruptured urinary bladder. This clinical study was carried out on 84 clinical cases （61 goats and 23 calves） based on the history, clinical signs and physical examination along with common laboratory techniques at the Chittagong Veterinary and Animal Sciences University during January 2015-December 2016. Physical parameters like heart rate, respiratory rate, rectal temperature and dehydration status of animals were noted and corrected abnormality before surgery. Some cases had slightly higher haemoglobin （Hb）, packed cell volume （PCV） and uric acid and epithelial casts in urine. The study revealed that abnormal calcium-phosphorus ratio was predisposing the animals to urolithiasis. It was found that young ruminants （3-5 months） were most commonly affected in both species. All affected animals were male in this study, in which calves were not castrated but in goats 95.08% animals were castrated. Rupture of bladder was more common in calves as compared to goats. Postoperatively all cases were administered with broad-spectrum antibiotic, anti-inflammatory agent and caliculolytic agents like ammonium chloride. Tube cystostomy with Foley’s catheter was the most satisfactory technique for the management of obstructive urolithiasis in small ruminants. Postoperative complications were recorded only in four animals and remaining 80 animals had a normal recovery from tube cystostomy. Tube cystostomy is a simple, inexpensive and very effective procedure for the treatment of urolithiasis in ruminants.
