A programme to audit the use of urinary catheters

• ? This paper describes the development of a tool to audit the use of urinary catheters on surgical wards; the overall objectives being a reduction in the inappropriate use of urinary catheters, and in the number of urinary tract infections.
• ? The literature is reviewed to determine the criteria necessary to audit urinary catheters effectively. The implementation of an audit of urinary catheters on one surgical ward over 6 weeks showed that 27 catheters were used. All catheters passed in the ward were of the appropriate size, balloon and lumen. Significant bacteriuria was found in 5/18 (28%) of catheters in situ for 3 days. All three catheters which remained in situ longer than 10 days had significant bacteriuria. The results were favourable; this was possibly due to the patient population and the individual reasons for catheterizations.
• ? The need for the results of audit tools such as this to be interpreted on a ward-to-ward basis, and not to compare wards with each other is highlighted. This audit tool could be used by other surgical wards.

     

Mobile health technologies for the management of urinary incontinence: A systematic review of online stores in Brazil

BackgroundUrinary incontinence (UI) is a serious condition for which often times insufficient non-surgical treatment options are provided or sought. Mobile health (mHealth) applications (apps) offer potential to assist with the self-management of UI.ObjectiveTo perform a systematic review of available mHealth apps for UI in Brazil.MethodsA search for UI mHealth apps from the Google Play Store and AppStore in Brazil was performed by two independent reviewers on June 4 2020, and the quality of eligible mHealth apps was assessed using the Mobile App Rating Scale (MARS).ResultsOf the 1111 mHealth apps found, 12 were eligible for inclusion. Four offered exclusively exercise programs, six offered exercise and educational content, and two offered tools to track patient-reported symptoms. The included apps scored poorly on the MARS quality scale, with a mean ± standard deviation score of 2.7 ± 0.6 on a 0–5 scale. Most apps scored poorly based on credibility, user interface and experience, and engagement.ConclusionAlthough there is growing interest in the development of mHealth technologies to support patients with UI, currently available tools in Brazil are of poor quality and limited functionality. Effective collaboration between industry and research is needed to develop new user-centered mHealth apps that can empower patients with UI.     

Neuroblastoma Causing Acute Urinary Retention: A Rare Presentation

Background: Neuroblastoma is the most common extracranial solid tumor in children under the age of 5 years and, after acute lymphoblastic leukemia, is the second most prevalent malignancy in childhood. Acute urinary retention is rare in children, especially due to a neuroblastoma. Objectives: To present the potential complications of a pelvic neuroblastoma. Case report: A 9-month-old infant presented with urinary retention that had been attributed in the past to the infant's chronic constipation. She was catheterized and a large residual of urine was obtained; she was discharged home. She returned the following day with the same complaint. Plain radiographs suggested a soft tissue density in the pelvic region with no evidence of constipation. Rectal examination revealed a mass, and a computed tomography scan showed a large, solid mass. Pathological examination confirmed a pelvic neuroblastoma, which was resected. Conclusions: The most common causes of acute urinary retention are urinary tract infections, lower urinary stones, neurologic processes, trauma, and constipation. A detailed and focused history and physical examination can be very helpful in diagnosing a pathological cause of urinary retention, such as a pelvic neuroblastoma.     

Catheter‐Associated Urinary Tract Infections: A Nurse‐Sensitive Indicator in an Inpatient Rehabilitation Program

Urinary tract infections account for 40% of all hospital‐acquired infections; 80% of those infections are associated with indwelling urethral catheters. To meet the requirement for medical necessity, patients are being admitted to rehabilitation programs earlier in their hospital stays than in the past. As a result, there has been an increase in the use of urinary catheters, which prompted an evaluation of infection rates. A collaborative project between nursing and infection control was designed to collect baseline data on catheter‐associated urinary tract infections (CAUTI) in a nonintensive care unit inpatient setting. Two inpatient rehabilitation units within our health system participated. The purpose of this article is to share the process used to determine a baseline CAUTI rate, the interventions implemented to reduce use of catheters, and the outcomes associated with this project. The results demonstrate an overall reduction in the use of catheters, as well as a reduction in CAUTI.     

两种方法检测尿沉渣中管型的临床分析

目的 分析比较使用尿沉渣分析仪及显微镜两种方法 检验尿液管型的差别。方法 选择2011年2月至2013年2月在该院进行治疗的238例患者,对其尿液标本进行研究,分别使用尿沉渣分析仪及显微镜检查仪对标本进行管型分析。结果 238例患者的尿液标本中尿沉渣分析仪管型阳性率为19．75％,显微镜检查的阳性率为4．20％,两者差异有统计学意义（χ^2＝21．55,P＜0．05）。其中尿沉渣分析仪结果 中的假阳性率为82．98％,假阴性率为0．84％。影响尿沉渣假阳性的最重要因素是黏液丝。结论 使用尿沉渣分析仪对尿液标本管型进行检测时,假阳性结果 较多,可再结合显微镜检查,以提高工作效率并保证检验的准确性。     

Giant urethral calculus: A rare cause of acute urinary retention

We present a case of a 98-yr-old woman with acute urinary retention secondary to a large urethral calculus. This is a unique cause of obstructive uropathy for several reasons. First, urethral calculi are extremely rare in American-born Caucasian females. Second, urethral stones in females are nearly always associated with underlying genitourinary pathology; however, subsequent work up failed to reveal any strictures, diverticula, or related processes that may have predisposed this patient to urethral calculus formation. The epidemiology, pathogenesis, clinical presentation, and emergency management of large urethral calculi are reviewed.     

Prediction of diagnosis of immunoglobulin A nephropathy prior to renal biopsy and correlation with urinary sediment findings and prognostic grading

Several clinical markers correlate well with the diagnosis and prognosis of IgA nephropathy (IgAN). In the present study, we re-evaluated the usefulness of these four clinical markers for prediction of the diagnosis of patients with IgAN through a comparison between many more patients with IgAN and those with other types of renal diseases. 364 patients with IgAN and 289 with other types of renal disease were examined. An analysis was performed prior to renal biopsy, using clinical markers including, serum IgA, serum IgA/C3 ratio, number of red blood cells in urinary sediments, and urinary protein. Patients with IgAN were divided into four groups according to histopathological findings. Presence of microscopic hematuria, persistent proteinuria, high serum IgA levels, and the serum IgA/C3 ratios are useful for prediction of diagnosis of IgAN and distinguishing it from other renal diseases. Blood pressure, urinary protein, serum uric acid, renal function, and urinary sediment findings may be useful for prediction of prognostic grading in patients with IgAN.     

神经源性膀胱尿路功能障碍的全面分类建议

本文在既往下尿路功能障碍分类方法的基础之上,提出一种包含上尿路功能的神经源性膀胱患者全尿路功能障碍的新分类方法,其中对肾盂输尿管积水扩张新提出分度标准。此分类方法可为评估、描述、记录上尿路及下尿路的病理生理变化、制订治疗方案提供全面、科学及客观的基础。     

泌尿系结石患者的健康教育需求调查分析

目的：为了解150例泌尿系结石患健康教育需求。方法：采用问卷与面谈方式，对患进行了健康获得观念，教育内容，方式需求的调查，结果：患缺少较深层次的健康知识，能解决实际问题的教育内容需求较多，教育方法需求大多选择医护讲解和演示，发放宣传资料及电话咨询。结论：健康教育质量需提高，应加强健康教育人才培养，护士充当主力军并应重视其内容和形式的研究。     

Resistance of uropathogenic bacteria to first-line antibiotics in mexico city: A multicenter susceptibility analysis

Abstract

Background

Growing antibiotic resistance demands the constant reassessment of antimicrobial efficacy, particularly in countries with wide antibiotic abuse, where higher resistance prevalence is often found. Knowledge of resistance trends is particularly important when prescribing antibiotics empirically, as is usually the case for urinary tract infections (UTIs). Currently, in Mexico City, ampicillin, cotrimoxazole (trimethoprim/sulfamethoxazole), and ciprofloxacin are used as “first-line” antibiotic treatment for UTI.

Objective

The aim of this study was to analyze the resistance of bacterial isolates to antibiotics, with a focus on first-line antibiotics, in Mexican pediatric patients and sexually active or pregnant female outpatients.

Methods

In this multicenter susceptibility analysis, bacterial isolates from urine samples collected from pediatric patients and sexually-active or pregnant female outpatients presenting with acute, uncomplicated UTIs in Mexico City from January 2006 through June 2006, were included in the study. Samples were tested for susceptibility to 10 antibiotics by the disk-diffusion method.

Results

Four-hundred and seventeen bacterial isolates were derived from sexually active or pregnant female outpatients (324 Escherichia coli) and pediatric patients (93 Klebsiella pneumoniae). We found a high prevalence of resistance towards the drugs used as “first-line” when treating UTIs: ampicillin, cotrimoxazole, and ciprofloxacin (79%, 60%, and 24% resistance, respectively). Ninety-eight percent of K pneumoniae isolates were resistant to ampicillin, whereas 66% of the E coli isolates were resistant to cotrimoxazole. Resistance towards third-generation cephalosporins was also high (6%–8% of E coli and 10%–28% of K pneumoniae). This was possibly caused by chromosomal β-lactamases, as 30% of all isolates were also resistant to amoxicillin/clavulanate. In contrast, 98% of the E coli isolates and 84% of the K pneumoniae strains (96% of all isolates) were found to be susceptible to nitrofurantoin, which has been in clinical use for much longer than most other drugs in this study.

Conclusion

In these urine samples from laboratories in Mexico City, resistance of K pneumoniae and E coli isolates to first-line treatment (ampicillin, cotrimoxazole, or ciprofloxacin) of UTI was high, whereas most E coli and K pneumoniae isolates were susceptible to nitrofurantoin and the fourth-generation cephalosporin cefepime. (Curr Ther Res Clin Exp. 2007;68:120–126) Copyright © 2007 Excerpta Medica, Inc.Key Words: urinary tract infection, uropathogenic bacteria     

糖尿病早期肾损害尿液不同诊断指标检测意义

目的探讨不同尿液指标在糖尿病早期肾损害预测中的临床价值。方法2型糖尿病患者30例（观察组）,体检健康者60例为对照组,2组采用ELISA法检测尿转铁蛋白、尿微量白蛋白、尿半胱氨酸蛋白酶抑制剂C、尿视黄醇结合蛋白及尿β2-微球蛋白,采用对硝基苯酚比色法检测N乙酰-β—D-氨基葡萄糖苷酶水平,采用ROC曲线评价各项检测指标诊断糖尿病早期肾损害的价值。结果观察组尿转铁蛋白、尿微量白蛋白、尿半胱氨酸蛋白酶抑制剂C、尿视黄醇结合蛋白、尿β2微球蛋白、尿N-乙酰-β-D-氨基葡萄糖苷酶及血清肌酐水平及阳性率均明显高于对照组（P〈0．05）;尿转铁蛋白、尿微量白蛋白、尿半胱氨酸蛋白酶抑制剂C、尿8：-微球蛋白、尿视黄醇结合蛋白、尿N-乙酰-β-D-氨基葡萄糖苷酶及血清肌酐诊断糖尿病早期肾损害的AUC分别为1．000、0．985、0．985、0．942、0．921、0．891、0．785。结论不同尿液指标均显示较好的敏感性,联合应用多种尿液指标可较好预测糖尿病早期肾损害的发生,对预防糖尿病肾病的发展有重要临床价值。     

全自动尿沉渣分析仪的临床应用评价

  目的  对一种全自动尿沉渣分析仪的临床应用进行评价, 并建立其对尿液有形成分分析的正常参考范围。  方法  从仪器精密度、携带污染率、分析测量范围以及与人工镜检的可比性4个方面进行评价, 同时建立仪器检测红细胞(red blood cell, RBC)、白细胞(white blood cell, WBC)、鳞状上皮细胞(squamous epithelial cell, EC)及管型的正常参考范围。  结果  RBC低值、中值和高值精密度的变异系数分别为129.10%、20.59%和7.80%;WBC低值、中值和高值精密度的变异系数分别为65.73%、14.30%和13.00%;EC中值和高值精密度的变异系数分别为27.01%和21.46%。RBC、WBC和EC的携带污染率均为0;RBC分析测量范围为0~83 608个/μl, WBC分析测量范围为0~15 624个/μl, 细菌分析测量范围根据菌种不同而结果有明显差异。仪器与人工镜检相比, RBC、WBC和EC的一致率分别为82.80%、73.82%和57.56%。男性尿液有形成分的参考范围显示, RBC为0~8个/μl, WBC为0~12个/μl, EC为0~13个/μl, 管型为0~4个/μl, 结晶为0~34个/μl; 女性尿液有形成分的参考范围显示, RBC为0~12个/μl, WBC为0~21个/μl, EC为0~42个/μl, 管型为0~4个/μl, 结晶为0~2个/μl。  结论  该全自动尿沉渣分析仪对尿中的RBC和WBC有较好的识别性能, 对结晶、管型、真菌、异形细胞等难以自动识别的成分, 可利用仪器的审核功能进行人工识别, 必要时进行人工复检, 为临床提供可靠的检验报告。     

A Rapid Quality Control Initiative to reduce the incidence of urinary tract infection in the paediatric intensive care patient--Part one

Urinary tract infection is one of the common bacterial infections in children and can lead to substantial morbidity. If the infection results in renal scarring, various long-term risks include hypertension and renal insufficiency. Nosocomial urinary tract infections (NUTI) in children occur with varying frequency with approximately 60–80% of these infections being strongly correlated with urethral instrumentation. This paper presents stage one of a Rapid Quality Control Initiative to reduce the incidence of NUTI in the paediatric patient at King Faisal Specialist Hospital and Research Centre.     

脑卒中后尿失禁住院患者排尿情况及膀胱管理分析

目的:了解脑卒中后尿失禁患者的一般情况及膀胱管理现状。方法:采用便利抽样的方法,对广州市10家医院的723例脑卒中住院患者进行问卷调查,调查内容包括一般人口统计学资料、卒中情况、既往史、膀胱管理情况等。结果:723例调查对象中,尿失禁患者共有321例,脑卒中后尿失禁总发生率为44.4%。其中脑卒中急性期尿失禁发生率为34.6%,恢复期发生率为50.9%,后遗症期发生率为54.5%。67.9%的尿失禁患者每天有数次漏尿,48.6%的尿失禁患者因受各种因素影响未进行膀胱再训练。结论:脑卒中后尿失禁患者的膀胱管理仍需进一步加强与完善,医护人员应重视此类患者并取得其本人及家属的配合,尽早开展膀胱训练,使患者的身心健康得到最大程度的恢复。     

全膀胱切除术后不同尿流改道方式的疗效比较

[目的]探讨全膀胱切除术后三种尿流改道方式的效果.[方法]回顾性分析全膀胱切除术后尿流改道病例37例,其中回肠膀胱术14例,原位回肠代膀胱术19例,输尿管皮肤造口术4例.[结果]回肠膀胱手术组与原位回肠代膀胱手术组在手术时间、出血量方面比较,无显著差异(P>0.05),输尿管皮肤造口手术组与另外两组比较,有显著差异(P<0.05).术后1个月原位回肠代膀胱术组出现轻度肾积水4例,回肠膀胱术组出现轻度肾积水1例,术后两个月复查B超积水消失.所有病例术后随访6～18个月,患者恢复良好.无肿瘤复发.[结论]膀胱全切是膀胱多发肿瘤及浸润性膀胱肿瘤的首选治疗方法,回肠膀胱术及原位回肠代膀胱术都是尿流改道的较好选择,部分特殊病例可选择输尿管皮肤造口术.     

泌尿系外伤患者导尿管留置术后并发尿路感染的危险因素分析

目的探讨泌尿系外伤患者导尿管留置术后并发尿路感染的危险因素,为制订针对性护理措施提供依据。方法回顾性分析2009年1月至2013年12月泌尿外科收治的138例泌尿外伤患者的临床资料,并对尿路感染的危险因素进行Logistic回归分析。结果 138例患者中行导尿管术后并发尿路感染42例,感染率为30.43%。年龄、损伤严重程度评分、并发糖尿病、导尿次数、导尿管留置时间、术前应用抗生素是泌尿外伤患者导尿术后并发尿路感染的独立危险因子。结论泌尿系外伤导管术后并发UTIC是由多因素共同作用引起的,对患者采用综合预防措施将有助于降低尿路感染发生风险。     

更换集尿袋频率与尿路感染发生的关系观察

目的 通过对每天更换集尿袋与否的分组对照观察，评价其对尿路感染发生率的影响。方法 计算观察组与对照组间尿液金黄色葡萄球菌、大肠杆菌阳性率及取尿管后尿频尿急症状发生率方面的差异，并行统计学分析。结果 观察组（67例）和对照组（70例）各有2例经尿袋放尿口取样的尿液有金黄色葡萄球菌数〉200／ml（x^2=0．214，P〉0，05）0分别有5例和7例大肠杆菌〉10^5／ml（x^2=0．050，P〉0．05）；其中分别有5例和4例取出导尿管后有尿急、尿频症状（x^2=0．0046，P〉0．05）。观察组与对照组间在尿液金黄色葡萄球菌、大肠杆菌阳性率及取尿管后尿频、尿急症状发生率方面差异均无显著性。结论 每天更换集尿袋对留置尿管患者尿液中细菌生长、尿路刺激发生，没有显著的预防意义。     

A feasibility study of urinary catheter removal protocol following transurethral prostatectomy procedure in older patients

We hypothesized that older patients who underwent a urinary catheter removal protocol would not have an increased risk of postoperative complications. We further hypothesized that the revised protocol would be more suitable for clinical application. This study aimed to develop a urinary catheter removal protocol after Transurethral Resection of the Prostate and to assess the feasibility of the protocol to support catheter removal and promote recovery of self-voiding function. Delayed catheter removal after Transurethral Resection of the Prostate was associated with urinary tract infection and longer hospital stays. However, no strategy has been described to promote recovery of self-voiding function after catheter removal after Transurethral Resection of the Prostate. The urinary catheter removal protocol was developed through expert consensus, including strategies for caring for urinary catheters, assessment of urinary catheter removal, and strategies after urinary catheter removal. Moreover, a quasi-experimental design was adopted in the urology ward of a tertiary care medical centre in southern Taiwan. Patients aged ≥65 years who underwent Transurethral Resection of the Prostate were included. A total of 13 patients (intervention = 5; control = 8) were included in the feasibility evaluation. A urinary catheter removal protocol after Transurethral Resection of the Prostate was developed and the consensus among experts on the urinary catheter removal protocol was 99%. There were no significant differences in terms of bleeding, urine retention, urinary tract infection, or re-catheterization between the two groups. However, in the intervention group, the pain score decreased significantly on the second day after Transurethral Resection of the Prostate. This revised urinary catheter removal protocol after Transurethral Resection of the Prostate may be suitable for clinical applications. However, small size reduces the statistical power of the findings and further studies are needed to examine the current protocol does not have an increased risk of postoperative complications.     

降钙素原危急值与泌尿系感染相关性分析

目的：分析降钙素原危急值与泌尿系感染相关性,为泌尿系严重感染的临床诊疗提供一定参考价值。方法回顾2015年1月1日至2015年12月31日该院泌尿外科所有降钙素原危急值报告结果,分析其与泌尿系感染相关性。结果所查552例降钙素原中,共报告23例降钙素原危急值,其中与泌尿系结石相关共19例,占82．61％,与输尿管软镜手术相关12例,占52．17％。结论降钙素原是泌尿系严重感染较为敏感及准确的一项检验指标,其危急值的出现对临床有着极其重要的警示作用,需要引起临床医生的高度重视。