A nursing trial of urinary sheath systems on male hospitalized patients

An investigation was carried out on six hospitalized elderly male urinary incontinent patients for 21 days to test three urinary sheath systems by means of a quasi-experimental trial, incorporating crossover. Observations were made, and recorded, of detachment or leakage in systems and of skin condition round the shaft of the penis. Results suggest that two of the systems differ significantly in their performance and that performance of the urinary sheath was probably the limiting factor in overall performance. Incidence of skin problems, and other problems within systems, were minimal. It was also observed that patients differ significantly in their suitability for the application of sheath systems. This observation was made at two time intervals. A further line of investigation is suggested to test the effect of components, other than sheaths, on performance of systems.     

Selecting a urinary catheter and drainage system

Selecting the most appropriate urinary catheter and drainage system is an important factor towards patient comfort. Inappropriate selection may introduce an array of unnecessary catheter-associated problems and discomfort for the patient. The author has found that nurses may be able to name or recognize catheters they use, but not other makes and models of similar products produced by other companies. Therefore, selecting a catheter and drainage system can be confusing due to the vast array of catheters, materials used and drainage systems available from various companies. Consideration should also be given as to when catheter care begins: before or following catheter insertion. This article is written to help in the selection of a urinary catheter and drainage system which is best suited for the patient.     

Transfix: a new range of all-silicone male incontinence sheaths

Urinary incontinence can have a significant detrimental effect on a person's body image and self-esteem because it undermine society's norms relating to control of the body. This can be further complicated by the use of devices to control urinary incontinence. Sheath drainage systems are the most common method of managing urinary incontinence in men. A discreet, reliable sheath drainage system can have both physical and psychological benefits. A full continence assessment is paramount for a successful outcome as there are several potential problems associated with this method of management. There are many products available, so the health professional needs a comprehensive knowledge of both products and application techniques. The Sims Portex Transfix range of all-silicone self-adhesive sheathes have many benefits and offer a reliable form of sheath management for male urinary incontinence.     

An assessment of urethral catheter valves.

Catheter valves have rarely been compared with conventional urinary drainage systems. Valves may only be suitable for certain patients. Patients should be counselled on the use and choice or combination of systems.     

A guide to the management of one-piece urinary sheaths

Urinary sheaths are a treatment option for the management of urinary incontinence but unfortunately their use is not widespread. They are available as one- and two-piece systems, but the one-piece sheath is more commonly used. Adele Brodie outlines the assessment process that should be followed before selecting a sheath. She also offers practical tips for applying a sheath and coping with problems.     

Urinary incontinence in women. How to determine when surgery is not the answer

Diagnosis of a nonanatomic cause of urinary incontinence in a female patient depends on the examiner's powers of observation and willingness to listen and take a thorough history and perform a meticulous physical examination to identify symptoms that seem atypical of stress incontinence. In particular, the external genitalia, urethra, vagina, perineum, and lower extremities should be carefully examined. Also, thorough assessment of neurologic status is a must because abnormal neurologic function of the bladder is an absolute contraindication to surgery. Laboratory studies to rule out infection, intrinsic urinary tract disease, and associated medical problems presenting as voiding difficulties must be performed when deemed appropriate. Tests of bladder capacity and intravesical pressure and internal examination of the bladder and urethra may be done when the problem is not straightforward. In the majority of patients, however, the cause of urinary incontinence can be diagnosed or strongly suspected without such studies. Most likely to benefit from systematic evaluation and, depending on the findings, pharmacologic therapy are patients whose urinary incontinence does not match the pattern usual for stress incontinence. These patients may or may not have a demonstrable anatomic lesion, but their voiding complaints are definitely inconsistent with stress incontinence. Medical management may also produce great improvement in incontinent patients who are unfit for surgery or have undergone one or more failed operations. Most patients with atypical voiding problems, including those in whom incontinence develops after pelvic surgery, can meet with a great degree of success if evaluated and treated as described herein.     

Urinary catheters for intermittent use

The long-term use of intermittent catheterisation is often suitable for patients with voiding problems who are able to perform self-care. Use of the technique may result in fewer urinary tract problems, the achievement of continence and improvements in quality of life.     

Solving Selected Problems of the Aging Urinary Tract

One of the important things to keep in mind when treating elderly patients for common urinary problems is not to overtreat them. Therapy that would be right for a younger patient may be entirely inappropriate for an elderly one.     

Introital and perineal sonography in diagnosing stress urinary incontinence - possible clinical applications

Urogynecological ultrasound as a part of the diagnostic work-up of stress urinary incontinence enables the morphologic and dynamic assessment of the lower urinary tract and has replaced radiography in the primary diagnostic work-up of stress urinary incontinence. It is possible to classify the sonographically identified changes of the endopelvic fascia, whereby any dynamic changes must be interpreted in context with the clinical findings. Stress urinary incontinence, besides voiding dysfunction, recurrent urinary tract infections and dyspareunia, may be associated with urethral diverticula, which can be detected by ultrasound. Postoperative voiding problems, de novo urgency or recurrent urinary tract infections can be assessed by demonstrating possible causes, such as haematomas, overcorrection with postvoid residual, misplacement of the tape at the level of the bladder neck or intravesical displacement of suture or tape material. Introital and perineal ultrasound might also be used for monitoring the proper placement of sutures to reduce postoperative complications.     

The improbable intravesical foreign body.

Foreign objects in the urinary bladder can occasionally pose perplexing diagnostic problems, especially in the face of a seemingly incredible history. This case illustrates the importance of investigating such claims. Occasionally, alternate diagnostic methods such as fluoroscopy or ultrasonography may assist in noninvasive diagnosis and management.     

Chronic urinary catheter blockage

Catheter blockage is a common complication of long-term urinary catheterisation which causes distress to the patient and presents management problems for both nursing and medical practitioners. Jennifer Kohler-Ockmore's study aimed to investigate some of the factors which may cause catheter blockage and how they may be overcome. Fifty-four patients, resident in the community, were monitored over a period of six months. The findings revealed that patients were divided into two groups, those with and those without catheter blockage. The only factors identified which differentiated these patients were urinary pH and the incidence of proteus organisms in the urine. The presence or history of bladder stones was also noted among patients who presented with chronic episodes of blockage.     

地震后伤员泌尿系问题的处理与康复

地震创伤可直接损伤泌尿系统或造成脊髓损伤而导致泌尿系问题,本文重点介绍了地震创伤后常见的早期及后期泌尿系主要问题如尿潴留、少尿或无尿、肾损伤、膀胱和尿道损伤、脊髓损伤后神经源性膀胱等,分析其原因,介绍正确的处理原则,各种康复措施以减少并发症和后遗症,以及长期随访中应注意的问题。     

Practical management of urinary incontinence

A comprehensive evaluation of incontinence using office-based techniques may discover reversible problems such as delirium, urinary infections, vaginitis, depression, drug effects, endocrinologic causes, immobility, or impaction. Treatment of these causes may alleviate incontinence. Bedside urodynamics are a sensitive, specific, and useful office-based technique that can identify detrusor instability, overflow incontinence, or stress incontinence. Low urinary flow rate, difficulty with catheterization, slow bladder filling or severe urgency, bladder capacity over 600 ml, and post-void residual over 150 ml need referral. Patients with hematuria, recurrent infections, recent surgery or pelvic irradiation, and pelvic or prostatic masses also need further evaluation. A number of medical and behavioral therapies are available for stress incontinence and detrusor instability that can substantially reduce incontinence, but most patients with overflow have more complicated problems requiring further evaluation, surgery, or long-term bladder drainage.     

Psychogenic urinary retention in women.

There appears to be a spectrum of psychogenic urinary retention that is seen mostly in women. The degrees of psychiatric disorder and bladder disorder do not necessarily coincide. Some patients with psychogenic retention may have one acute episode temporally related to psychologic trauma. Others may present with problems related to large residual volumes such as recurrent urinary tract infection or incontinence. All patients require complete neurologic, urologic, and psychiatric evaluation. Permanent urethral catheterization is avoided if possible. Intermittent self-catheterization should be used during periods of psychotherapy and bladder training. Patients with neurogenic bladder, as determined by urodynamic studies, should be managed by bladder training and the use of pharmacologic agents when indicated.     

Indwelling catheter-associated urinary tract infections

Catheter associated urinary tract infection accounts for a large proportion of all hospital-acquired infections, and there has been little change in the incidence of such infections since the introduction of closed sterile urinary drainage systems in the 1960s. The aim of this paper is to review the literature on the subject of catheter associated urinary tract infections, with reference to the use and possible improvement of closed sterile catheter drainage systems.     

Clean intermittent catheterization and self-catheterization

Intermittent catheterization (IC) is a widely used technique for emptying the bladder, first recorded in 1000?bce. This article describes the normal anatomy and physiology of bladder filling and emptying, and discusses the reasons why emptying may be incomplete. Incomplete emptying usually has a neurogenic or obstructive cause, leading to symptoms such as frequency, urge incontinence and urinary tract infection. IC may be carried out for several reasons: as an acute intervention for transitory problems with bladder emptying; to enable the instillation of drugs into the bladder; or as a long-term intervention where there is a regular post-void residual volume of more than 100?ml. Ideally, the patient intermittently catheterizes his/her own bladder, but a relative or healthcare professional may carry out this task. Some patients have specific requirements and problems, and case studies are presented to illustrate how these problems may be resolved.     

Colicins prevent colonization of urinary catheters

OBJECTIVES: Natural microbial defence systems, such as bacteriocins, may be a novel means to prevent catheter-associated urinary tract infection. We investigated in vitro whether a colicin-expressing strain of Escherichia coli could prevent urinary catheter colonization by a colicin-susceptible, uropathgenic strain of E. coli. METHODS: Segments of urinary catheter were inoculated with colicin-producing E. coli K-12 and then exposed to either colicin-susceptible E. coli (a uropathogenic clinical isolate) or colicin-resistant E. coli (derived from the susceptible clinical isolate). Catheters were then incubated overnight, rinsed and sonicated. RESULTS: The presence of colicin-producing E. coli K-12 on the catheter surface completely prevented catheter colonization by colicin-susceptible E. coli but not by resistant E. coli. The colicin-susceptible strain but not the colicin-resistant strain also disappeared from broth cultures in the presence of colicin-producing E. coli K-12. CONCLUSIONS: The observed inhibition of catheter colonization by the uropathogenic clinical isolate of E. coli can be attributed to the presence of a colicin-producing strain of E. coli on the catheter surface. Bacteriocin production by a non-pathogenic organism may have clinical applicability as a means to prevent catheter-associated urinary tract infection.     

Male pelvic anatomy/post-prostatectomy incontinence

There is an intricate relationship between structure, position, and function within the lower urinary tract. To understand the individual problems that may occur with post-prostatectomy incontinence, it is necessary to be aware of these relationships.