改性几丁质喷雾剂预防留置尿管所致尿路感染

目的探讨改性几丁质喷雾剂预防留置尿管所致尿路感染的效果。方法将128例留置气囊导尿管患者随机分为观察组（78例）和对照组（50例）。观察组采用改性几丁质喷雾剂于尿道口及周围皮肤5cm范围、导尿管近端5cm处进行喷洒,每日2次;对照组常规采用1∶2000氯己定溶液擦洗尿道外口及会阴部,每日2次。结果留置导尿期间观察组尿路感染发生率显著低于对照组,尿路感染发生时间较对照组显著推迟（均P〈0.05）。结论留置气囊导尿管患者使用改性几丁质喷雾剂,可降低尿路感染发生率,且操作简单,使用方便。     

自制气囊尿管外固定囊在女性患者留置导尿中的应用

目的 探讨女性患者留置导尿气囊导尿管最佳外固定方法.方法 将女性留置导尿患者60例按导尿先后顺序编号分组,单号为观察组(30例),双号为对照组(30例),观察组应用自制气囊尿管外固定囊固定导尿管,对照组用胶布将导尿管固定于患者一侧大腿内侧.比较两组患者留置尿管期间舒适度、导尿管相关菌尿症发生率.结果 留置尿管期间观察组舒适度显著高于对照组(均P＜0.05),留置导尿管第5、7天导尿管相关菌尿症发生率显著低于对照组(均P＜0.05).结论 气囊尿管外固定囊用于女性留置导尿患者,可提高患者舒适度,降低患者导尿管相关菌尿症发生率.     

老年女性患者导尿管气囊注水量对留置效果的影响

目的探讨老年女性患者留置导尿过程中,气囊注水量对留置效果的影响。方法将164例神经内科老年女性 需留置导尿患者(平均年龄74.18岁)随机分为对照组与观察组,各82例。观察组患者导尿管气囊内注入15～20 ml生理盐水固定,对照组气囊内注入生理盐水5～8ml。结果观察组溢尿率显著低于对照组(P<0.01),且留置导 尿管2周泌尿系感染(发热、混浊血性尿液、膀胱刺激征、尿道口异常分泌物等)发生率显著低于对照组(P<0.01)。 结论老年女性患者气囊导尿管注入15～20ml生理盐水,可有效地防止尿液外渗及导尿管脱出,减少泌尿系感染 率的发生,对临床留置导尿技术有指导意义。     

老年女性患者导尿管气囊注水量对留置效果的影响

目的探讨老年女性患者留置导尿过程中,气囊注水量对留置效果的影响.方法将164例神经内科老年女性需留置导尿患者(平均年龄74.18岁)随机分为对照组与观察组,各82例.观察组患者导尿管气囊内注入15～20ml生理盐水固定,对照组气囊内注入生理盐水5～8 ml.结果观察组溢尿率显著低于对照组(P＜0.01),且留置导尿管2周泌尿系感染(发热、混浊血性尿液、膀胱刺激征、尿道口异常分泌物等)发生率显著低于对照组(P＜0.01).结论老年女性患者气囊导尿管注入15～20 ml生理盐水,可有效地防止尿液外渗及导尿管脱出,减少泌尿系感染率的发生,对临床留置导尿技术有指导意义.     

洁悠神长效抗菌材料预防留置导尿管患者尿路感染效果观察

目的观察洁悠神长效抗菌材料预防留置导尿管患者尿路感染的效果。方法选取2016-01—2017-06间在安钢职工总医院ICU留置导尿管的180例患者。随机分为2组,各90例。对照组行常规尿道口护理,观察组在对照组基础上用洁悠神长效抗菌材料喷洒于尿道口、导尿管及集尿袋接口。比较2组患者尿路感染的发生率。结果留置尿管期间,观察组尿路感染率低于对照组,差异有统计学意义(P0.05)。结论对留置导尿管的患者使用洁悠神长效抗菌材料进行导尿管壁和尿道口喷洒,可形成一层物理抗菌分子膜,能有效降低尿路感染率。     

剖宫产术留置双腔气囊导尿管产妇的护理体会

目的总结剖宫产术留置双腔气囊导尿管产妇的护理体会。方法对50例剖宫产术留置双腔气囊导尿管的产妇,做好心理、疼痛、拔管、健康指导等护理措施。结果 50例产妇双腔气囊导尿管均一次留置成功。其间未发生尿路感染及严重不适感、尿管堵塞、拔出困难等。拔出尿管后均恢复正常自行排尿。结论对剖宫产术留置双腔气囊导尿管的产妇,加强心理疏导和健康教育、做好并发症的观察及预防等护理措施,有利于提高双腔气囊导尿管成功留置率、减轻患者的不适感及减少尿路感染发生率,为拔出尿管后顺利恢复正常自行排尿提供可靠保证。     

酸性氧化电位水预防留置导尿患者尿路感染研究

目的探讨酸性氧化电位水用于留置尿管患者预防尿路感染的效果。方法将100例留置尿管患者分为观察组和对照组各50例,观察组用酸性氧化电位水、对照组用0.5%碘伏每日擦洗会阴及尿管近端2次,比较两组会阴护理后第3、7、10天中段尿细菌培养结果和尿道口的不良反应。结果留置尿管第3、7、10天,观察组中段尿细菌培养阳性率与对照组比较,差异无统计学意义(均P0.05),尿道口不良反应发生率显著低于对照组(P0.01)。结论酸性氧化电位水和0.5%碘伏用于预防尿路感染的效果相当,但酸性氧化电位水可显著降低尿道口的不良反应,提高患者的满意度。     

洁悠神(JUC)在预防留置导尿管伴随性尿路感染(CAUTI)的应用

目的观察洁悠神(JieUC,JUC)长效抗菌材料应用于留置导尿患者尿道口护理,是否能降低导尿管伴随性尿路感染(CAUTI)的发生。方法将169例留置导尿管患者,随机分为对照组82例和实验组87例。对照组,按常规清洁后用聚维酮碘棉球行尿道口。实验组用生理盐水清洁后采用5 mL洁悠神喷洒于尿道口。观察两组患者留置尿管后第3、5、7天膀胱内尿液标本细菌培养结果。结果实验组尿培养尿路感染病例数明显低于对照组(P0.01)。结论洁悠神长效抗菌材料应用于留置导尿患者尿道口护理可降低CAUTI的发生。     

护士主导的留置导尿管拔除模式构建与实施

目的探索护士主导留置导尿管拔除的可行性。方法采用历史对照研究,对照组375例留置导尿患者按常规拔除留置导尿管,干预组293例留置导尿患者实施护士主导的导尿管拔除:根据指南制定留置导尿适应证,建立拔除导尿管后留置导尿的替代方案;通过每日评估导管,膀胱扫描仪测定残余尿量,选择替代方案管理尿失禁和尿潴留。结果干预组不合理使用导尿管率、尿管留置时间及导管相关性尿路感染率显著低于对照组(均P0.01)。结论护士主导的留置导尿拔除模式的实施,能识别导管相关性尿路感染预防的关键因素,有效缩短置管时间,降低导管相关性尿路感染的发生。     

洁悠神预防卒中患者留置尿管致尿路感染的临床分析

目的:应用长效物理抗菌功能的洁悠神喷洒在尿管留置的卒中患者的尿道口及尿管表面,观察其对留置导尿管伴随性尿路感染(CAUTI)的发生率的影响。方法:将我科100例脑卒中后留置导尿管的患者,年龄40～85岁,随机分为对照组50例和实验组50例。对照组,按常规行尿道口护理,2次/天;实验组,按常规行尿道口护理后,加用洁悠神喷洒于导尿管壁及尿道口,2次/天。结果:实验组脑卒中患者发生尿路感染的病例数明显低于对照组,差异有统计学意义(χ2=21.42,P<0.01)。结论:对留置导尿管的卒中患者使用洁悠神喷洒导尿管表面和尿道口,可形成一层物理抗菌分子膜,阻止细菌生物膜的形成,能有效降低卒中后尿路感染的发生。     

Acute urinary retention in ileum conduit urinary diversion

Three years after ileum conduit urinary diversion, a 68-year-old patient was referred to us with acute urinary retention. Ultrasound examination demonstrated an extremely dilated, urine-filled ileum conduit and dilated kidneys. Placing a catheter into the subfascial part of the conduit to drain the urine was impossible because of extreme kinking and compression of the conduit in the fascial level. Ultrasound-guided puncture of the conduit was performed, and 170 mL of urine was aspirated. Afterward, a 16F catheter was easily placed. Clear urine drained. At last follow-up, no further episodes of urinary retention had occurred.     

Evaluation of urinary cytology for upper urinary tract disease

One hundred and seventy-two patients with upper urinary tract disease were examined by cytological study of ureteral urine which was taken by ureteral catheterization. Of 139 patients with benign disease or ureteral stricture due to non-urological cancer, only one case with renal cyst revealed positive findings (false positive rate: 0.7%). Two positive cases, which were a renal hemorrhage without followup and a uterine cervical cancer with squamous cancer cells in the ureteral urine, were excluded. Although 6 of 17 (35%) uroepithelial cancers in the upper urinary tract were registered as positive, this examination was little use for detecting stage pTa, grade 1 or papillary non-invasive tumors. However, 2 out of 12 (17%) renal pelvic or ureteral cancer patients with negative results of voided urine were cytologically detected by ureteral urine. Five out of 6 cases of these cancers demonstrated malignant cells in the renal pelvic urine sampled from surgical specimen. We have recently experienced aspiration cytology for upper urinary tract disease, using the percutaneous puncture method, and five of 7 upper urinary tract patients were cytologically diagnosed. This procedure could be valuable for detecting even patients with associated bladder cancer or failure of ureteral catheterization.     

Continent urinary diversion using an artificial urinary sphincter.

We report a new and simplified method of continent urinary diversion employing a modified AMS 800 artificial urinary sphincter (AUS). Our aim in using this artificial valve is to make a stoma continent, while allowing intermittent catheterisation. The AMS 800 pump is replaced by a subcutaneous injection port. This allows, by direct puncture, the accurate setting of the closing pressure by varying the volume of the intra-prosthetic liquid, with subsequent adjustment of this pressure as necessary. The cuff is placed on the subcutaneous part of the intestinal loop diversion. The pressure-regulating balloon is implanted within the area of abdominal pressure, retroperitoneally. After first confirming the efficacy of the system in 3 dogs, the device was placed in 2 patients. The first had a neuropathic bladder treated initially by enterocystoplasty with an appendicocutaneous stoma. Secondary leakage was subsequently controlled by placement of the device, with continuing excellent results at 32 months. The second patient was a girl in whom a urogenital rhabdomyosarcoma had been treated by anterior exenteration, radiotherapy and a sigmoid conduit diversion. This was subsequently converted to a continent reservoir by simple augmentation of the conduit and placement of the device, with a good result being maintained after a follow-up of 20 months. These two cases illustrate the best indications for this procedure, namely primary or secondary leakage from a supposedly continent urinary diversion, and conversion of a freely draining conduit into a continent reservoir. Although long-term results are still pending, our experience thus far encourages us to recommend this technique as a simple means of achieving a continent urinary diversion.     

Treatment of stress urinary incontinence with artificial urinary sphincter

Stress urinary incontinence in women is usually due to either urethral hypermobility or intrinsic urethral weakness. Stress incontinence due to urethral hypermobility is usually cured with a cystourethropexy. That due to intrinsic urethral weakness, however, requires either periurethral injection, sling cystourethropexy or placement of an artificial urinary sphincter to achieve reasonable success rates. The artificial urinary sphincter has been used since 1972. Many modifications have been made to the original device, culminating in the currently available device, the AS-800, made by American Medical Systems. This paper reviews patient selection, surgical technique and complications of artificial urinary sphincter placement in the treatment of women with intrinsic urethral weakness (type III incontinence).     

Complete urinary obstruction following periurethral polytetrafluoroethylene injection for urinary incontinence

We report a unique case of foreign body granulomatous reaction after periurethral polytetrafluoroethylene injection causing complete urinary obstruction. Urinary obstruction in the immediate postoperative period and granuloma formation following polytetrafluoroethylene injection are not unusual. To our knowledge delayed complete urinary obstruction after polytetrafluoroethylene injection has not been described previously in the urological literature.     

Massive bilateral perirenal hematoma following urinary catheterization for urinary obstruction

Urinary tract obstruction is a common problem associated with many complications. Decompression of an enlarged bladder has been associated with several complications, mainly vesicular bleeding. We report a case of a 42-year-old male patient who developed bilateral renal subcapsular hematomas secondary to relief of an extremely enlarged bladder.     

Does low urinary sIgA predispose to urinary tract infection?

Median urinary secretory IgA (sIgA) (ELISA technique in unprocessed urine) was 1.36 mg/liter (range, 0.29 to 2.31) in healthy female controls at various times of the menstrual cycle. It was significantly lower in women with urinary tract infection (UTI) without antibody-coated bacteria. Such decrease was found both in women with acute UTI episodes (median, 0.16; range, 0.06 to 1.71) and in asymptomatic nonbacteriuric women with a history of UTI (median, 0.52; range, 0.05 to 2.13). In the latter women, sIgA in nasal secretions tended to be low, but salivary sIgA was unchanged. Urinary sIgA was elevated significantly in individuals with nephrostomy and antibody-coated bacteria (14.4 mg/liter, range, 3.6 to 20). The study showed that locally synthesized sIgA immunoglobulins were low in the urine of individuals with recurrent UTI independent of the presence or absence of bacteriuria at the time of the study. UTI per se did not interfere with sIgA secretion as shown by high sIgA in patients with upper UTI. Low urinary sIgA may represent one factor predisposing to recurrent UTI.     

尿流改道术后尿路结石的治疗

目的 探讨尿流改道术后尿路结石的治疗方法.方法 选取20例既往因膀胱癌接受尿流改道的尿路结石患者(肾结石6例,输尿管结石5例,储尿囊结石9例),接受个性化的治疗:其中经皮肾取石术8例,经皮肾顺行输尿管软镜碎石术3例,储尿囊流出道入路手术5例,经皮膀胱穿刺人路手术3例,开放取石1例.结果 手术时间60～130min,平均104min;术后结石清除率90％(18/20);术后发热4例(20％o),其中l例经皮肾镜技术(PCNL)术后液胸,行胸腔闭式引流.结论 针对尿流改道术后的尿路结石患者,采取个性化治疗方案,能够有效的清除尿路结石.