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PURPOSE: We determined whether routine replacement of a chronic indwelling catheter before instituting antimicrobial therapy leads to an improved bacteriological or clinical outcome when treating symptomatic urinary tract infection in elderly nursing home residents. MATERIALS AND METHODS: We performed a prospective randomized open clinical trial at 2 long-term care facilities. Patients were randomized to indwelling catheter replacement before initiating antimicrobial therapy or no replacement. Urine and blood cultures were done before antimicrobial therapy began. Clinical and microbiological outcomes were assessed after 3 days of therapy, and 7 and 28 days after therapy was complete. RESULTS: Enrolled in our study were 21 male and 33 female nursing home residents with a mean age of 72.6 years, a chronic indwelling catheter and a clinical diagnosis of urinary tract infection. A total of 27 cases were randomized to either catheter replacement and no replacement before antimicrobial therapy. Polymicrobial bacteriuria significantly decreased 3 days after therapy was initiated, and 7 and 28 days after it was discontinued in 24 versus 8 (p = 0.002), 18 versus 9 (p = 0.01) and 13 versus 5 (p = 0.02) patients with and without catheter replacement, respectively. Catheter replacement was also associated with a shorter time to afebrile status, improved clinical status 72 hours after the initiation of therapy in 25 versus 11 patients (p <0.001) and a lower rate of symptomatic clinical relapse 28 days after therapy in 3 versus 11 (p = 0.015). CONCLUSIONS: Clinical and bacteriological outcomes are improved when long-term indwelling catheters are replaced before initiating antimicrobial therapy for symptomatic urinary tract infection.  相似文献   

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OBJECTIVE: To identify the factors involved in the incidence of febrile urinary tract infection (UTI) in a retrospective study of children with myelodysplasia who were treated by clean intermittent catheterization. METHODS: A total of 76 myelodysplastic children were included in the present study. Any factors, including urodynamic parameters and urinary tract abnormalities, that may have been associated with the incidence of febrile UTI were evaluated using both a univariate analysis and a multiple logistic regression analysis. RESULTS: Of the 76 patients, 19 (25%) had one or more episodes of febrile UTI. A univariate analysis showed low bladder compliance (<10 mL/cmH2O), detrusor overactivity, bladder trabeculation and the presence of vesico-ureteral reflux (VUR) to be significant factors in the incidence of febrile UTI. The presence of detrusor overactivity and a low bladder compliance, in addition to the presence of VUR, were found to be significant factors for the incidence of febrile UTI using a multivariate analysis. CONCLUSION: These results demonstrate that, in addition to VUR, urodynamics linked to bladder storage function disorder appear to be directly correlated with the cause of febrile UTI in children with myelodysplasia.  相似文献   

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OBJECTIVE: To assess if a short course of antibiotics starting at the time of the removing a short-term urethral catheter decreases the incidence of subsequent urinary tract infection (UTI). PATIENTS AND METHODS: Patients across specialities with a urethral catheter in situ for >/= 48 h and 相似文献   

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OBJECTIVE: To determine whether a preliminary period of clean intermittent self-catheterization (CISC) before transurethral resection of the prostate (TURP) improves bladder contractility and surgical outcome in men with chronic urinary retention (CUR), and whether pressure-flow studies (PFS) before TURP predict the outcome. PATIENTS AND METHODS: The study was a two-centre, pragmatic and randomized trial. Included were 41 men scheduled for TURP with lower urinary tract symptoms (LUTS), an International Prostate Symptom Score (IPSS) of > 7, benign prostatic enlargement and a persistent postvoid residual urine volume (PVR) of > 300 mL. They had conventional PFS using unphysiological filling. The patients then gave consent and were randomized into two treatment groups; the first had TURP after stabilizing renal function by indwelling catheterization if indicated, and the second was taught CISC. Men in both groups were reviewed at 3 and 6 months after surgery or the start of CISC, by the IPSS, urine culture and assay of plasma creatinine, and upper tract imaging and repeat PFS at 6 months. The primary outcome variables were IPSS, maximum urinary flow rate, voiding and end-filling pressures, and mean PVR; secondary variables included treatment failure, complications and other urodynamic measures. RESULTS: Of the 41 patients, 17 (mean age 67 years, range 52-84) were randomized to immediate TURP and 24 (mean age 69 years, range 55-85) to CISC. There was a significant improvement in IPSS and quality of life at 6 months in both groups (P < 0.001). In the CISC group there was a significant improvement in voiding and end-filling pressures, indicating recovery of bladder function (P < 0.001 for each). Of the 41 men, nine (22%) with voiding pressures of < or = 45 cmH2O had no significant improvement in symptoms or urodynamic variables. Detrusor overactivity was found in 17 (41%) patients, of whom six had upper tract dilatation which resolved after treatment. CONCLUSION: The present results emphasize the usefulness of CISC in ensuring the recovery of bladder function in men with CUR. Measuring the voiding pressure before TURP can predict the surgical outcome. Both CISC and immediate TURP are effective for relieving LUTS and result in a better quality of life. A preliminary period of CISC before TURP for men with CUR and low voiding pressure may be valuable. The presence of upper tract dilatation is associated with high end-void and end-fill bladder pressures, and such men have a good outcome from surgery.  相似文献   

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Abstract:   Natural disasters cause several medical problems for victims, especially for physically challenged people. The great earthquake in the Chuetsu district in Niigata Prefecture that occurred on October 23, 2004 caused serious damage in the disaster area. We investigated the effect of this earthquake on patients managing urination with clean intermittent self-urethral catheterization (CIC) using a questionnaire by mailing. The questionnaire was collected from 86 patients (60 men, 25 women, one sex unknown). The average age was 64.6 years old (males 64.1, females 65.8). By the first week after the earthquake, the patients with urological symptoms made up 3.8% of subjects surveyed. All of the patients had insufficient fluid intake, and did not live in their own homes, or perform CIC at home, for the period of time after the earthquake. During disasters, it is important that we secure CIC patients a living space, where they can perform CIC, with sufficient drinking water.  相似文献   

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PURPOSE: Based on Greek and Latin sources the use of the urinary catheter in Western medicine between 200 and 1000 CE was reviewed. MATERIALS AND METHODS: Computerized databank searches permitted the identification and analysis of ancient and early medieval texts that include material on the catheter. RESULTS: Ten medical authors mentioned the catheter and its use. In the Byzantine world they include the encyclopedists Oribasius, Aetius and Paul of Aegina. The best known Latin author is Caelius Aurelianus. These writers often put together summaries of earlier works. Innovation or independent research was not easily found at a time during which neither anatomical autopsy nor experimentation was widely practiced. CONCLUSIONS: Old texts contain numerous instructions on how to skillfully use the catheter. As a technical achievement, it was independent of philosophical trends. Its primary indications, namely urinary retention, bladder stones and the administration of cures, changed little with time. As one of the oldest and most important instruments at the disposal of physicians, the history of the catheter should be known to every urologist.  相似文献   

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Purpose

We instituted early clean intermittent catheterization (CIC) in 1997 for all newborn infants with spina bifida (SB). We compared this group to a historical group managed expectantly to see if early catheterization was associated with a reduction in renal scar rate as determined by DMSA scanning.

Methods

Data were studied retrospectively on all infants with SB over a recent 13-year period who were treated with early universal CIC in a regional pediatric urology department. These were compared to our previously published outcomes in a historical group (1985–1994) that was managed expectantly [Brown et al. Chronic pyelonephritis in association with neuropathic bladder. Eur J Pediatr Surg 1999;9 Suppl 1:29–30.]

Results

114 infants were born with SB from 1997 to 2010, of which 13 were excluded from this analysis. Mean follow-up was 11.4?years. In the historical cohort there were 126 infants born from 1985 to 1994, with 26 exclusions; follow-up then ranged from 4 to 13?years. DMSA scan showed renal scarring in 19/101 (18.8%) of the recent cohort versus 39/100 (39%) of the previous group (P?=?0.002). Renal scarring at a later age also appeared to be a feature of the recent group, with first detection occuring by 4?years in only 9/19 (47%) in the latest cohort compared to 28/39 (72%) in the historical cohort.

Conclusion

Based on these renal protective data, we recommend indwelling and then intermittent catheterization from birth in all patients with SB.

Level of evidence

Level III.

Type of study

Retrospective, cohort comparison study.  相似文献   

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