Increased urinary calcium excretion caused by ceftriaxone: possible association with urolithiasis

The administration of ceftriaxone is known to be associated with biliary pseudolithiasis, although the development of urolithiasis has only rarely been reported. We treated a young male with bacterial meningitis complicated by urinary precipitates composed of ceftriaxone–calcium salt, which prompted us to study whether ceftriaxone administration predisposes children to the formation of urinary precipitates. The case–control study reported here included 83 children with bacterial pneumonia aged from 3 months to 8.9 years. The children were divided into one group of 43 children who received ceftriaxone (group A) and a second group of 40 children who received amoxicillin (group B). Paired samples of serum and urine before and after treatment were obtained from the patients in each group. There were no significant differences in demographic characteristics and blood biochemistry between the groups. However, the mean urinary calcium to creatinine ratio (uCa/Cr; mg/mg) was significantly higher in group A patients than in group B patients after treatment (0.19 vs. 0.09, respectively; p < 0.001), and analysis of the paired urine samples revealed that the uCa/Cr significantly increased after treatment only in group A patients(p < 0.001). There was a weak but non-significant relationship between the dose of ceftriaxone and the uCa/Cr in group A (p = 0.10, r = 0.24). Our results are the first to demonstrate that ceftriaxone has the potential to significantly increase urinary excretion of calcium, which may be linked to ceftriaxone-related urolithiasis or sludge. We therefore suggest that it is worthwhile monitoring the uCa/Cr levels in patients on ceftriaxone as they may be at greater risk for developing large stones and renal damage.     

疝囊剥离与横断在男性腹股沟斜疝中的随机对照研究

目的前瞻性比较前入路Kugel修补术中疝囊完全剥离与疝囊横断远端旷置2种不同处理方式对男性腹股沟斜疝患者的临床疗效。 方法收集2014年1月至2016年12月,福建医科大学附属第一医院120例原发性男性腹股沟斜疝患者临床资料。采用随机数字表法分成疝囊完全剥离组和疝囊横断旷置组。比较2组手术时间、术后住院时间、术后视觉模拟疼痛评分（visual analogue score,VAS）、血肿、血清肿、切口感染、异物感、复发率发生情况。 结果疝囊完全剥离组在术后第1天疼痛VAS评分（2.4±0.7）、血清肿（1例）、术后2周恢复活动人数（57例）及异物感（4例）方面明显优于疝囊横断旷置组（2.7±0.9、7例、50例、12例）,差异均有统计学意义（P均<0.05）。而2组在手术时间、术中出血量、术后住院时间、术后血肿、尿潴留、阴囊积液、切口感染、术后4周恢复活动人数、慢性疼痛、精索和睾丸并发症及复发率比较,差异无统计学意义（P>0.05）。 结论男性腹股沟斜疝患者术中疝囊完全剥离可明显降低术后早期疼痛及血清肿发生,有利患者早期恢复。     

Infección urinaria en pacientes con vejiga neurógena: patrones de resistencias de los uropatógenos más frecuentes

PurposeTo analyze the most frequent causes and resistances of the uropathogens in patients affected by neurogenic bladder.Material and methodsA total of 284 patients, in whom a total of 284 urinary cultures were performed, were included. Of these, 106 came from patients with neurological injuries, 28 from a non-neurogenic control group, 75 from patients admitted to the intensive care unit (ICU) of our Hospital and 75 patients who came into the emergency room with the symptoms of an acute urinary tract infection. A quantitative urine culture was performed in a chromogenic media and the resistances of all urine cultures that were positive for one or two micro-organisms were identified and studied.ResultsA total of 67% of the patients with neurological injuries had positive urine cultures compared to 25% of control group patients. The urine cultures of patients admitted into the ICU and those of the Emergency Room group were 100% positive, since the first 75 positive urine cultures were selected for the study. E.coli was the most-frequently microorganism isolated in the group of neurological patients, as well as among the patients from the Emergency Room and from the control group. In the ICU, the most-frequently isolated micro-organism was Enterococcus spp. (19.4%), followed by P. aeruginosa (16.5%). The study of resistances in general E. coli has high rates of resistance to ampicillin and co-trimoxazole and, although to a lesser degree to ciprofloxacin.ConclusionsE. coli is the micro-organism most frequently isolated among all of the groups except in the ICU, where it is surpassed by Enterococcus spp. and P. aeruginosa. The resistances among the four population groups studied have different features, overall showing a low rate of resistance to nitrofurantoin and especially to fosfomycin, observed in patients from the Emergency Room or admitted to the ICU and neurological patients.     

Preputial Bacterial Colonisation in Preschool and Primary School Children

Objectives: Preputial bacterial colonisation was investigated in preschool and primary school children with and without phimosis before the circumcision procedure. Method: The study group consisted of 32 boys admitted to our clinic consecutively between June 2003 and September 2003 for circumcision. The indication for surgery was religious belief in all patients. Immediately before the procedure, a swab was swept circumferentially once around the surface of the glans starting just proximal to the urethral meatus. In case of phimosis the same procedure was performed after complete retraction of the foreskin avoiding external contamination. The cultures were repeated in all patients after cleansing the glans and nearby preputium with polyvidon-iodine solution. Results: The mean age of the patients’ was 6 (4–12) years. All 5 (100%) patients with phimosis had clinically significant (≥100,000 cfu/ml) uropathogenic bacterial colonisation. In 27 (84.3%) patients without phimosis culture reports revealed the absence of growth in 8 (29.6%) patients while 3 (11.1%) had Diphteroids and 1 (3.7%) had α-haemolytic Streptococci isolated from their preputial swabs which were accepted as harmless skin commensals. The rest of the boys (55.5%) had uropathogenic species in their preputium and all except 2 (7.4%) cases had counts exceeding 100,000 cfu/ml. The overall rates for individual species including any count were found as E. coli 3.1%, Klebsiella 18.8%, coagulase-negative Staphylococci12.5% and Enterococcus 43.8%. Cleansing of perimeatal and periurethral region with 10% polyvidon-iodine solution markedly decreased the bacterial count in 80% of the patients with phimosis. Including eight patients with no growth before cleansing 88.9% of the patients in the non-phimosis group were free of preputial bacteria after cleansing with iodine solution. Conclusion: Significant preputial colonisation with uropathogens might still be present in preschool and primary school children.     

Differences in preputial-colonizing bacteria between balanoposthitis and physiological phimosis

ObjectiveRedundant prepuce and phimosis are known risk factors for balanoposthitis. It is usually caused by retrograde infection and is related to the preputial bacterial flora. We investigated differences in the preputial bacterial flora between patients with balanoposthitis and physiological phimosis.Materials and MethodsFifty-six male children were included in the study. Fifteen patients presented to the emergency room or outpatient department with balanoposthitis. Forty-one patients with physiological phimosis received a circumcision. Preputial swab cultures were done. Differences in age, body weight, and preputial flora between these two groups of patients were compared.ResultsPatients with balanoposthitis in this study were significantly younger. Common uropathogens were predominant in patients with balanoposthitis, whereas in patients with physiological phimosis, the main isolates were enteric flora other than common uropathogens. Patients with a body weight higher than the 50th percentile of the normal growth curve had a lower risk of balanoposthitis (odds ratio = 0.212).ConclusionsThe preputial bacterial flora in patients with physiological phimosis may change from enteric flora to common uropathogens which are predominant in patients with balanoposthitis. Furthermore, patients at a younger age and with a lighter body weight also had increased susceptibility to balanoposthitis.     

Circumcision for the prevention of significant bacteriuria in boys

The aim of this study was to determine whether circumcision affects significant bacteriuria in boys. During a 60-month prospective study, 100 boys with microbiologically confirmed symptomatic urinary tract infection (UTI) were evaluated. Twelve patients with abnormal ultrasonography findings were excluded from the study. Eighteen of the boys had not been circumcised due to parental choice. The remaining 70 boys with normal renal ultrasonography were randomly allocated into two groups. In the first group 35 boys ranging in age from 6 months to 10 years (mean 33.2±30.9 months) were observed for 6 months and urinary cultures were taken monthly. When they had a positive urine culture (with or without any symptoms), they received antibiotic treatment. After 6 months they were circumcised and then observed for another 6-month period. Group 2 comprised 35 boys aged from 3 months to 9 years (mean 29.1±36.7 months). They were circumcised immediately after the first UTI and were followed for 6 months. Urine samples were obtained by the bag technique in infants and by the mid-stream technique in older patients. In the uncircumcised group, the rate of significant bacteriuria per patient did not change in two 6-month follow-up periods (3.46±0.91 and 3.33±0.97 episodes). In group 1, the rate of positive urine cultures dropped from 3.57±1.11 to 0.14±0.35 episodes after circumcision (P<0.001). In the second group, the rate of significant bacteriuria was 0.17±0.38 episodes after circumcision. Among the uncircumcised patients, symptomatic UTI was observed in 6 cases (3 cases in the first period of group 1, 1 case in the first and 2 cases in the second period of the uncircumcised group), whereas after circumcision no patient had symptomatic UTI. The mean age at circumcision was 42.7±28.4 months. No complication due to circumcision occurred in any patient. UTI may also occur in boys after the 1st year of life. The present study indicated that circumcision in boys decreases the rate of positive urine cultures. Therefore circumcision could be considered as a part of UTI therapy. Received: 30 January 2001 / Revised: 25 June 2001 / Accepted: 26 June 2001     

Maintenance therapy with mycophenolate mofetil after rituximab in pediatric patients with steroid-dependent nephrotic syndrome

Rituximab (RTX) has a significant steroid-sparing effect in children with steroid-dependent nephrotic syndrome (SDNS). However, patients are likely to relapse with the recovery of CD20+ cells. We conducted a small prospective cohort study with a historical control to evaluate the effect of RTX infusion followed by mycophenolate mofetil (MMF) as a maintenance therapy. Nine patients with SDNS who stopped their steroid treatment but were treated with MMF after RTX infusion were prospectively observed (group A). Seven patients with SDNS who discontinued steroid and immunosuppressive agents after RTX administration served as a control (group B). During the first year after the administration of RTX, six patients in group A and one patient in group B did not suffer a relapse (p < 0.05). The number of patients who relapsed during the 1 year preceding RTX treatment did not differ between the two groups [4.1 (A) vs. 5.7 (B)], but it was significantly lower in the MMF-treated group 1 year after the RTX treatment [0.4 (A) vs. 2.3 (B), p < 0.005]. The daily amount of prednisolone after the RTX treatment was lower in group A than in group B (0.11 vs. 0.46 mg/kg/day, respectively; p < 0.05). Three patients in group A and five patients in group B relapsed to SDNS and needed additional RTX treatment(s) within 1 year (odds ratio 5.0). Based on these results, we conclude that maintenance therapy with MMF after RTX is a good clinical option.     

Preputial calculus: a case report

A preputial calculus developed postoperatively in a child with epispadias. Analysis of the pathophysiological development of this lesion and a review of the literature are presented. The inert subpreputial space may become calculogenic in the presence of phimosis and urinary stasis.     

Course and long-term outcome of idiopathic IgA nephropathy in children

The long-term outcome of idiopathic IgA nephropathy (IgAN) in children was investigated with regard to clinical course and biopsy changes. All patients with biopsy-verified IgAN (diagnosed by kidney biopsy 1970–1985) at three children's clinics in Sweden were included in the study. Thirty-four (10 females, 24 males), out of a total of 72 patients, had a follow-up period of 8 years or more (10.7±1.9 years, range 8–14). After this duration of follow-up, urine abnormalities were found in 47% (group A), proteinuria in 35%, hypertension in 9%, and decreased glomerular filtration rate (GFR) in 3% of patients. However, 53% had no clinical signs of disease (group B). GFR depression at the time of clinical presentation of IgAN was more common in group A than in group B (P=0.017). At the first renal biopsy, which was performed after the same duration of IgAN in both groups, focal segmental glomerular changes were more often found in group A (P=0.017), while diffuse proliferative changes were more common in group B (P=0.031). The course of the IgAN was thus often very protracted, with some children developing hypertension as well as decreased renal function. However, after a period of 8 years or more of follow-up half of the patients did not show any clinical signs of the disease, which may indicate low disease activity or, possibly, recovery.     

Impact of the bacteriology of diabetic foot ulcers in limb loss

Infections in feet of patients with diabetes mellitus is common, complex and costly. The aim of this study to investigate the isolated microorganisms in infected diabetic foot ulcers, and the impact of these infectious agents in limb loss in a tertiary medical center in Mexico City. We conducted a retrospective review in diabetic patients with infected foot ulcers from 1997 to 2014. Diabetic foot was defined according to the World Health Organization (WHO), the bacteriology of wound cultures and the impact of microorganisms in limb loss (major amputation) was studied. Patient's demographics, comorbidities, wound characteristics, and other factors associated in clinical outcomes were determined. A total of 165 subjects with soft tissue infections and/or osteomyelitis and positive cultures were included. One hundred and five (64%) were male, with a mean age of 60 year old +/? 15. One hundred fifty‐nine (96%) had Type 2 diabetes mellitus, 68 (41%) history of peripheral arterial disease (PAD) and 97 (59%) patients had osteomyelitis. In 89 patients (54%), cultures were polymicrobial and one single organism was isolated in 76 cultures (46%). During the follow up, 96 (58%) patients preserved their limbs and 69 (42%) required major amputation (above or below knee). Sixty percent of patients that suffered from limb loss had polymicrobial culture (p = 0.13). Growth of Escherichia coli and Enterococcus faecium (p = 0.03) and E. coli and Morganella morgagnii (p = 0.03) was associated to limb loss. Among monomicrobial cultures, infections associated with Proteous mirabilis had higher rate of progression to limb loss (p = 0.03). PAD was associated to limb loss (p = 0.001). Management of diabetic foot requires a multimodality approach. In this study, in patients that received appropriate antibiotic therapy and optimal surgical management, we observed that history of PAD, polymicrobial and isolated P. mirabilis infections were variables associated with higher rate of limb loss.     

Chlamydial infection of the urinary tract in children and adolescents with hematuria

Urogenital infection with Chlamydia trachomatis in adults and adolescents is a common sexually transmitted disease. The purpose of this study was to investigate whether isolated microhematuria in children and adolescents is associated with Chlamydia trachomatis infection of the urinary tract. The study group included 37 children and adolescents with isolated nonglomerular microhematuria. Urethral smears for the isolation of Chlamydia trachomatis in cell culture were taken at the time of cystourethroscopy from all patients. Polymerase chain reaction (PCR) for the detection of chlamydial DNA in urine was carried out in 25 of 37 (68%) patients and direct immunofluorescence (DIF) of urine in 16 of 37 (43%) patients. The control group included 33 children and adolescents without hematuria; PCR and DIF of urine were carried out in all controls. Chlamydia trachomatis infection of the urinary tract was confirmed in 8 of 37 (22%) patients in the study group, and in none in the control group (0 of 33, P<0.001). Further studies of larger groups of patients should be conducted, before recommending testing for Chlamydia trachomatis infection of the urinary tract in children and adolescents with unexplained microhematuria. Received: 26 January 2000 / Revised: 26 April 2000 / Accepted: 2 May 2000     

Surgical correction of buried penis: a review of 60 cases

BACKGROUND/PURPOSE: The authors reviewed 60 cases of buried penis, treated in a single institution with postoperative follow-up for at least 6 months. The review was aimed at providing information that might help to optimize the results in future surgical correction of this uncommon, but not rare, congenital disorder. METHODS: From January 1, 1989 to December 31, 1998, 62 boys with buried penis were treated with 1 of the following procedures: group 1A (n = 6), preputial unfurling alone; group 1B (n = 8), modified preputial unfurling; group 1C (n = 12), penoplasty devised by the first author with preservation of the preputial skin; and group 2 (n = 36), penoplasty with trimming of the inner preputial skin. Postoperative follow-up of more than 6 months after operation was achieved in 60 of 62 patients for a total of 25 patients in group 1 (A through C) and 35 patients in group 2. RESULTS: Recurrent buried penis developed in 8 of 60 patients (13%), and redundant penile skin with or without lymphedema occurred in 18 (30%). The complications occurred in 18 of 25 patients (72%) in group 1 (A through C) but in only 8 of 35 (23%) in group 2. The difference was significant (P =.001). Most of the complications were mild and acceptable. A second procedure was required in 5 of the 25 patients in group 1 but in none of group 2. The second procedures were required to correct recurrent buried penis in 1 and to resect excess redundant penile skin in 4. CONCLUSION: The superior results achieved in group 2 suggest that in addition to penoplasty with adequate fixation of the unfurling prepuce, resection of excess inner preputial skin is required to achieve an optimal outcome in children requiring surgical correction of buried penis.     

Recurrence and follow-up after urinary tract infection under the age of 1 year

In order to analyze the risk factors for recurrence and the value of routine follow-up by monthly urine cultures in a group of children who had their first episode of urinary tract infection (UTI) under 1 year of age, we performed a retrospective survey of 262 children (134 girls, 128 boys) who were treated for their first UTI while aged under 1 year in the Department of Pediatrics, University of Oulu, during the years 1978–1984. Detailed data on these children concerning their first and recurrent UTIs were collected from hospital records using a formulated data sheet. Causative bacteria and vesicoureteral reflux (VUR) were analyzed as possible risk factors for recurrent UTI. The time of recurrence and the possible symptoms during the recurrent UTI were also investigated. The follow-up period after the first UTI was 3 years; 35% of the boys and 32% of the girls contracted a recurrent UTI during the 3-year follow-up. In 86% of cases, the first UTI recurrence occurred within 6 months of the primary UTI. Recurrent UTIs were detected significantly earlier with routine monthly follow-up compared with those seeking treatment because of symptoms (log rank test P<0.01). There was a significant difference in the number of recurrences of UTI according to the grade of VUR (P=0.006). Recurrence-free survival was shorter and recurrent UTIs occurred more often in the children with grade 3–5 VUR than in those with grade 0–2 VUR (log rank test P=0.0005). Children without VUR and children with grade 1–2 VUR did not differ in the recurrence rate, and thus grade 1–2 VUR did not increase the risk for recurrent UTI. Monthly routine urine cultures are efficient in detecting recurrent UTI infections in children. Since grade 3–5 VUR is a risk factor both for increased recurrence rate of UTI and for possible subsequent renal damage, these children should be followed with monthly urine cultures for UTI recurrences if not on preventive medication. Since the vast majority of UTI recurrences occur within 6 months of the first UTI, routine follow-up for 6 months seems to be sufficient after symptomatic UTI in children with grade 3–5 VUR. Received: 10 January 2000 / Revised: 21 August 2000 / Accepted: 21 August 2000     

Clinicopathological correlation of IgA nephropathy in children

22 patients with IgA nephropathy aged 7-16 years, 15 of whom were found by mass urine screening of school children, were divided into three groups based on the degree of their proteinuria at admission: group A (n = 6) below 0.5 g/day of urine protein, group B (n = 7) between 0.6 and 3.0, and group C (n = 9) above 3.0 g/day of urine protein. The degree of proteinuria seemed to be related to the severity of pathological changes of the glomerular basement membrane; most severe in group C, moderate in group B, and minimal in group A. IgA deposits in the mesangial area were found in all groups of patients, but those in the capillary walls were most frequently found in group C. In addition to electron-dense deposits in the mesangial area, which was found in all groups of patients, the subendothelial and subepithelial deposits were the most remarkable changes found in group C. During the clinical observation period, which was between 2.0 and 7.1 years, no patient belonging to group A progressed to groups B or C. 4 cases in group C developed chronic renal failure, but none in the other groups did. The amount of urine protein might be used as a valuable parameter of the pathological damage of the glomerulus in children with IgA nephropathy.     

Urinary levels of interleukin-6 and interleukin-8 in patients with vesicoureteral reflux and renal parenchymal scar

The objective of this study was to assess the urine levels of interleukin-6 (IL-6) and interleukin-8 (IL-8) as noninvasive markers of vesicoureteral reflux (VUR) and renal parenchymal scarring (RPS) in children in the absence of a recent urinary tract infection (UTI) episode. Urine concentrations of IL-6 and IL-8 in 114 children aged 1 month to 16 years were evaluated. The children were divided into four groups: group 1, 26 children with VUR and RPS; group 2, 27 children with VUR without RPS; group 3, 34 children with RPS without VUR, group 4, 27 children without VUR and RPS, as the control group. After the first assessment, the children were divided into four larger groups for comparison purposes: group A (groups 1+2), 53 children with VUR; group B (groups 3+4), 61 children without VUR; group C (groups 1+3), 60 children with RPS; group D (groups 2+4), 54 children without RPS. Urinary IL-6 and IL-8 concentrations were determined. To avoid dilution effects and to the standardize samples, urinary levels of IL-6 and IL-8 were expressed as the ratio of cytokine to urinary creatinine (pg/mg). The median urine IL-6/creatinine was significantly higher in patients with VUR than in those without VUR (5.72 vs. 3.73). In patients with VUR, there was a significant but rather weak correlation between IL-6/creatinine concentrations and the reflux grade (p?<?0.05, R?=?0.305). The median urine IL-8/creatinine was significantly higher in patients with RPS than in those without RPS (43.12 vs. 16.36). In patients with RPS, there was a significant but rather weak correlation between IL-8/creatinine concentrations and the renal scar grade (p?<?0.05, R?=?0.251). The results of this study provide preliminary evidence that children with VUR have a high urine IL-6 concentration, whereas children with RPS have a high urine IL-8 concentration.     

Prophylactic antimicrobial treatment in transurethral prostatectomy How long should it be instituted?

Eighty-one patients with proved preoperative sterile urine and undergoing transurethral resection of the prostate were studied. The patients were divided into 3 groups: group A received sulfamethoxazole-trimethoprim (ST) preoperatively and postoperatively for ten days; group B received ST in 2 divided doses, one pre- and one postoperatively; group C received no prophylaxis. In groups A and B, we found urinary infection in 3.8 per cent of patients compared with 32 per cent in group C. Performing prostatic chip cultures, we found that most urinary infections were unrelated to a prostatic source. When the prostate was infected, 75 per cent had infected urine postoperatively. We believe that prophylactic antimicrobial treatment should be given to all patients undergoing transurethral prostatectomy. However, it seems that immediate perooperative treatment suffices.     

Urinary infections in patients with spinal cord injury

STUDY DESIGN: A retrospective study concerning urinary tract infections in spinal cord injury (SCI) patients. OBJECTIVES: To check whether the regular (1/week) urine cultures allow a more accurate treatment of urinary tract infections in SCI patients compared to empiric treatment. SETTING: Ghent University Hospital, East-Flanders, Belgium. METHODS: Group 1: 24 tetraplegic patients; group 2: 22 paraplegic patients; group 3: 28 other polytrauma patients as controls. These groups were chosen as catheterisation and other voiding methods differ according to the underlying pathology. RESULTS: An average of four clinically significant episodes of bacteriuria were found for groups 1 and 2, while group 3 experienced very few urinary infections. The mean species turnover of the first two groups was 2. No statistically significant difference was found in antibiotic-resistance patterns of organisms isolated. CONCLUSION: Despite different catheterisation techniques in para- and tetraplegic patients, we conclude that: (1) the number of episodes of clinical significant nosocomial urinary infections is not different; (2) the mean species turnover is the same; (3) because of the species turnover, the value of regular urine cultures for 'documented' treatment of clinical relevant urinary infections seems to be limited. So urine culture could be performed less frequently or only when therapy becomes mandatory; (4) No oral antibiotic with superior activity was found: treatment is best started empirically (after sampling for urine culture) and adjusted to the resulting antibiotic sensitivity screening.     

First urinary tract infection in neonates, infants and young children: a comparative study

In an attempt to evaluate first urinary tract infection (UTI) in neonates and infants, we estimated retrospectively in 296 patients (62 neonates and 234 infants) clinical and laboratory findings, occurrence of vesicoureteral reflux (VUR), urinary tract abnormalities and pyelonephritis. First UTI occurred more often in male than female neonates, whereas male and female infants/young children were affected at an equal rate. The pathogens isolated in urine cultures of neonates and infants did not statistically significantly differ (P>0.05); Escherichia coli predominated. Gram-negative bacteria other than E. coli affected boys more often than girls (P=0.0022). Fever was the most frequent symptom. Neonates had lower-grade fever of shorter duration than infants (P<0.05). The incidence of reflux and urinary tract abnormalities did not differ between neonates and infants, male and female neonates and infants (P>0.05). Pyelonephritis affected neonates and infants at an equal rate; it was more prevalent among female patients (P=0.038) and patients with VUR or urinary tract abnormalities other than VUR (P<0.0001). Neonates with reflux were more often affected by Gram-negative bacteria other than E. coli than were neonates without reflux (P=0.0008).     

Midnight removal of urinary catheters — Improved outcome after gynecological surgery

By convention, most indwelling urethral catheters are removed in the morning. The authors carried out a randomized prospective study of 101 patients with postoperative urethral catheters and compared midnight removal with the more usual practice of morning removal. Patients were randomized into two groups: group A (n=46) had their catheters removed at 6:00 am and group B (n=49) had their catheters removed at midnight. Six patients were excluded from the study (1 patient on distigmine and 5 with preexisting urinary tract infections). The groups were comparable in age, use of night sedation, operative procedures and incidence of postoperative urinary tract infections. Patients in group B passed urine a median of 1 hour 40 minutes earlier, with a median volume 175 ml greater than group A (P=0.012 and <0.001); 13 patients in group A subsequently required recatheterization for urinary retention, compared to only 6 patients in group B. Patients in group B were also discharged significantly earlier from hospital (median of 2 days earlier from removal of catheter) than those in group A (P=0.032). Midnight removal of indwelling catheters after gynecologic surgery significantly decreases hospitalization and improves bladder function in terms of time and volume of first void.     

Sac excision is essential to adequate laparoscopic repair of paraesophageal hernia

Background: We compared the incidence of early hernia recurrence in nonrandomized but consecutive patients undergoing laparoscopic repair of paraesophageal hernia (LRPH) without and with excision of the hernia sac. Methods: LRPH was completed in 55 of 58 patients. In the first 25 patients, the sac was not excised. Total sac excision was performed in the subsequent 30 patients. All patients had crural repair with or without fundoplication, or gastropexy. Results: Mean age of patients was 68 years (range, 34–95). There were three conversions; one patient died postoperatively. Mean operative time was 225 min in the first group and 190 min in the sac excision group. Median length of stay was 2 days (range, 1–15) for both groups. Conclusions: A precise method of total sac excision simplified dissection. It also ensured complete reduction of the hernia and availability of adequate esophageal length. Operative time was not increased, and no subsequent early recurrences were observed (p < 0.05). Received: 3 April 1997/Accepted: 18 July 1997