A case of migrating “saf-t-coil” presenting with a vesicovaginal fistula and vesicovaginal calculus

Intrauterine devices (IUDs) are reliable method for contraception. Although, they are generally regarded as safe, serious consequences may occur in case of uterine perforation or intravesical migration. We present a rare case of a 74 year old lady with a forgotten IUD for 42 years resulting in intravesical migration, formation of vesicovaginal fistula (VVF) without uterine perforation, complete urinary incontinence, recurrent urinary tract infections (UTIs) and a large vesicovaginal calculus

Perceptions of Higher Specialist Trainees and Fellows of the Proposed Sláintecare Consultant Contract and Implications for Workforce Planning in Ireland

To explore the perceptions of higher specialist trainees and fellows in Ireland with respect to the Irish Department of Health’s recent proposal to implement a drafted, non-negotiated, consultant contract under a new model for healthcare, termed the Sláintecare plan. A customized survey, incorporating multiple-choice and Likert-scale questions and a free-text option, was disseminated to doctors enrolled in Irish higher specialist training (HST) programmes and pre-consultant HST graduates (fellows). Responses were compiled and analysed. There were a total of 1109 respondents across all specialities. Trainees were particularly concerned regarding the Sláintecare contract’s potential impact on their abilities to engage in patient advocacy and provide optimal patient care in the future, the maintenance of specialist skillsets, their ownership of intellectual property and a stable location of the practice.  Of respondents, 93.7% (1003/1070) indicated that they would consider working abroad rather than accept the proposed contract. This study highlights the perceptions and concerns of the higher specialist trainees and fellows of Ireland. A large proportion may emigrate rather than accept the Sláintecare proposals.  Concerns exist surrounding the ability to advocate for patients, to provide patient care, the proposed working conditions and perceived potential to deskill under this contract’s terms

A Prospective Multi-Institutional Evaluation of Iatrogenic Urethral Catheterization Injuries

Objectives To perform a multi-institutional investigation of incidence and outcomes of urethral trauma sustained during attempted catheterization. Patients & Methods A prospective, multi-center study was conducted over a designated 3-4 month period, incorporating seven academic hospitals across the UK and Ireland. Cases of urethral trauma arising from attempted catheterization were recorded. Variables included sites of injury, management strategies and short-term clinical outcomes. The catheterization injury rate was calculated based on the estimated total number of catheterizations occurring in each center per month. Anonymised data were collated, evaluated and described. Results Sixty-six urethral catheterization injuries were identified (7 centers; mean 3.43 months). The mean injury rate was 6.2 ± 3.8 per 1000 catheterizations (3.18–14.42/1000). All injured patients were male, mean age 76.1 ± 13.1 years. Urethral catheterization injuries occurred in multiple hospital/community settings, most commonly Emergency Departments (36%) and medical/surgical wards (30%). Urological intervention was required in 94.7% (54/57), with suprapubic catheterization required in 12.3% (n = 7). More than half of patients (55.56%) were discharged with an urethral catheter, fully or partially attributable to the urethral catheter injury. At least one further healthcare encounter on account of the injury was required for 90% of patients post-discharge. Conclusions This is the largest study of its kind and confirms that iatrogenic urethral trauma is a recurring medical error seen universally across institutions, healthcare systems and countries. In addition, urethral catheter injury results in significant patient morbidity with a substantial financial burden to healthcare services. Future innovation to improve the safety of urinary catheterization is warranted

A prospective multi-institutional evaluation of Iatrogenic urethral catheterization injuries

Objectives:  To perform a multi-institutional investigation of incidence and outcomes of urethral trauma sustained during attempted catheterization. Patients & Methods: A prospective, multi-center study was conducted over a designated 3-4month period, incorporating seven academic hospitals across the UK and Ireland. Cases of urethral trauma arising from attempted catheterization were recorded. Variables included sites of injury, management strategies and short-term clinical outcomes. The catheterization injury rate was calculated based on the estimated total number of catheterizations occurring in each center per month. Anonymised data were collated, evaluated and described. Results:  Sixty-six urethral catheterization injuries were identified (7 centers; mean 3.43months). The mean injury rate was 6.2±3.8 per 1000 catheterizations (3.18–14.42/1000). All injured patients were male, mean age 76.1±13.1years. Urethral catheterization injuries occurred in multiple hospital/community settings, most commonly Emergency Departments (36%) and medical/surgical wards (30%). Urological intervention was required in 94.7% (54/57), with suprapubic catheterization required in 12.3% (n=7). More than half of patients (55.56%) were discharged with an urethral catheter, fully or partially attributable to the urethral catheter injury. At least one further healthcare encounter on account of the injury was required for 90% of patients post-discharge. Conclusions:  This is the largest study of its kind and confirms that iatrogenic urethral trauma is a recurring medical error seen universally across institutions, healthcare systems and countries. In addition, urethral catheter injury results in significant patient morbidity with a substantial financial burden to healthcare services. Future innovation to improve the safety of urinary catheterization is warranted. </p