Catheters and Infections

Catheters are used for effective drainage of the bladder, either temporally or permanently, in the presence of physiological and anatomical defects or obstruction of the lower urinary tract. Catheters are used for a variety of reasons, as follows, to maintain bladder drainage during and following surgery or epidurals anesthesia for minimizing and prevention of the risk of distension injuries; investigations, for accurate urine output measurement, and measurement of post-micturition residuals; treatments, to relieve urinary retention or for chemotherapy instillation; intractable incontinence, as the final option for containment

Current Trends in Urinary Diversion in Men

Prior to the introduction of the ileal conduit more than four decades ago, the options for urinary diversion after cystectomy were extremely limited. Direct cutaneous anastomoses of the collecting system (cutaneous pyelostomies, ureterostomies) offered patients a short-term diversion, but the benefits were outweighed by significant complications: recession or stenosis of the stoma. The first choice of diversion was the ureterosigmoidostomy with or without antireflux technique. Then it fell in popularity and was replaced with continent/non-continent uretero-ileo-cutaneous diversions. Only in the last years the continent orthotopic neobladder has been widely employed as first procedure choice. At present, patients can be offered a non-continent cutaneous diversion, a continent cutaneous diversion or an orthotopic neobladder urinary reconstructio

Development of a questionnaire specifically for patients with Ileal Orthotopic Neobladder (IONB)

The ileal orthotopic neobladder (IONB) is often used in patients undergoing radical cystectomy. The IONB allows to void avoiding the disadvantages of the external urinary diversion.In IONB patients the quality of life (QoL) appears compromised by the need to urinate voluntarily. The patients need to wake up at night interrupting the sleep-wake rhythm with consequences on social and emotional life.At present the QoL in IONB patients is evaluated by generic questionnaires. These are useful when IONB patients are compared with patients with different urinary diversions but they are less effective when only IONB patients are evaluated. To address this problem a specific questionnaire-the IONB-PRO-was developed. METHODS: A) Based on a conceptual framework, narrative-based interviews were conducted on 35 IONB patients. A basic pool of 43 items was produced and organized throughout two clinical and four QoL dimensions. An additional 15 IONB patients were interviewed for face validity testing.B) Psychometric testing was conducted on 145 IONB patients. Both classic test strategy and Rasch analysis were applied. Psychometric properties of the resulting scales were comparatively tested against other QoL-validated scales. RESULTS: The IONB-PRO questionnaire includes two sections: one on the QoL and a second section on the capability of the patient to manage the IONB. For evaluation of the QoL, three versions were delivered: 1) a basic 23-item QoL version (3 domains 23-items; alpha 0.86÷ 9.69), 2) a short-form 12-item QoL scale (alpha = 0.947), and 3) a short-form 15-item Rasch QoL scale (alpha = 0.967). Correlations of the long version scales with the corresponding dimensions of the EORTC-QLQ C30 and the EORTC-BLM30 were significant. The short forms exhibited significant correlations with the global health dimension of the EORTC-QLQ and with the urinary subscales of the EORTC-BLM30. The effect size was approximately 1.00 between patients at the 1-year follow-up period and those with 3, 5, and > 5-year follow-up periods for all scales. No relevant differences were observed between the 12-item short-form and the Rasch scale. CONCLUSIONS: The IONB-PRO long and short-forms demonstrated a high level of internal consistency and reliability with an excellent discriminanting validity

Transvaginal bone-anchored sling procedure: 4 years of follow-up on more than 200 consecutive patients

OBJECTIVES To report intermediate-term results with reference to quality of life (QoL) and complications in 232 consecutive patients with stress urinary incontinence (SUI) treated with a transvaginal pubic bone-anchored sling (BAS). METHODS We retrospectively reviewed 232 consecutive patients affected by SUI who underwent BAS using biologic and synthetic materials, with a mean follow-up of 50 months. Stress urinary incontinence was due to a defect of anatomic Support and to intrinsic sphincteric deficiency in 220 patients and 12 patients, respectively. In all cases QoL was evaluated by Korman questionnaire. RESULTS The questionnaire outcomes of 232 patients were evaluated. One hundred seventy-three patients (74.5%) reported being cured, 21 patients (9.0%) were unchanged, and 38 patients ( 16.5%) failed. One hundred seventy-Seven patients (76.2%) were satisfied with the BAS procedure, and 38 (16.3%) would perhaps still choose BAS implantation, whereas 17 patients (7.5%) would not repeat this choice again. Sixty patients (25.8%) reported pelvic pain that was occasional in 47 patients (20.2%) and recurrent in 13 patients (5.6%). Twenty-five patients (14.1%) reported dyspareunia that was occasional in 17 patients (10.7%) and recurrent in 8 patients (3.4%). CONCLUSIONS The BAS procedure shows an overall acceptable Subjective cure rate, even if in the presence of a high percentage of complications. In this setting the BAS procedure cannot be proposed for correction of SUI