“Bladder training”Catheter associated UTI
Present by Ri 洪菱謙
Questions?
Q1: Should we perform “bladder training” before removing urinary catheter?
Q2: Should we need to remove the urinary catheter in 48~72 hours of smoothly post op patients to reduce the rate of catheter associated UTI?
Rate of catheter associated UTI in 48~ 72 hours?
Q3: How to preventing catheter-related UTI
Should we perform “bladder training” before removing urinary catheter?
“Bladder training?”
Absent nomenclature !!!!!!!! in MEDLINE
“Foley training”
“Clamping Foley”
“Foley clamp”
“Catheter clamp” etc.





“Bladder training”
Bladder training →Urine incontinence
Roe, B, Williams, K, Palmer, M. Bladder training for urinary incontinence in adults. Cochrane Database Syst Rev 2004; :CD001308
Fantl, JA., Wyman, JF, McClish, DK, et al. Efficacy of bladder training in older women with urinary incontinence. JAMA 1991; 265:609.
Prospective evaluation of inpatient and outpatient bladder training in children with functional urinary incontinence.
Bladder training →Urine retention
Nil Study in MEDLINE !!!!!!!!!!!!!!111




Resolution of urinary retention
Management of postoperative urinary retention: a randomized trial of in−out versus overnight catheterization
Hung Lau and Becky Lam
,University of Hong Kong Medical Centre, Sheung Wan, Hong Kong
Method
 1448 patients
Inpatient elective general surgery
Exclusion
Ambulatory surgery, endoscopic procedures, local anaestheisa, urological procedures
Abdominal operation that required preoperative urinary catheterization
January 2002~June 2003
Respective and randomized
Postoperative urinary retention
Failed to pass urine or a palpable urinary bladder
in−out catheterization V. S. Indwelling catheter for 24 h after surgery.

Incidence of Urinary retention
Proportion of patients developing urinary retention
Result
 A total of 1448 patients was recruited
Incidence of urinary retention was 4.1% (n = 60=31+ 29).
Significant risk factors
old age
anorectal procedures
use of spinal anaesthesia.

Conclusion
Postoperative urinary retention should be managed by in−out catheterization.
Indwelling catheterization for 24 h appeared to bestow no additional benefits.
The incidence of urinary retention (Overall 4.1%, 1.1%~ 12%) increases with
Age
anorectal procedures
use of spinal anaesthesia.


Unclear information of this study
Without intra-operative urinary catheterization? ? Not reasonable ….
Exclusion criteria
Abdominal operation that required preoperative urinary catheterization
Inpatient elective general surgery
No cardio-vascular surgery
Number of patient with urinary retention was too small (60)
Indwelling catheterization for 24 h
no additional benefits
But also no additional disadvantage





Postoperative urinary retention--why the patient cannot void.
Tammela T.
Division of Urology, Tampere University Hospital, Finland.
Abstract
The etiology of postoperative urinary retention involves a combination of many factors, including
Sedation, type of anesthesia
increased sympathetic stimulation
Overdistension of the bladder by large quantities of fluids given intravenously
pain and anxiety.
The optimal form of urinary drainage afteracute retention of urine
M.I. PATEL, W. WATTS and A. GRANT

The Department of Urology, Royal Newcastle Hospital, Newcastle, NSW, Australia

Abbreviation
CICS: Clean intermittent Self-catheterization
IDC: indwelling catheterization
AUR: acute urinary retention
Method
55 men with s/s of AUR
After short term of IDC
Taught how to use CISC
If failed, then IDC+ valve or IDC + bag
(Not randomized!!!!!!)
Assessment of spontaneous voiding, UTI, patient satisfaction

Results
Conclusion
All men in AUR showed be offered CICS
Similar acceptance
More spontaneous voiding
fewer UTI


Major limitation of this study
Lack of randomization
CICS group, younger and had smaller prostates
Able to manage of CICS
Higher spontaneous voiding rate
Before TURP
56% (19/34) VS 25 % (4/16)
After TURP
100% (34/34) VS 75% (12/16)
Only Men being studied
Urinary retention → mostly due to BPH ?
Acute Urinary Retention: a reviewof the aetiology and management
K Thomas1*, K Chow1 & RS Kirby1
1Urology Department, St George’s Hospital, London, UK

Pathogenesis of AUR
Postoperative AUR
Prolonged procedure with the patient uncatheterised
Men who have had mild symptoms of BPH preoperatively.
Opiates, concomitant anticholinergic administration
Generalised increase in alpha-adrenergic activity that exists after surgery.

Risks factors for AUR
Prevention of AUR with durgs in Men
Alpha blockers
Alfuzosin V.S. placebo
55% V.S. 28% (P= 0.03)
↑passing a trial without catheter
48 h prior to trial without catheter after 24 h
5 alpha –reductase inhibitors
Finasteride V.S. placebo
AUR in 3% V.S. 7%
50% risk reduction !
Alpha blocker + 5 alpha- reductase inhibitors
Doxazosin + finasteride
↓long term risk of AUR
Crude rate per 100 patient years; placebo 0.6, doxazosin 0.4, finasteride 0.2, combination therapy 0.1



The outcome of trial off catheter after acute retention of urine.
Lim KB. Wong MY. Foo KT.
Department of Urology, Singapore General Hospital.
Acute retention of urine (ARU) due to benign prostatic hypertrophy (BPH)
From 1 June to 15 October 1997
79 patients (150-71)
Exclude chronic retention, bladder stones and cancer of the prostate
58% (n = 46) had a successful trial off catheter.
The risk factors for failure:
high residual urine (more than 800 ml)
high prostatic specific antigen (PSA) value (10.9 versus 21.5).

Total Joint Arthroplasty and Incidence ofPostoperative Bacteriuria With an IndwellingCatheter or Intermittent Catheterization WithOne-Dose Antibiotic ProphylaxisA Prospective Randomized Trial
I. C. J. B. van den Brand, MD, and R. M. Castelein, MD, PhD
the Department of Orthopaedic Surgery, Isala Clinics, location
Weezenlanden, Zwolle, The Netherlands.

Method
A prospective,randomized, controlled trial was conducted in primary THA and TKA patients.
One dose of cefazolin, 1 g, IV given preoperatively.
Indwelling V.S. Intermittent
Indwelling catheterization group
Pre-OP to post-OP for 48 hours
Intermittent catheterization group
Post-OP Q6H, until spontaneous bladder emptying
Bacteriuria
Positive urine sediment for bacteria or
WBC > 100000 colonies in urine culture

Indwelling V.S. Intermittent
Number of intermittent catheterization V.S. post OP bacteriuria
Conclusion
In the setting of primary TKA and THA with only 1 dose of cefazolin prophylaxis
Intermittent catheterization
Less bacteriuria than indwelling catheter for 48 hours
Significant for man
More intermittent catheterization, ↑Risk of post-OP bacteriuria (average 5.3 straight catheterizations)
Rate of bacteriuria in indwelling catheter group in 48 hours post-OP
Average 24 %
Catheter-related UTI
Preventing Catheter-Related BacteriuriaShould We? Can We? How?[Review Article]
Saint, Sanjay MD, MPH; Lipsky, Benjamin A. MD
Department of Internal Medicine, University of Michigan Health System, Ann Arbor (Dr Saint); and the Department of Medicine, University of Washington and General Internal Medicine Clinic, Veterans Affairs Puget Sound Health Care System, Seattle, Wash (Dr Lipsky).
Epidemiology
Up to 25% of hospitalized patients
urinary catheterization
Catheter associated nosocomial UTI
5% per day !
Nosocomial UTI
40% of nosocomial infection
Bacteria ascend intraluminally into the bladder
within 24 to 72 hours (from Harrison’s 16th)
> 1 month of catheterization
Nearly all will be bacteriuic
Long-term (>30 days) and short-term ( 1 month of catheterization
Nearly all will be bacteriuic
Long-term (>30 days) and short-term ( 1 month of catheterization
Nearly all will be bacteriuic
Long-term (>30 days) and short-term (30 days) and short-term (30 days) and short-term (30 days) and short-term (30 days) and short-term (30 days) and short-term (30 days) and short-term (30 days) and short-term (30 days) and short-term (

Free register and download UseNet downloader, then you can free download from UseNet.
Download "“Bladder training”Catheter associated UTI" from Usenet!