Transvaginal closure of urinary bladder opening and Mitrofanoff technique in a neurologically impaired female with chronic indwelling catheter: a case presentation

Abstract Background Chronic catheterization remains the only attractive option in specific circumstances, especially in neurologically impaired patients. Complications produced by the indwelling catheters, like patulous urethra and bladder neck destruction, usually lead to severe incontinence and significant nursing difficulties. Here, we describe a rare case, a urinary bladder opening representing massive and extensive destruction of the urethra and bladder sphincter due to an indwelling catheter. Case presentation We present a 46-year-old paraplegic woman complaining of recurrent febrile urinary tract infections and severe urinary incontinence. She suffered from persistent malodorous urine and skin breakdowns from constant urine leakage. The vaginal examination revealed extensive destruction of the urethra and a 10 cm opening permitting the urinary bladder wall to prolapse into the vagina. The patient underwent a combined surgical approach; a transvaginal bladder closure with anterior colporrhaphy and a Mitrofanoff procedure to ensure a continent stoma for future clean intermittent self-catheterization (CISC). The patient is compliant with CISC and, remains continent twelve years after surgery. Conclusion This case demonstrates that in the era of CISC, there are still neurologically impaired females suffering from rare but critical adverse effects of indwelling catheters. The urethra and bladder neck erosion represent a demanding treatment assignment. The Mitrofanoff procedure for continent stoma and the transvaginal closure of urinary bladder opening produced a lifesaving potential treatment.

Download Full-text

Reducing the Use of Indwelling Urinary Catheters During Cesarean Deliveries

POJ Nursing Practice & Research ◽

10.32648/2577-9516/1/2/004 ◽

2017 ◽

Vol 1 (2) ◽

pp. 1-5

Author(s):

Michelle Borland

Keyword(s):

Urinary Tract ◽

Needs Assessment ◽

Cesarean Delivery ◽

Small Community ◽

Urinary Catheters ◽

Indwelling Catheter ◽

Indwelling Catheters ◽

Cesarean Deliveries ◽

Increased Risk ◽

Tract Infections

One concern for medical professionals and women experiencing cesarean deliveries is the use of indwelling urinary catheters, which is associated with a delay in first void time, slower ambulation time, increased discomfort, longer hospital stays, and an increased risk for urinary tract infections. The purpose of this project was to determine if a practice change regarding the use of urinary catheters among pregnant women decreases the number of women receiving a catheter prior to having a cesarean section in a small community hospital. The knowledge to action and Rosswurm and Larabee’s models were used to guide this project, which was comprised of 2 phases. Phase 1 included a team of 10 experts that created the needs assessment that would establish hemodynamic stability using a 4-point scale. The items for inclusion in the needs assessment included primary cesarean, repeat cesarean, no urinary tract infection present, no fetal distress present, no systemic disorders present, no hypertensive disorders present, and no contraindications for anesthesia. Phase 2 was the implementation and evaluation of the needs assessment and new practice guidelines. Statistical analysis was performed using the Mann Whitney U test. There was 98% compliance (p < 0.001.) with the use of the assessment in women undergoing a cesarean delivery and a 64% reduction in the length of time an indwelling catheter was left in place. However, there was no significant change in the number of women receiving a catheter prior to cesarean delivery after a needs assessment was performed (p = 0.805). This project has potential implications that would support social change by reducing the use of indwelling catheters among hemodynamically stable women undergoing cesarean deliveries. Key words: Indwelling catheter, Urinary catheter, Foley, Cesarean, C-section

Download Full-text

Does the method of “securing the catheter” make any difference?

Journal of Clinical Urology ◽

10.1177/2051415817707156 ◽

2017 ◽

Vol 11 (1) ◽

pp. 21-26

Author(s):

James WH Macneil ◽

Rachel G Wilkins ◽

Russell P Taylor ◽

Howard M Lau

Keyword(s):

Bladder Neck ◽

Drainage System ◽

Adhesive Tape ◽

Test Apparatus ◽

Force Transmission ◽

Catheter Drainage ◽

Indwelling Catheter ◽

Indwelling Catheters ◽

System A ◽

Transmitted Force

Objectives: The purpose of this study was to determine whether commonly used methods of securing an indwelling catheter decrease the force transmission along the indwelling catheter to the bladder neck in response to an externally applied force. Materials and methods: A test apparatus was constructed to simulate key features of a catheter drainage system. A “bladder neck” was suspended from a force gauge, with an indwelling catheter inserted through it, tensioned with a urine drainage bag. The system was calibrated, and various methods of securement were tested, with the level of force transmitted to the bladder neck recorded. The methods of securement tested included: adhesive tape taped used a number of ways (including direct taping and a taped mesentery), and three commercially available devices. Results: Some securement devices were able to completely eliminate force transmission to the bladder neck (the Flexi-Trak and Grip-Lok devices). A taped mesentery performed well reducing the transmitted force by up to 85% compared with an unsecured control. Conclusion: Within the limitations of this study we were able to demonstrate that some of the commonly used methods of securing indwelling catheters do work. We were also able to show that adhesive tape was still effective, although not as effective as commercially available devices.

Download Full-text

Primary Squamous Cell Carcinoma of the Urinary Bladder Presenting as Peritoneal Carcinomatosis

Advances in Urology ◽

10.1155/2010/179250 ◽

2010 ◽

Vol 2010 ◽

pp. 1-3 ◽

Cited By ~ 4

Author(s):

Himisha Beltran ◽

Brian D. Robinson ◽

Scott T. Tagawa

Keyword(s):

Squamous Cell Carcinoma ◽

Urinary Bladder ◽

Cell Carcinoma ◽

Peritoneal Carcinomatosis ◽

Squamous Cell ◽

The United States ◽

Primary Squamous Cell Carcinoma ◽

Indwelling Catheter ◽

Rare Malignancy ◽

Tract Infections

We report an unusual case of a 78-year-old Caucasian female, who presented with peritoneal carcinomatosis and hypercalcemia, and was found to have a rapidly progressive primary squamous cell carcinoma of the urinary bladder. Squamous cell bladder carcinoma is a rare malignancy in the United States, accounting for just 1–3% of bladder tumors. Interestingly our patient lacked the established risk factors, including exposure to the parasiteSchistosoma haematobium, recurrent urinary tract infections, bladder calculi, radiation exposure, chronic indwelling catheter, neurogenic bladder, or tobacco abuse. Although hypercalcemia has been rarely described, an initial presentation of peritioneal carcinomatosis has not been previously reported.

Download Full-text

Frank haematuria secondary to ruptured pseudoaneurysm of the inferior vesical artery: a case report and review of the literature

Journal of Medical Case Reports ◽

10.1186/s13256-021-02668-x ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Mohammed Suoub ◽

Ghassan Talahmeh ◽

Salah Abdelraouf ◽

Fadi Sawaqed

Keyword(s):

Urinary Bladder ◽

Bladder Neck ◽

Insertion Site ◽

Rectal Surgery ◽

Massive Bleeding ◽

Review Of The Literature ◽

Case Presentation ◽

Packed Red Blood Cells ◽

Abdominal Exploration ◽

Urological Intervention

Abstract Background Pseudoaneurysm of a vesical artery is an extremely rare iatrogenic complication; however, it may cause fatal haematuria. Case presentation A 21-year-old Arab Jordanian male had multiple optical urethrotomies for an iatrogenic urethral stricture after he had rectal surgery for Hirschsprung’s disease at the age of 2 years. During one of his admissions to the Emergency Room (ER) with urinary retention, an attempt at suprapubic catheter insertion was complicated by massive bleeding at the insertion site of the catheter. Abdominal exploration showed a distended urinary bladder with clots and bleeding seen at the bladder neck that was controlled with multiple sutures. The patient rebled again two times; the first was controlled with cystoscopy and cautery for a pulsatile bleeder seen at the bladder neck. The second time, the patient required blood transfusion of three units of packed red blood cells. Angiography was performed, and a pseudoaneurysm at the base of the urinary bladder from the inferior vesical artery was diagnosed, which was controlled by embolization. Conclusion Pulsatile bladder haemorrhage following urological intervention is suggestive of pseudoaneurysm or arteriovesical fistula, and angiography with embolization is recommended.

Download Full-text

Vasovagal reaction secondary to bladder overdistension in a dog undergoing a unique timeline of medical and surgical treatment for Corynebacterium urealyticum encrusting cystitis: a case report

BMC Veterinary Research ◽

10.1186/s12917-021-03028-z ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Ryan F. Peiffer ◽

Carly Iulo ◽

Tessa LeCuyer ◽

Timothy Bolton

Keyword(s):

Urinary Tract ◽

Urinary Bladder ◽

Lower Urinary Tract ◽

Bladder Wall ◽

Surgical Debridement ◽

Treatment Modalities ◽

Vasovagal Reaction ◽

Tract Infections ◽

Corynebacterium Urealyticum ◽

Lower Urinary

Abstract Background Corynebacterium urealyticum urinary tract infections can result in a rarely reported condition called encrusting cystitis whereby plaque lesions form on and within the urinary bladder mucosa. Chronic lower urinary tract signs manifest subsequent to the infection-induced cystitis and plaque-induced decreased bladder wall distensibility. Because of the organism’s multidrug resistance and plaque forming capability, infection eradication can be difficult. While systemic antimicrobial therapy is the mainstay of treatment, adjunctive surgical debridement of plaques has been used with relative paucity in such cases, thereby limiting our understanding of this modality’s indications and success rate. Consequently, this report describes the successful eradication of Corynebacterium urealyticum encrusting cystitis utilizing a unique timeline of medical and surgical treatments. Additionally, this represents the first reported veterinary case of a vasovagal reaction due to bladder overdistension. Case presentation A 6-year-old female spayed Miniature Schnauzer was evaluated for lower urinary tract clinical signs and diagnosed with Corynebacterium urealyticum encrusting cystitis. The infection was persistent despite prolonged courses of numerous oral antimicrobials and urinary acidification. A unique treatment timeline of intravenous vancomycin, intravesical gentamicin, and mid-course surgical debridement ultimately resulted in infection resolution. During surgery, while the urinary bladder was copiously flushed and distended with saline, the dog experienced an acute vasovagal reaction from which it fully recovered. Conclusions Surgical debridement of bladder wall plaques should be considered a viable adjunctive therapy for Corynebacterium urealyticum encrusting cystitis cases failing to respond to systemic antibiotic therapy. The timing in which surgery was employed in this case, relative to concurrent treatment modalities, may be applicable in future cases of this disease as dictated on a case-by-case basis. If surgery is ultimately pursued, overdistension of the urinary bladder should be avoided, or at least minimized as much as possible, so as to prevent the possibility of a vasovagal reaction.

Download Full-text

Reducing the rate of post-surgical urinary tract infections in orthopedic patients

BMJ Open Quality ◽

10.1136/bmjoq-2017-000177 ◽

2018 ◽

Vol 7 (2) ◽

pp. e000177 ◽

Cited By ~ 13

Author(s):

Amit Thakker ◽

Natasha Briggs ◽

Azusa Maeda ◽

Julie Byrne ◽

John Roderick Davey ◽

...

Keyword(s):

Quality Improvement ◽

Urinary Tract ◽

Nurse Practitioners ◽

Improvement Program ◽

Indwelling Catheter ◽

Indwelling Catheters ◽

Inappropriate Use ◽

Acs Nsqip ◽

Leadership Group ◽

Tract Infections

Urinary tract infection (UTI) is the fourth leading cause of healthcare-associated infections, with approximately 70%–80% being attributed to the inappropriate use of indwelling catheters. In many cases, indwelling catheters are used inappropriately without any valid indication, creating potentially avoidable and significant patient distress, discomfort, pain and activity restrictions, together with substantial care burden, cost and hospitalisation. In the Division of Orthopedic Surgery at Toronto Western Hospital (TWH), we identified UTI rate reduction as a quality improvement priority. Patients who underwent total hip and knee joint replacements and hip fracture repairs at TWH were monitored for the incidence of UTI and the usage of catheters. The data collected as part of the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) revealed UTI rate of 2.1% among 666 patients who were treated between January and June 2016. Data collected through a custom field in the ACS NSQIP workstation further revealed that indwelling catheters were overused, with 55.2% of patients receiving indwelling catheters in the same time period. These data were presented to the orthopaedic leadership group and surgeons at TWH in July 2016 to set the quality improvement target and create the working group. Nursing staff was provided education to strictly follow the institutional catheter-associated UTI prevention guidelines and change ideas based on the guidelines were implemented in July 2016. As a result, the rate of UTI decreased to 1.1% and the use of indwelling catheter decreased to 19.8% among 883 patients who were treated between July 2016 and March 2017. The study indicated that a systematic approach, engaging all front-line staff including nurse educators and nurse practitioners, helps to facilitate implementation of practice changes. We expect that ongoing reminders and education ensure that the changes are sustainable.

Download Full-text

Malakoplakia of the urinary bladder in a young French Bulldog

Journal of the American Veterinary Medical Association ◽

10.2460/javma.20.12.0676 ◽

2021 ◽

pp. 1-6

Author(s):

Michael Brückner

Keyword(s):

In Situ Hybridization ◽

Urinary Tract ◽

Urinary Bladder ◽

Fluorescence In Situ Hybridization ◽

Urinary Tract Infections ◽

Bacterial Culture ◽

Bladder Wall ◽

Tract Infections ◽

French Bulldog

Abstract CASE DESCRIPTION A 4-month-old 5.9-kg sexually intact female French Bulldog was presented because of recurrent urinary tract infections in combination with pollakiuria, hematuria, and urinary incontinence. CLINICAL FINDINGS A diagnosis of malakoplakia was made on the basis of results of hematologic and serum biochemical testing, abdominal ultrasonography, bacterial culture, and cystoscopic biopsies of the urinary bladder wall. Biopsy samples were sent for routine histologic examination and fluorescence in situ hybridization to confirm the presence of intracellular and subendothelial bacteria. TREATMENT AND OUTCOME Treatment with enrofloxacin was started after the diagnosis of malakoplakia was confirmed. During treatment, polypoid changes in the urinary bladder decreased dramatically but did not disappear. On follow-up ultrasonography after 12 weeks of treatment, marked improvement was visible and results of repeated bacterial culture and fluorescence in situ hybridization of bladder wall samples were negative. The patient was free from clinical signs and had an ultrasonographically normal urinary bladder 59 weeks after antimicrobial treatment was discontinued. CLINICAL RELEVANCE Malakoplakia, a granulomatous disease characterized by impaired histiocytes that are unable to completely digest phagocytized bacteria, is a very rare disease in dogs, but early suspicion of the condition is essential to allow timely diagnosis and avoid disease progression and the need for prolonged treatment. Malakoplakia should be considered in young dogs with chronic urinary tract infections; the diagnosis can be made through a combination of histologic examination and fluorescence in situ hybridization of bladder wall biopsy samples.

Download Full-text

Live ascaris in urinary bladder: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-03045-4 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Gashaw Mesele ◽

Zelalem Mengistu

Keyword(s):

Case Report ◽

Gastrointestinal Tract ◽

Urinary Bladder ◽

Bladder Wall ◽

Northwest Ethiopia ◽

Fistula Formation ◽

Inflammatory Mass ◽

Case Presentation ◽

Enterovesical Fistula ◽

High Index Of Suspicion

Abstract Introduction Ascaris in urinary bladder is an extremely rare phenomenon. It may occur after fistula formation between urinary and gastrointestinal tract or by retrograde migration of adult worm, and is associated with complications. Case presentation A 47-year-old Amhara woman from rural northwest Ethiopia presented with a complaint of difficulty to fully evacuate her bladder of 1 year duration. Ultrasonography showed thickened bladder wall with echo debris. There were also thickened bowel and fluid-filled loops of intestine adjacent to urinary bladder. On cystoscopy examination, there was live ascaris swimming inside the bladder. Enterovesical fistula was entertained and explorative laparotomy performed. Findings confirmed presence of iliovesical fistula. The fistula was divided and the continuity of the intestine restored. The inflammatory mass was subjected to histopathology study and turned out to be benign inflammatory reaction. She was also given antihelminthics. Postoperatively, her course was uneventful, and she was discharged cured. Conclusion Though it is extremely rare to have urinary symptoms from ascariasis, it is important to have a high index of suspicion for all possibilities.

Download Full-text