Buccal mucosa graft tube urethroplasty for the treatment of bulbopenile urethral trauma accompanied with massive tissue loss due to improvised explosive device injury

Urinary diversion with suprapubic cystostomy and delayed urethroplasty is recommended for the treatment of penetrating posterior urethral traumas. A devastating urethral trauma caused by a blast injury due to an improvised explosive device is an extremely rare clinical condition and treatment options are limited due to accompanying massive tissue and muscle loss. Staged urethral reconstruction using a pedicled gracilis muscle flap with a skin or buccal mucosa graft is the preferred treatment option for complex urethral traumas. In case of a devastated urethra due to an intensive explosive device injury, treatment options are limited, especially if the gracilis muscle cannot be used. We report the case of a 30-year-old male patient with a devastated bulbopenile urethra and massive local tissue and adjacent muscle loss including the gracilis muscle. The patient was successfully treated by buccal mucosa graft tube urethroplasty. Urethral stricture recurred but was successfully treated by means of endoscopy. At 24 months’ follow-up, the patient was continent and urinated normally.

FIVE YEARS CHARACTERISTIC OF URETHRAL TRAUMA IN TERTIARY HOSPITAL IN WEST JAVA FROM 2013-2017

Objective: In this study, we try to describe the characteristics of patients with urethral trauma in Hasan Sadikin Hospital Bandung from 2013 to 2017. Material & Methods: The data were taken retrospectively from medical records in the Department of Urology with the permission of the ethical committee. The patient characteristics were then classified according to their age, etiology of trauma, location of trauma, grade of trauma, associated trauma, and initial management. Results: The number of trauma cases in Hasan Sadikin Hospital during 2013-2017 was 20.489, 477 of which (2.33%) were urogenital trauma. Of the total urogenital trauma, there were 124 patients with urethral trauma, male patients were more common (84.67%), with an average age of 34.67 (1-82) years. Seventy two patients (58.06%) were iatrogenic trauma (catheter instrumentation 44.35%, circumcision 6.45%, and others 7.25%), and fifty two patients (41.94%) were non-iatrogenic trauma (traffic accident 31.45%, falls from a height 7.25%, and occupational accident 3.22%). In non-iatrogenic trauma group, 40 patients (76.92%) had posterior urethral trauma and 12 patients (23.08%) had anterior urethral trauma. We found 22 (42.31%) of 52 patients with non-iatrogenic trauma were AAST grade I-II and 30 patients (57.69%) were AAST grade III-V. In patients with posterior urethral trauma, 25 patients (62.5%) had pelvic fractures. There were 10 patients (19.23%) who underwent primary endoscopic realignment within the first 72 hours while 30 patients (57.69%) underwent delayed urethroplasty 3 months after trauma, and the rest (23.08%) were treated conservatively. Conclusion: Urethral trauma in males occurs more frequently than in females. with the most common cause were catheter instrumentation (iatrogenic) and traffic accidents (non iatrogenic). Posterior urethral traumas had higher incidence than anterior urethral traumas, which were commonly associated with pelvic fractures.

Urethral polyembolokoilamania: not a bread-and-butter issue

Urethral polyembolokoilamania, the self-insertion of a foreign body into the male urethra for sexual gratification and autoerotism, is an uncommon urological emergency with potentially severe consequences. We present the case of a 27-year-old male who presented to our emergency unit after apparently sustaining a penile injury during sexual intercourse. Clinically, a foreign body was thought to be palpable, extending from the mid-shaft of the penis to the penoscrotal junction. Pelvic X-rays confirmed a radiopaque penile foreign body in the region of the anterior urethra. Cystoscopy confirmed the presence of an encrusted foreign body in the anterior urethra. It noted that the surrounding mucosa was very inflamed with areas of necrosis, suggesting that the foreign body had been present in the urethra for some time. To avoid further urethral trauma, we approached the foreign body via an external urethrotomy and removed a plastic knife in three parts. The urethra was repaired over a 16F catheter. The patient had an uneventful postoperative course, and a peri-catheter urethrogram 6 weeks after the procedure showed no signs of contrast extravasation or urethral stricture.

An Unusual Iatrogenic Injury of Urinary Bladder Following Foley’s Catheterization

Urinary bladder perforation is most commonly observed after pelvic trauma. It can also be a result of iatrogenic injury during various surgical procedures. Very rarely, diseased bladder can spontaneously rupture. Traumatic bladder rupture is a serious event with mortality rate approaching 50%. Urinary bladder diverticulae are present of the bladder wall and are a consequence of bladder outflow obstruction, for example in prostatic enlargement. Foley’s catheterization is most commonly associated commonly with urethral trauma. We presented a emphasis is made unique case of perforation of urinary bladder diverticulum after Foley’s catheterization. To the best of our knowledge, such a case has never been reported before in the medical literature. An emphasis was made on the fact that, physicians should keep in mind the differential of perforated urinary bladder while attending a patient with abdominal pain because the signs and symptoms are very non specificurinary bladder while attending a patient with abdominal pain just because its signs and symptoms are very non-specific. In addition, missing a perforated urinary bladder is easy and can result in significant morbidity and mortality. Keywords: Bladder Diverticulum; Urinary Catheters; Perforation.

CAUTIs in Patients With Thoracic Epidurals

Background: The Surgical Care Improvement Project 9 (SCIP 9) mandates the removal of urinary catheters within 48 hours following surgery to reduce the risk of catheter-associated urinary tract infections (CAUTIs). Although patients with thoracic epidurals are not exempt from SCIP 9, these patients may be inherently different from other surgical patients. Early removal of Foley catheters may cause urinary retention and recatheterization, which in turn can lead to CAUTI or urethral trauma. Our hospital’s current policy is to allow Foley catheters to remain in place until the thoracic epidural is removed. The goal of our study was to identify and compare the rate of CAUTI in patients with thoracic epidural catheters to the rate of CAUTI in patients without thoracic epidural catheters Methods: We performed a retrospective cohort study of patients with and without thoracic epidurals who had Foley catheters during hospitalization from July 1, 2017, to May 31, 2019. We used descriptive statistics to compare CAUTI rates based on unit between the 2 groups of patients. Results: We identified 1,834 unique patients with thoracic epidurals and urinary catheters during the study period. We found 4 CAUTIs of 9,896 catheter days (0.4 CAUTIs per 1,000 catheter days) in patients with epidural catheters and 43 CAUTIs of 36,809 catheter days (1.17 CAUTI per 1,000 catheter days) in patients without thoracic epidurals for a rate ratio of 0.346 (95% CI, 0.1242– 0.9639; P < .03). We conducted a sensitivity analysis on a subset of patients admitted under the cardiothoracic service and compared the patients with Foley catheters with and without thoracic epidurals. In this subset, we found 1 CAUTI in 5,890 catheter days (0.17 CAUTI per 1,000 catheter days) in patients with thoracic epidurals and 4 CAUTIs in 9,429 catheter days (0.42 CAUTIs per 1,000 catheter days) in patients without thoracic epidurals), for a rate of 0.4002 (95% CI, 0.0447–3.5808; P < .39). In this subgroup, 7.0% of patients with thoracic epidurals required a second Foley catheter compared to 16.9% of patients without thoracic epidurals who required a second Foley catheter (P < .01). Conclusions: Although patients with thoracic epidurals maintain Foley catheters beyond 48 hours, the CAUTI rate in these patients is lower than in patients without thoracic epidurals. Therefore, removing Foley catheters within 48 hours of surgery in patients with thoracic epidurals may not reduce the risk of CAUTI and, in fact, could be harmful. Further evaluation of confounding variables is warranted.Funding: NoneDisclosures: None

An Unusual Self-Inflicted Foreign Body in the Urinary Bladder and Urethra: A Case Report

Introduction: Most foreign bodies in the lower genitourinary tract are self-inserted via the urethra as the result of exotic impulses, psychometric problems, sexual curiosity, or sexual practice while intoxicated. Diagnosis of these foreign bodies can be done by clinical history, physical examination, and image studies of the patient. The treatment of foreign bodies is determined by their size, location, shape, and mobility. In most cases, minimally invasive procedures such as endoscopic removal are recommended to prevent bladder and urethral injuries. In some cases, however, surgical treatment should be done if the foreign bodies cannot be removed by the endoscopic procedure or further injuries are expected as a result of the endoscopic procedures. Case Presentation: Herein we present a case of self-inserted lower genitourinary foreign body. A 60 years old man presented with complaints of dysuria, dribbling, haematuria and suprapubic pain for 3 weeks. An X-ray of the pelvis showed a coiled up radio opaque shadow of telephone wire in the bladder region extending downwards which was removed by suprapubic cystostomy. Discussions: Bladder foreign body is not common. Plain radiograph is sufficient to diagnose and minimally invasive procedure is usually successful. In this case retrieval by cystostomy was done to avoid the risk of bladder and urethral injury. Conclusion: Introduction into the bladder may be through self-insertion, iatrogenic means or migration from adjacent organs. Extraction should be tailored according to the nature of the foreign body and should minimize bladder and urethral trauma. The possibility of an intravesical foreign body should be considered in any patient with chronic unexplained lower urinary tract symptoms. Bangladesh Journal of Urology, Vol. 18, No. 2, July 2015 p.94-97

Difficulties of patients and caregivers in performing clean intermittent catheterization: scoping review

Objective: To identify the main difficulties reported by patients and caregivers in the use of clean intermittent catheterization described in the scientific literature. Methods: Scoping review with studies published in Portuguese, English or Spanish, without date limit, in electronic databases and digital libraries, using descriptors and keywords. Results: 790 studies were identified, including 34 studies published between 1984 and 2019. The main difficulties reported in performing clean intermittent catheterization were related to catheter insertion, pain, discomfort, urethral trauma, public bathrooms with inadequate facilities, physical difficulties and lack of access to necessary inputs. Conclusion: The studies analyzed show the difficulties that patients who use clean intermittent catheterization and their caregivers face on a daily basis, which are related to intrinsic and extrinsic, institutional and governmental factors and can decrease satisfaction and adherence to rehabilitation programs bladder, with an impact on the quality of life of patients and their caregivers. Therefore, it highlights the need for health education for the proper teaching of performing clean intermittent catheterization, emphasizing the importance of the nurse’s role in this process.