Intraoperative ureter identification with a novel fluorescent catheter

Iatrogenic ureteral injuries (IUI) occur in 0.5–1.3% of cases during abdominal surgery. If not recognized intraoperatively, IUI increase morbidity/mortality. A universally accepted method to prevent IUI is lacking. Near-infrared fluorescent imaging (NIRF), penetrating deeper than normal light within the tissue, might be useful, therefore ureter visualization combining NIRF with special dyes (i.e. IRDye 800BK) is promising. Aim of this work is to evaluate the detection of ureters using stents coated with a novel biocompatible fluorescent material (NICE: near-infrared coating of equipment), during laparoscopy. female pigs underwent placement of NICE-coated stents (NS). NIRF was performed, and fluorescence intensity (FI) was computed. Successively, 0.15 mg/kg of IRDye 800BK was administered intravenously, and FI was computed at different timepoints. Ureter visualization using NS only was further assessed in a human cadaver. Both methods allowed in vivo ureter visualization, with equal FI. However, NS were constantly visible whereas IRDye 800BK allowed visualization exclusively during the ureteral peristaltic phases. In the human cadaver, NS provided excellent ureter visualization in its natural anatomical position. NS provided continuous ureteral visualization with similar FI as the IRDye 800BK, which exclusively allowed intermittent visualization, dependent on ureteral peristalsis. NS might prove useful to visualize ureters intraoperatively, potentially preventing IUI.

GAMBARAN KEJADIAN INFEKSI SALURAN KEMIH PADA IBU HAMIL DI BADAN RUMAH SAKIT UMUM TABANAN

Background:Urinary tract infection (UTI) is an inflammatory reaction of urothelium cells that line the urinary tract due to the proliferation of microorganisms. During pregnancy, dilatation occurs on the ureter and there is a decrease in ureteral peristalsis which increases the risk of bacterial growth. Aims:The purpose of this study was to determine the incidence of UTI in pregnant women at BRSU Tabanan. Methods:This study was a descriptive study with population of 160 people and sample of 32 people selected by non-probability sampling technique with accidental sampling method.Examination of respondent's urine sample was done by urine culture with standard loop method. Results:The result of this study indicate 19% of pregnant women had calculated colony 105 CFU/ml which can be indicated as UTI.Conclusion:From the result of the study, it was concluded that the incidence of UTI was most prevalent in pregnant women of the age group 20-35 years, pregnant women in the third trimester of pregnancy, in pregnant women with sexual activity 1x/week, in pregnant women with elementary and high school education, and in pregnant women who change underwear twice or more per day and clean the external urinary tract from the front to the back. Keywords :Urinary Tract Infection (UTI), pregnancy

Three-Dimensional Numerical Simulations of Peristaltic Contractions in Obstructed Ureter Flows

Ureteral peristalsis can be considered as a series of waves on the ureteral wall, which transfers the urine along the ureter toward the bladder. The stones that form in the kidney and migrate to the ureter can create a substantial health problem due to the pain caused by interaction of the ureteral walls and stones during the peristaltic motion. Three-dimensional (3D) computational fluid dynamics (CFD) simulations were carried out using the commercial code ansys fluent to solve for the peristaltic movement of the ureter, with and without stones. The effect of stone size was considered through the investigation of varying obstructions of 5%, 15%, and 35% for fixed spherical stone shape. Also, an understanding of the effect of stone shape was obtained through separate CFD calculations of the peristaltic ureter with three different types of stones, a sphere, a cube, and a star, all at a fixed obstruction percentage of 15%. Velocity vectors, mass flow rates, pressure gradients, and wall shear stresses were analyzed along one bolus of urine during peristalsis of the ureteral wall to study the various effects. It was found that the increase in obstruction increased the backflow, pressure gradients, and wall shear stresses proximal to the stone. On the other hand, with regard to the stone shape study, while the cube-shaped stones resulted in the largest backflow, the star-shaped stone showed highest pressure gradient magnitudes. Interestingly, the change in stone shape did not have a significant effect on the wall shear stress at the obstruction level studied here.