Ureteric Rupture: Rare Complication of Inappropriate Urinary Bladder Catheterization

We have reported case of 71-year-old male with acute urinary retention due to gross prostatomegaly. Due to inappropriate catheterization, urinary bladder remained distended and ultimately caused left ureteric rupture. This article is peculiar as it shows that misplaced Foley's catheter may also lead to exceedingly rare complication of ureteric rupture and highlights importance of proper management of difficult catheterization which is otherwise considered a simple procedure.

Foley catheter tourniquet for uncontrollable extra-uterine placental hemorrhage: description of a novel surgical technique.

Introduction Hemorrhage from a partially or fully detached placenta with an advanced abdominal pregnancy can be profuse and catastrophic. The general approach to placenta management is removal of “all or nothing’’. In the event of acute hemorrhage, every attempt to achieve hemostasis quickly is critical. The Foley catheter has shown utility when used to control placental hemorrhage or as a temporary tourniquet applied around structures surrounding the implantation site to aid placental removal with minimal hemorrhage. We report use of the technique on four occasions with good surgical outcomes. Case Presentation We report a case of a 33 year-old primigravida admitted at term with an ultrasound diagnosis of breech presentation and placenta previa grade four. Her pre-operative clinical assessment however, raised suspicion of an abdominal pregnancy. At laparotomy, a live female infant was delivered from the extra-uterine gestation sac, weighing 3640g and with an Apgar score of 7 and 6 at one and 5 minutes respectively. Following delivery, there was profuse bleeding from the partially detached distal portion of the placenta that derived rich blood supply from the poorly accessible posterior pelvic wall. We applied a novel, simple and effective surgical technique for minimizing blood loss from the partially detached placenta using a Foley’s catheter tourniquet that was applied between the detached and still attached parts of the placenta. The tourniquet was left in situ and removed at laparotomy 4 days later. The placenta was not removed. The mother and baby did well postoperatively and were discharged after 10 and 21 days respectively in good condition. The surgical technique was similarly used in 3 additional cases with good clinical outcomes. Discussion Use of a Foley catheter as an intraoperative tourniquet has become accepted as a useful technique in obstetric and gynecological surgery. We describe a simple life saving technique of applying a Foley tourniquet across a partially detached placenta following an advanced extra-uterine pregnancy to control acute hemorrhage. Conclusion We recommend that surgeons keep in mind the option of intraoperative tourniquets when faced with uncontrollable bleeding as a short-term or medium-term temporizing measure.

Catheter knotting in a neonate

A 36-week preterm neonate with anal atresia and rectoperineal fistula was catheterized with a size 6F Foley’s catheter when she underwent anoplasty on the second day after birth. When the patient recovered from anesthesia, it was decided to remove the catheter. While the catheter was being removed, resistance was felt halfway through the procedure. Abdominal plain films revealed a catheter coiled in the pelvis. With copious lubricant injected into the bladder through the catheter and patient sedated, it was removed by manipulation alone using gentle traction (Figure 1). The infant had no bleeding at the urethral meatus and no obvious abnormality in urination during the 3-month of follow-up.

INTRA-VAGINAL MISOPROSTOL ALONE VS MISOPROSTOL IN COMBINATION WITH INTRA-CERVICAL FOLEY’S CATHETER FOR SECOND TRIMESTER ABORTION: A COMPARATIVE STUDY

Pregnancy termination in the second trimester is riskier than in the first. The primary objective is to create a more effective means of termination while also reducing induction time. To compare the efficacy, safety, and acceptability of intra-cervical foley's catheter with vaginal misoprostol versus vaginal misoprostol for second-trimester pregnancy termination. This clinical study involved 400 pregnant women who were scheduled to have their pregnancy terminated between 13 and 22 weeks of pregnancy for any reason. The enrolled women were divided into two categories: Category I (Misoprostol category): intra-cervical Foley’s catheter inserted with a standard regimen of moistened misoprostol tablets (400 g) 4 hourly inserted vaginally to a maximum of 5 doses; Category II (Combined category): intra-cervical Foley catheter inserted with a standard regimen of moistened misoprostol tablets (400 g) 4 hourly inserted vaginally to a maximum of 5 doses 4 hourly intra-vaginal injections were employed. Misoprostol was retained in the posterior fornix, and the dose was repeated every 4 hours until the catheter was removed, or until a maximum of five doses had been administered. The mean induction to abortion interval in the misoprostol category was 15.38 + 1.25 hours and 8.25 + 2.25 hours in the combination category, which was statistically significant (p= 0.001). The misoprostol category had a 94 percent success rate, while the combined category had a 97 percent success rate. The use of a combined intra-cervical foley's catheter and vaginal misoprostol to end a pregnancy in the second trimester is a novel, safe, effective, and acceptable procedure.

Early Outcome of Cold Knife Ablation and Diathermy Fulguration of Posterior Urethral Valve; A Comparative Study

Background: Posterior urethral valve (PUV) is the most common obstructive anomaly of the urethra. Urethral valves have a wide range of clinical and anatomical presentations and today most patients are diagnosed in the prenatal or early neonatal period. Cold knife and diathermy fulguration are two of the technique of PUV ablation. Objective: To find out early outcome of posterior urethral valve ablation between cold knife and diathermy fulguration. Methodology: This prospective comparative interventional study was conducted in the Department of Pediatric surgery in Dhaka Shishu Hospital (DSH), Dhaka. 54 patients with PUV, admitted for valve ablation during study period were included in this study. Patients were divided in to two group. Among them, 27 were in Group-A, whose PUV ablation were done by cold knife and 27 were in Group-B whose PUV ablation were done by diathermy fulguration. Successful ablation was confirmed under endoscopic vision as well as with the demonstration of good stream following supra pubic compression, at the end of the procedure. All patients were kept with 72 hours of urethral catheterization (All silicon self retaining Foley’s catheter according to body texture ) .Post PUV ablation pt. were given discharged with prophylactic antibiotics on 4th POD. Results: The mean age was found 18.37±16.13 months in cold knife ablation group and 12.70±11.03 months in diathermy fulguration group. Significant number (06/22.2%) of cases were associated with residual valve in diathermy fulguration group and non signicant number (301/3.7%) cases in cold knife ablation group . Significant number (04/14.8%) of cases were associated with post PUV ablation stricture urethra also in diathermy fulguration group and no stricture was found in cold knife ablation group . Significant hematuria. was present in 2(7.4%) in cold knife ablation group and 1(3.7%) in diathermy fulguration group. Conclusion: This study concludes that use of cold knife in case of ablation of PUV causes less post ablation obstruction (residual valve and stricture urethra) than using diathermy fulguration and can be regarded a safe and better option for PUV treatment.

TO COMPARE THE EFFICACY OF INTRA CERVICAL FOLEY’S CATHETER WITH INTRA CERVICAL DINOPROSTONE GEL IN CERVICAL RIPENING FOR THE SUCCESSFUL INDUCTION OF LABOR

Background: This study compared the efficacy and safety of the intracervical Foley catheter and dinoprostone insert for cervical ripening to achieve successful labor induction. Methods: This was a randomized controlled study conducted. Group A received Dinoprostone cervical gel 0.5mg instilled in the cervical canal. Maximum of three doses (1.5mg dinoprostone) could be administered 6 hours apart. Patients randomized to group B were subjected to Foleys catheter insertion. Primary efficacy parameter was change in Bishops score as compared to baseline. Conclusion: Our study showed that for pre induction cervical ripening there was no difference in efficacy between intracervical Foleys catheter and PGE2 gel. Keywords: Foleys catheter, Induction of labour, Prostaglandins

Various modalities of induction of labour and its feto-maternal outcomes: An observational study

: In order for induction to be successful, it should result in labour with adequate uterine contraction and progressive dilatation of cervix with the outcome of a vaginal delivery with minimal risk to both mother and foetus. Primary outcome of the current study was to compare various modalities of Induction of Labour, alone or in combination & to evaluate the different outcomes of mother and baby.: History, general, obstetrical, vaginal examination to record Modified Bishop score, basic investigations and recent obstetric ultrasound was noted of 200 pregnant mothers and the results were analyzed. Foetal monitoring was done in all except those with confirmed IUFD cases. Methods used were Dinoprostone, Misoprostol, Oxytocin, Amniotomy and Mechanical Dilatation with Foley’s catheter; single or in combination with each other.: Among the 200 mothers, 118(59%) delivered vaginally and 82 (41%) mothers underwent LSCS. Dinoprostone gel was the dominant method used followed by misoprostol and oxytocin respectively. NICU admissions were required in 21.7%, 25,8% & 33.3% of the mothers who were induced with Dinoprostone, Misoprostol and Oxytocin respectively. 14 babies were diagnosed with IUFD, all delivered vaginally, out of which 10 were induced with misoprostol and 4 were induced with mechanical dilatation. Majority of the patients who underwent induction with dinoprostone alone delivered by LSCS (63.4%) but Dinoprostone with ARM & oxytocin for induction had a better outcome. Induction with Dinoprostone followed by misoprostol lead to more LSCS than SVD and there were 1%(2 babies) of perinatal mortality due to Meconium Aspiration Syndrome.: Misoprostol and Mechanical induction were the most preferred method in cases of IUFD. Induction with a combination of Dinoprostone with ARM or Oxytocin lead to more vaginal delivery than Dinoprostone alone, so this should be preferred. Induction with Dinoprostone followed by misoprostol lead to more LSCS and perinatal mortality so a combination of them should be given cautiously.

Median Duration of Hospital Stay after Early Removal of Foley’s Catheter among Patients Undergoing Transurethral Resection of Prostate: A Descriptive Cross-sectional Study

Introduction: Transurethral resection of the prostate requires a catheter in situ post-surgery. Early removal of catheter can reduce the length of hospital stay reducing the healthcare cost. It can also reduce the risk of infection due to prolonged catheterization. Our aim was to determine the median duration of hospital stay after early foley’s removal after transurethral resection of prostate among patients in a tertiary care hospital. Methods: A descriptive cross-sectional study was done in a tertiary care hospital from July 2019 to December 2020 and ethical clearance was obtained from the institutional review committee. Foley’s catheter were removed on the first post-operative day, who met the criteria of catheter removal. Convenience sampling was done. After foley’s removal patients were observed for spontaneous voiding. Patients with complications like hematuria, clot retention, urinary retention were recatherized. The data were expressed in mean with standard deviation, median with interquartile range and frequency and percentage as applicable using Statistical Package for the Social Sciences version 16. Results: Out of the 150 participants included in the study, the median duration of hospital stay after the early removal of foley's catheter was 3 days (interquartile range 2-4 days). A total of 20 (13.3%) patients underwent recatherization. Nine (6%) patients had to be recatheterized due to clot retention, and 11 (7.3%) were due to urinary retention. Conclusions: This study showed that the median duration of hospital stay after early removal of foley's catheter among patients undergoing transurethral resection of the prostate was similar to studies done in national/international settings.