DOCSLIB.ORG

Urinary Catheterization of the Adult Female

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Urinary Catheterization of the Adult Female ClInICal PRaCTICe PRoCeduRe Urinary Catheterization of the Adult Female Introduction nique of aseptic catheterization should insert a catheter. The professional should be familiar with Urinary catheterization is an invasive medical the facility or practice policy and standard precau- procedure (referred to as “in and out” catheterization tions for urethral catheterization. Prior to insertion, or straight catheterization) that involves the inser- an order from a health care provider should be veri- tion of a single-lumen urinary catheter through the fied. The patient and the patient’s family and/or urethra and into the bladder for urine drainage or caregiver, if present, should be informed of the rea- collection. The catheter is removed once the bladder son for catheterization and what to expect in terms of is drained. Catheterization is performed in all care discomfort. Other considerations prior to beginning settings, but more frequently, in acute care hospitals. the procedure are as follows: Catheterization is a common procedure performed • Determine any potential allergies (e.g., latex, by urology nurses in an outpatient setting or urologic betadine). Note any pertinent past medical and practice. Catheterization is often performed before, urologic history that may impair passage of the during, or after certain types of surgery; following catheter, including urethral strictures (rare), trauma; and during childbirth. Table 1 lists indica- pelvic organ prolapse and prior bladder, urethral tions for urinary catheterization. It may also be per- or pelvic surgery or radiation, or any pathologi- formed to deliver liquids used for treatment (e.g., cal condition that may impair passage of the chemo therapeutic agents) or for the diagnosis of catheter. bladder conditions (e.g., X-rays, urodynamic tests). • Assess the patient’s ability to cooperate with the This Clinical Practice Procedure provides informa- procedure (e.g., level of consciousness, ability to tion for the health care professional on the sterile keep knees separated during procedure), and insertion of a non-dwelling catheter through the ure- history of recent and/or difficult catheteriza- thra for bladder drainage in an adult female patient. tions. • Consider obtaining assistance (e.g., two-person Preparation insertion, mechanical aids, additional lighting) to facilitate appropriate visualization and to Female urethral catheterization is generally sim- ensure aseptic insertion technique in high-risk ple, straightforward, and uncomplicated, allowing populations (e.g., patients who are obese or with for ease of catheterization, whether inserting any dementia/behavioral issues). urethral catheter. The length of the female urethra is • Challenging aspect of female urethral cathe - approximately 4 cm long, 6 to 8 mm in diameter terization is localization of the urinary mea- (Figure 1, Female Urethra), slightly curved, extends tus. from the bladder neck to the vaginal vestibule, and ends between the clitoris and vagina (Figure 2, Female External Genitalia). Catheter methods and Task Force Chair characteristics are found in “Teaching Tool: Methods Diane K. Newman, DNP, ANP-BC, FAAN, BCB-PMD and Types of Urinary Catheters Used for Indwelling or Intermittent Catheterization.” The most challeng- Task Force Contributors Susanne A. Quallich, PhD, ANP-BC, NPC, CUNP, FAUNA, ing aspect of female catheterization is locating the FAANP meatal orifice, even more difficult in an obese Margaret A. Hull, DNP, WHNP-BC woman with a large girth or in women with anatom- Gina Powley, MSN, ANP-BC ical differences (e.g., intravaginal urinary meatus) or Katie Wall, MSN, FNP-C post-menopausal vaginal atrophy. If the patient has an artificial urinary sphincter, the implant must be Peer Review opened before catheterization. Urologic Nursing and the Society of Urologic Nurses and If catheterization is being performed in an insti- Associates appreciate the assistance of the individuals listed tution (e.g., acute care, nursing home) or in the below who contributed to this project by providing com- patient’s home by a visiting nurse, aseptic technique ments and direction during the peer review process. is maintained throughout the insertion (see Their reviews do not necessarily imply endorsement of these “Teaching Tool: Methods and Types of Urinary documents. Catheters Used for Indwelling or Intermittent Catheterization”) because failure to properly adhere Laura R. Flagg, DNP, ANP-BC, CUNP to strict aseptic technique when catheterizing the David Martin Julien, DNP, FNP-C, CUNP bladder has been linked to infections and sepsis. Michelle J. Lajiness, MSN, FNP-BC, FAUNA Only health care professionals trained in the tech- Donna L. Thompson, MSN, CRNP, FNP-BC, CCCN-AP UROLOGIC NURSING / March-April 2021 / Volume 41 Number 2 65 Clinical Practice Procedure Table 1. Figure 1. Indications for Urinary Catheterization Female Urethra • Post-operative urinary retention. • To obtain a sterile urine specimen. • Relieve urinary obstruction. • To assess residual urine in the bladder after voiding (if a bladder scanner is not available). • Suspected incomplete bladder emptying/urinary retention in patients with neurogenic lower urinary tract dysfunction causing incomplete bladder emptying, detrusor-sphincter dyssynergia, underactive bladder, or atonic bladder, which leads to incomplete bladder emptying or urinary retention. Neurological conditions include multiple sclerosis, Parkinson’s disease, stroke, diabetes mellitus, spinal bifida, spinal tumors, cerebral palsy, multiple system atrophy, spinal-cord injury, and motor neuron disease. Source: Courtesy of Diane K. Newman, DNP. • Instillation of chemotherapeutic drugs, antibiotics in patients with recurrent urinary tract infections. • Irrigation of blood clots (passive irrigation). Figure 2. • Chronic urinary retention, inability to empty any Female External Genitalia amount of bladder volume due to anatomical or functional bladder outlet obstruction. • Preferred treatment option for urethral stricture dilation and catheterization method of continent urinary diversions. • To empty bladder before and during surgery, and before certain diagnostic examinations. • Use of epidural anesthesia during labor and delivery. • Postnatal urinary retention. • Following procedures used to treat urinary urgency and frequency (e.g., Botulinum toxin injections to the bladder). • Acute bladder outlet obstruction (e.g., gross hematuria, pelvic organ prolapse, strictures). • Administration of drugs directly into the bladder (e.g., chemotherapeutic medication to treat bladder cancer). Source: Courtesy of Diane K. Newman, DNP. equipment • If unsure about size, always start with a standard 14 Fr and increase diameter as Assemble all equipment before beginning proce- needed. dure. • The use of an anesthetic gel is usually not nec- • Lighting as needed. Consider use of a flashlight essary because the main benefit may be from the to assist in visualization of meatus. lubrication as opposed to the anesthetic effect • Disposable clean medical gloves. (Averch et al., 2014). But its use should be con- • Waterproof pad. sidered if this is the patient’s first catheteriza- • Catheter insertion trays (kit) may differ, but most tion or if a difficult catheterization is suspected, include cleaning solution incorporated into an especially if actual discomfort with catheter applicator or swab or added to cotton balls, sterile insertion is anticipated (see “Clinical Practice fenestrated drape with opening in the center, sec- Procedure: Insertion of an Indwelling Urethral ond square-shaped drape may also be available, Catheter in the Adult Female”). sterile gloves, single-use lubricant, 14 Fr single- • Check for lidocaine sensitivity if using a lumen catheter, and measuring container for lubricant containing lidocaine. urine (Figure 3, Catheterization Insertion Tray). • Consider need to assess patient’s bladder for • If the patient has been identified as having fullness (e.g., scan bladder). an allergy to latex, use a 100% silicone catheter. 66 UROLOGIC NURSING / March-April 2021 / Volume 41 Number 2 Urinary Catheterization in the Adult Female Figure 3. Figure 4. Catheterization Insertion Tray Draping Perineum Photo: Courtesy of Diane K. Newman, DNP. Photo: Courtesy of Diane K. Newman, DNP. Procedure • Hygiene before aseptic catheterization re- moves secretions, urine, and feces that Provide as much privacy for the patient as possible. could contaminate the sterile field. • Identify patient using two identifiers (name, • Remove and discard soiled gloves. date of birth) according to facility/practice poli- Set up sterile tray for catheter insertion and cy. maintain a sterile field throughout the catheteriza- • Perform hand hygiene and put on clean medical tion procedure. If there is a break in sterile tech- gloves. nique during preparation or the actual procedure, • Raise bed and position lighting as necessary to restart process with new insertion tray, sterile provide adequate visualization of perineum. gloves. • Assist patient into a dorsal recumbent position • Place the tray so it is more easily accessible (e.g., with knees drawn up and separated in a frog on a mayo tray, bedside table, between the position or with feet flat on bed. patient’s legs), within reach so as to minimize • Sim’s (upper leg drawn up flexed at knee chance of contamination. The tray can be used and hip [supported with pillows, if neces- as a container for urine collection. sary], knee to chest) or lateral position can • Open the outer
Load more

Recommended publications
  • A Clever Technique for Placement of a Urinary Catheter Over a Wire
    [Downloaded free from http://www.urologyannals.com on Monday, August 24, 2015, IP: 107.133.192.199] Original Article A clever technique for placement of a urinary catheter over a wire Joel E. Abbott, Adam Heinemann, Robert Badalament, Julio G. Davalos1 Department of Urology, St. John Providence, Michigan State University, Detroit, MI 48071, 1Chesapeake Urology Associates, University of Maryland, Baltimore, MD 21061, USA Abstract Objective: The objective was to present a straightforward, step-by-step reproducible technique for placement of a guide-wire into any type of urethral catheter, thereby offering a means of access similar to that of a council-tip in a situation that may require a different type of catheter guided over a wire. Materials and Methods: Using a shielded intravenous catheter inserted into the eyelet of a urinary catheter and through the distal tip, a “counsel-tip” can be created in any size or type of catheter. Once transurethral bladder access has been achieved with a hydrophilic guide-wire, this technique will allow unrestricted use of catheters placed over a wire facilitating guided catheterization. Results: Urethral catheters of different types and sizes are easily advanced into the bladder with wire-guidance; catheterization is improved in the setting of difficult urethral catheterization (DUC). Cost analysis demonstrates benefit overuse of traditional council-tip catheter. Conclusion: Placing urinary catheters over a wire is standard practice for urologists, however, use of this technique gives the freedom of performing wire-guided catheterization in more situations than a council-tip allows. This technique facilitates successful transurethral catheterization over wire in the setting of DUC for all catheter types and styles aiding in urologic management of patients at a cost benefit to the health care system.
    [Show full text]
  • CMS Manual System Human Services (DHHS) Pub
    Department of Health & CMS Manual System Human Services (DHHS) Pub. 100-07 State Operations Centers for Medicare & Provider Certification Medicaid Services (CMS) Transmittal 8 Date: JUNE 28, 2005 NOTE: Transmittal 7, of the State Operations Manual, Pub. 100-07 dated June 27, 2005, has been rescinded and replaced with Transmittal 8, dated June 28, 2005. The word “wound” was misspelled in the Interpretive Guidance section. All other material in this instruction remains the same. SUBJECT: Revision of Appendix PP – Section 483.25(d) – Urinary Incontinence, Tags F315 and F316 I. SUMMARY OF CHANGES: Current Guidance to Surveyors is entirely replaced by the attached revision. The two tags are being combined as one, which will become F315. Tag F316 will be deleted. The regulatory text for both tags will be combined, followed by this revised guidance. NEW/REVISED MATERIAL - EFFECTIVE DATE*: June 28, 2005 IMPLEMENTATION DATE: June 28, 2005 Disclaimer for manual changes only: The revision date and transmittal number apply to the red italicized material only. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents. II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual not updated.) (R = REVISED, N = NEW, D = DELETED) – (Only One Per Row.) R/N/D CHAPTER/SECTION/SUBSECTION/TITLE R Appendix PP/Tag F315/Guidance to Surveyors – Urinary Incontinence D Appendix PP/Tag F316/Urinary Incontinence III. FUNDING: Medicare contractors shall implement these instructions within their current operating budgets. IV. ATTACHMENTS: Business Requirements x Manual Instruction Confidential Requirements One-Time Notification Recurring Update Notification *Unless otherwise specified, the effective date is the date of service.
    [Show full text]
  • Vocabulario De Morfoloxía, Anatomía E Citoloxía Veterinaria
    Vocabulario de Morfoloxía, anatomía e citoloxía veterinaria (galego-español-inglés) Servizo de Normalización Lingüística Universidade de Santiago de Compostela COLECCIÓN VOCABULARIOS TEMÁTICOS N.º 4 SERVIZO DE NORMALIZACIÓN LINGÜÍSTICA Vocabulario de Morfoloxía, anatomía e citoloxía veterinaria (galego-español-inglés) 2008 UNIVERSIDADE DE SANTIAGO DE COMPOSTELA VOCABULARIO de morfoloxía, anatomía e citoloxía veterinaria : (galego-español- inglés) / coordinador Xusto A. Rodríguez Río, Servizo de Normalización Lingüística ; autores Matilde Lombardero Fernández ... [et al.]. – Santiago de Compostela : Universidade de Santiago de Compostela, Servizo de Publicacións e Intercambio Científico, 2008. – 369 p. ; 21 cm. – (Vocabularios temáticos ; 4). - D.L. C 2458-2008. – ISBN 978-84-9887-018-3 1.Medicina �������������������������������������������������������������������������veterinaria-Diccionarios�������������������������������������������������. 2.Galego (Lingua)-Glosarios, vocabularios, etc. políglotas. I.Lombardero Fernández, Matilde. II.Rodríguez Rio, Xusto A. coord. III. Universidade de Santiago de Compostela. Servizo de Normalización Lingüística, coord. IV.Universidade de Santiago de Compostela. Servizo de Publicacións e Intercambio Científico, ed. V.Serie. 591.4(038)=699=60=20 Coordinador Xusto A. Rodríguez Río (Área de Terminoloxía. Servizo de Normalización Lingüística. Universidade de Santiago de Compostela) Autoras/res Matilde Lombardero Fernández (doutora en Veterinaria e profesora do Departamento de Anatomía e Produción Animal.
    [Show full text]
  • Interventional Radiology and Interventional Endoscopy Practical Applications for Veterinary Medicine
    Interventional Radiology and Interventional Endoscopy Practical Applications for Veterinary Medicine Megan Morgan, VMD, DACVIM Marnin Forman, DVM, DACVIM This lecture is sponsored by… Outline – Background on Interventional Radiology (IR) and Interventional Endoscopy (IE) – IR and IE in the treatment of Urolithiasis – IR and IE in the treatment of Urinary incontinence – IR and IE in the treatment of Tracheal collapse – IR and IE in the treatment of Urinary obstructions IR and IE-Background • What is Interventional Radiology (IR)? – A specialty that utilizes image guidance to perform minimally invasive procedures to diagnose and treat disease. Thoracic radiograph of a patient with a tracheal stent 4 IR and IE-Background • What is Interventional Endoscopy (IE)? – A specialty that utilizes endoscopic guidance to perform minimally invasive procedures to diagnose and treat disease. Cystoscopic image of a patient with bilateral ectopic ureters 5 IR and IE-Background • Image guidance tools - Fluoroscopy - Ultrasound - Digital radiography - CTA - MRA Seldinger Technique • Minimally invasive access http://www.accessmedicine.ca - Natural orifice - Seldinger technique 6 IR and IE-Background • IR and IE goals – Palliation of clinical signs – Adjuvant therapy – Definitive treatment Fluoroscopic image of a retrograde contrast urethrocystogram in a patient with urethral transitional cell carcinoma 7 IR and IE-Background . IR and IE equipment – Guidewires • Most common sizes –0.035 inch--fits through an 18 gauge needle –0.018 inch--fits through a 22 gauge needle –0.025 inch--fits through a 20 gauge needle – Specialized catheters • Categorized by the type of tip Vascular access catheters IR and IE-Background . IR and IE equipment – Sheaths • Sized by the size of the catheter accepted by the sheath • The actual diameter of the sheath is larger than the listed sheath size Vascular access sheath – Stents • Multiple material types • Wire mesh vs.
    [Show full text]
  • Preventing Catheter Associated Urinary Tract Infections (CAUTI): What You Need to Know About Urinary Catheterization
    Preventing Catheter Associated Urinary Tract Infections (CAUTI): What You Need to Know About Urinary Catheterization Presented by Mary W. Sears, RN, BA, CWOCN with Capital Nursing Education Objectives • List two (2) advantages of intermittent catheterization over indwelling catheterization • List two (2) specific clinical conditions that are considered acceptable for the placement of an indwelling urinary catheter Capital Nursing Education ©2015. All rights reserved. WOCN Best Practices Can be ordered from WOCN Bookstore @ wocn.org Capital Nursing Education ©2015. All rights reserved. Urinary Catheterization Should only be undertaken when all other methods of urinary system management have been deemed inappropriate or have failed. Short or long-tem usage-depends on cause of urinary dysfunction (Newman-2008) • Indwelling • Intermittent – Urethral – Suprapubic Capital Nursing Education ©2015. All rights reserved. Suprapubic Catheterization • Definition: • Inserted surgically through the anterior abdominal wall 2 cm above pubic bone into the bladder • Allows for continuous drainage • Indications: – Short term use following surgery – Alternative to chronic indwelling catheter – Option for long-term catheterization – To avoid urethral damage in men Capital Nursing Education ©2015. All rights reserved. Suprapubic Catheters • Advantages: – Decreases risk of contamination from organisms from fecal material – Decreases risk of infection due to less antimicrobial content on abdomen vs perineum • Potential problems: – Urine leakage – Skin erosion – Hematoma – Catheter reinsertion difficulty Capital Nursing Education ©2015. All rights reserved. Suprapubic Catheter Insertion/Reinsertion • Initial insertion by physician or specially trained urology specialist • New suprapubic tract takes 10 days to 4 weeks to become established • Reinsertion by appropriately trained health care professional when tract is well established • Interval can range from 2 to 10 weeks WOCN Best Practice (2009) Capital Nursing Education ©2015.
    [Show full text]
  • Female Urethral Catheterization
    T h e new england journal o f medicine videos in clinical medicine Female Urethral Catheterization Rafael Ortega, M.D., Linda Ng, M.D., Pavan Sekhar, B.S., and Michael Song, M.A. Introduction Female urethral catheterization, the insertion of a catheter through the urethra into From the Departments of Anesthesiology the urinary bladder to permit drainage of urine, is a fundamental skill for the prac- and Urology, Boston University Medical Center, Boston. Address reprint requests ticing health care professional. to Dr. Ortega at the Department of Anes- thesiology, Boston University Medical Center, 88 E. Newton St., Boston, MA Indications 02118, or at [email protected]. Female urethral catheterization is indicated for both therapeutic and diagnostic pur- N Engl J Med 2008;358:e15. poses. It permits effective bladder drainage in patients with acute or chronic urinary Copyright © 2008 Massachusetts Medical Society. retention. A urinary catheter may be used to instill medication for local intravesical therapy or for irrigation to remove blood and clots from the urinary bladder. Urethral catheterization facilitates diagnosis in several circumstances, such as ob- taining sterile urine specimens for urinalysis, measuring residual volumes after void- ing, instilling contrast media for imaging procedures, and monitoring the urinary output of critically ill patients.1 Contraindications Urethral injury can be a contraindication to catheterization. Urethral injuries are rare and most commonly result from pelvic fractures. If blood is found at the urethral meatus, urethral or bladder neck injury should be considered. If there is any ques- tion of injury, genital and rectal exams should be performed and retrograde urethrog- raphy should be considered before catheterization is attempted; consultation with a specialist before catheterization is prudent.
    [Show full text]
  • Self-Catheterization of Urinary Bladder Complicated with Extraperitoneal Abscess That Mimics an Infected Bladder Diverticulum
    Urological Science 25 (2014) 137e138 Contents lists available at ScienceDirect Urological Science journal homepage: www.urol-sci.com Case report Self-catheterization of urinary bladder complicated with extraperitoneal abscess that mimics an infected bladder diverticulum Yu-Cing Juho, Seng-Tang Wu, En Meng, Chih-Wei Tsao, Tai-Lung Cha, Dah-Shyong Yu, * Guang-Huan Sun, Cheng-Ping Ma, Sun-Yran Chang, Shou-Hung Tang Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC article info abstract Article history: For patients who are suffering from neurogenic lower urinary tract dysfunction, intermittent urinary Received 4 April 2014 catheterization is an efficient way to empty the bladder.1 However, the method may result in various Received in revised form complications. Herein we present a rare complication of extraperitoneal abscess owing to intermittent 17 August 2014 urinary catheterization in a 62-year-old male who had cervical spine injury and was treated with Accepted 18 August 2014 intermittent urethral catheterization for neurogenic lower urinary tract dysfunction. Treatment and a Available online 28 October 2014 literature review are also described. Copyright © 2014, Taiwan Urological Association. Published by Elsevier Taiwan LLC. Keywords: bladder perforation Open access under CC BY-NC-ND license. extraperitoneal abscess intermittent urinary catheterization neurogenic bladder 1. Introduction Repeated urinary tract infections were noted a few times each year after the patient started to receive CIC. It was only a few days Clean intermittent self-catheterization (CIC) of the urinary before coming to our hospital that he began experiencing low- bladder, proposed by Dr Lapedes in early 1972, is accepted as the grade fever as well as a markedly poor appetite.
    [Show full text]
  • Assessment of the Renal/Urinary System
    Assessment of the Renal/Urinary System Professor Minodora Mazur Chisinau 2019 Why person has 2 eyes or 2 ears? And only one nose? How many kidneys does the person have? Urinary system • Kidneys • Ureters • Urinary bladder • Urethra Kidneys • Paired organs • Located retroperitoneally on the posterior wall of the abdomen from T12-L3 • The average adult kidney weighs 4.5oz = 125-150 gr • The right kidney sits is lower in the abdomen due to liver placement • An adrenal gland sits are on top of each kidney Kidney Anatomy Each kidney has two parts • The renal medulla is the inner portion – consists of renal pyramids which are collecting ducts that drain into renal pelvis – Once urine leaves the renal pelvis the composition or amount of urine does not change • The Cortex is the outer portion – contains nephrons Nephron • Each kidney has approximately 1 million nephrons • If the function is less than 20% replacement therapy is usually initiated • The nephron is responsible for the initial formation of urine Glomerulus Kidney functions • Urine formation • Excretion of waste products • Regulation of electrolytes • Regulation of acid-base balance • Control of water balance • Control BP • Regulation of RBC production • Synthesis of vitamin D to active form • Secretion of prostaglandins • Regulation of calcium and phosphorus balance Urine Formation • Urine is formed in the nephrons in a three step process – Glomerular filtration – Tubular reabsorption – Tubular secretion • Glomerular Filtration produces ultrafiltrate which enters the tubules • Selective
    [Show full text]
  • Clinical and Functional Anatomy of the Urethral Sphincter
    Review Article International Neurourology Journal Int Neurourol J 2012;16:102-106 http://dx.doi.org/10.5213/inj.2012.16.3.102 pISSN 2093-4777 · eISSN 2093-6931 INJ Clinical and Functional Anatomy of the Urethral Sphincter Junyang Jung, Hyo Kwang Ahn, Youngbuhm Huh Department of Anatomy, Kyung Hee University School of Medicine, Seoul, Korea Continence and micturition involve urethral closure. Especially, insufficient strength of the pelvic floor muscles including the urethral sphincter muscles causes urinary incontinence (UI). Thus, it is most important to understand the main mechanism causing UI and the relationship of UI with the urethral sphincter. Functionally and anatomically, the urethral sphincter is made up of the internal and the external sphincter. We highlight the basic and clinical anatomy of the internal and the external sphinc- ter and their clinical meaning. Understanding these relationships may provide a novel view in identifying the main mechanism causing UI and surgical techniques for UI. Keywords: Urethral sphincters; Pudendal nerve; Autonomic nervous system; Urinary incontinence; Urination INTRODUCTION tomical damage to the ligaments, facial support, and pelvic floor musculature, including the levator ani [8]. The pudendal nerve The urethral sphincter is crucial for the maintenance of urinary innervating the EUS is susceptible to injury during vaginal birth continence [1,2]. The urethral sphincter refers to one of the fol- because it travels between the sacrospinous and sacrotuberous lowing muscles [3]: 1) the internal urethral sphincter (IUS), ligaments [9]. In this article, we discuss the basic and clinical which consists of smooth muscle and is continuous with the anatomy of the urethral sphincter and the relationship between detrusor muscle and under involuntary control, and 2) the ex- the urethral sphincter and UI.
    [Show full text]
  • Original Article Influence of Bladder Management on Epididymo-Orchitis
    Spinal Cord (2006) 44, 165–169 & 2006 International Spinal Cord Society All rights reserved 1362-4393/06 $30.00 www.nature.com/sc Original Article Influence of bladder management on epididymo-orchitis in patients with spinal cord injury: clean intermittent catheterization is a risk factor for epididymo-orchitis JH Ku1, TY Jung1, JK Lee1, WH Park2 and HB Shim*,1 1Department of Urology, Seoul Veterans Hospital, Seoul, Republic of Korea; 2Department of Urology, College of Medicine, Inha University, Seoul, Republic of Korea Study design: Retrospective study, based on cases of spinal cord injury (SCI). Objectives: To establish hazard ratios for risk of epididymo-orchitis in SCI. Setting: South Korea. Methods: A total of 140 male patients injured before 1987 were eligible for this investigation and have been followed up on a yearly basis from January 1987 to December 2003. Results: The average age at which the lesion occurred was 24.8 years old (range, 18–53). The average time since SCI was 16.9 years (range, 1–37). A total of 34 lesions (24.3%) were complete and 106 (75.7%) were incomplete. Over the 17 years, 39 patients (27.9%) were diagnosed with epididymo-orchitis. Epididymo-orchitis was more common for patients with a history of urethral stricture (66.7 versus 25.2%, P ¼ 0.014). We also found that epididymo-orchitis was more common for patients on clean intermittent catheterization (CIC) than with indwelling urethral catheterization (42.2% versus 8.3%, P ¼ 0.030). In multivariate analysis, patients on CIC had a 7.0-fold higher risk (odds ratio, 6.96; 95% confidence interval, 1.26–38.53; P ¼ 0.026); however, a history of urethral stricture lost statistical significance (P ¼ 0.074).
    [Show full text]
  • The Role of the External Sphincter
    PARAPLEGIA REFERENCES Ross, J. COSBIE, GIBBON, N. O. K. & DAMANSKI, M. (1967). B.J.S. 54, NO. 7. STAMEY, T. (1968). J. Urol. 97, (May). VINCENT, S. A. (1959). Ulster med. Jour. 28, 176. VINCENT, S. A. (1960). Lancet, 2, 292. VINCENT, S. A. (1964). Dev. Med. and Child Neurol. 6, 23. VINCENT, S. A. (1966a). Lancet, Sept., 631-632. VINCENT, S. A. (1966b). Bio-Engineering, Sept., p. 1. THE ROLE OF THE EXTERNAL SPHINCTER By J. COSBIE Ross Director of Urological Studies, University of Liverpool Introduction. It must be acknowledged that as yet no one knows the precise role of the external sphincter and there should, by right, be a question mark after the word 'sphincter'. The problem is much more complex and obscure than the simple, easily understood mechanism of the anal sphincter. However, there is much that is already known, and perhaps recent work has shed some light on the problem. First, the traditional view. In the 32nd Edition of Gray's Anatomy (1958), the description is as follows. 'The sphincter urethrae surrounds the membranous portion of the urethra, and lies deep to the inferior fascia of the urogenital diaphragm. Its superficial or inferior fibres arise in front from the transverse perineal ligament and from the neighbouring fascia. They pass backwards on each side of the urethra and converge on the perineal body for their insertion. Its deep fibres, some of which arise from the fascial sheath of the pudendal vessels and pass medially, form a continuous circular investment for the membranous urethra.' Actions. 'The muscles of both sides act together as a sphincter, compressing the membranous part of the urethra.
    [Show full text]
  • Methods and Types of Urinary Catheters Used for Indwelling Or Intermittent Catheterization
    TEACHING TOOL Methods and Types of Urinary Catheters Used for Indwelling or Intermittent Catheterization Diane K. Newman, DNP, ANP-BC, FAAN, BCB-PMD Figure 1. © 2021 Society of Urologic Nurses and Associates Color-Coded Catheter Size Chart Newman, D.K. (2021). Methods and types of urinary catheters used for indwelling or intermittent catheteriza- tion. Urologic Nursing, 41(2), 111-117. https://doi.org/ 10.7257/1053-816X.2021.41.2.111 There are various urinary catheterization techniques, and unfortunately, it is not always clear what is exactly meant by a certain technique that is mentioned in the lit- erature (Vahr et al., 2013). This Teaching Tool provides descriptive information on urinary catheterization meth- ods, characteristics of catheter type, and material, specific uses (indwelling urinary catheter, intermittent catheteri- zation), and considerations. Catheter Characteristics Urinary catheters can be divided into two categories: indwelling (referred to as indwelling urinary catheters [IUCs] or Foley catheters) or inserted as a single catheteri- zation (referred to as “straight” or “in-and-out,” or inter- mittent catheterization [IC]) (Newman, 2017; Newman et al., 2018). This section outlines the most commonly used catheters for IUCs and IC. Urinary catheters come in varying sizes, configura- tions and material. There is insufficient evidence to deter- Source: Courtesy of Robin Noel. mine whether there is an optimal catheter type for those requiring either short-term (Lam et al., 2014) or long-term Catheter size: The accepted measurement unit for bladder drainage (Jahn et al., 2012). catheters is the French catheter scale, French gauge (Fr or Catheter lumen: The main differences between an F) or Charriere (Ch), based on the cross-sectional diameter IUC and a catheter used for straight catheterization or IC of the catheter in millimeters (Newman et al., 2018).
    [Show full text]