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Abdominal and Genitourinary Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The genitourinary system comprises retroperitoneal structures, pelvic structures and external genitalia. Management of injuries to the retroperitoneum is covered in previous paragraphs. Investigation and management of lower urogenital trauma require specialist referral.60 Trauma patients may need a urinary catheter, but in the presence of blood at the meatus this should be attempted once by an experienced clinician. The risk of uretheral injury means that if a catheter cannot be passed, then a suprapubic catheter should be considered. A CT cysto-gram and retrograde urethrogram should be performed if there is suspicion of urethral or bladder injury such as frank haematuria following catheterization or failure to pass a catheter.61 Dilute contrast can be instilled via a catheter, which is then clamped, the patient then has a CT scan; this is typically performed to confirm a diagnosis suspected on a trauma CT.
Transappendicular Continent Cystostomy Technique (Mitrofanoff Principle)
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
At 3 weeks, the suprapubic tube should be clamped, the 14F appendiceal catheter is removed, and the surgeon should assess the ease of catheterization and its direction toward the bladder neck.8 The patient then should try to catheterize every 4 hours, and if no problems, the suprapubic catheter then should be removed.9
Catheter management
Published in Alexander Trevatt, Richard Boulton, Daren Francis, Nishanthan Mahesan, Take Charge! General Surgery and Urology, 2020
Tom Bracewell, Thomas Maggs, David Manson-Bahr, Sarah Y. W. Tang
The first change of a suprapubic catheter (when the tract has not yet epithelialised) is normally performed by the urology team to ensure the tract does not close up. Changes of suprapubic catheter are avoided wherever possible within the first 10 weeks following insertion with a new tract. If the suprapubic catheter has been in for a while and the tract has epithelialised, any junior doctor/nurse should be able to change it following the same procedure as a urethral catheter: removal of the old catheter and expeditious reinsertion of a new catheter into the hole that is revealed.
The impact of teacher’s presence on learning basic surgical tasks with virtual reality headset among medical students
Published in Medical Education Online, 2022
Sofianna Ojala, Joonas Sirola, Timo Nykopp, Heikki Kröger, Henrik Nuutinen
Three students felt that VR is not a good fit for them physically, mentally or educationally. The biggest reason was nausea due to the VR-glasses (Table 1). In this study, specific uses of VR were also tested. These included abscess incision, suturing and insertion of a suprapubic catheter. Usability of VR for these specific cases was perceived as good when the teacher was present with a rating of 7.4–8.5 ± 1.1–1.4 (Table 1). When teacher was not present, the usability of teaching incision of an abscess was still considered quite good with a rating of 6.0 ± 3.1 (p = 0.079), but the usability for teaching suturing was perceived as quite poor with a rating of 2.6 ± 3.0 (p = 0.007) (Table 1). Usability for teaching suprapubic catheter insertion without a teacher present was perceived as neither bad nor good with a rating of 5.4 ± 3.2 (p = 0.007) (Table 1).
Urinary undiversion by conversion of the incontinent ileovesicostomy to augmentation ileocystoplasty in spinal cord injured patients
Published in The Journal of Spinal Cord Medicine, 2022
Patrick J. Shenot, Seth Teplitsky, Andrew Margules, Aaron Miller, Akhil K. Das
The essential steps of undiversion of the ileovesicostomy are as follows; exposure of the bladder and ileovesicostomy via laparotomy, takedown of the stoma, detubularizing the limb of bowel on its antimesenteric border, creation of a “cup patch” using the approximately 15 cm ileal segment that previously served as the ileovesicostomy, and finally, anastomosis of the patch to the bivalved bladder to complete the augmentation ileocystoplasty (Figure 2). The fascial defect at the stoma site is closed. If the ileovesicostomy segment is not suitable for bladder augmentation, it may be resected and a new segment of ileum could be harvested to complete the bladder augmentation. This was not necessary in these our series. A temporary 24 French suprapubic catheter was left in place in all patients for three to four weeks to aid in healing. During this period, the catheter was capped for increasing periods allowing for temporary bladder filling. This bladder cycling protocol continued until capping times reached four hours per cycle. At this time, the suprapubic catheter was left capped, and intermittent catheterization was instituted. Initially, the suprapubic catheter was kept in place to allow bladder drainage if intermittent catheterization was unsuccessful. In all patients, the suprapubic catheter was removed after 72 h of successful intermittent catheterization.
The impact of educational interventions for patients living with indwelling urinary catheters: A scoping review
Published in Contemporary Nurse, 2020
Joby Alex, Yenna Salamonson, Lucie M. Ramjan, Jed Montayre, Jennifer Fitzsimons, Caleb Ferguson
Qualitative studies included in this review reported that patients are not well supported to cope and make adjustments to life with a catheter (Prinjha et al., 2016; Sweeney et al., 2007; Wilde & Cameron, 2003). Patients were not provided with enough high-quality information regarding catheter supplies and equipment (e.g. choice of drainage bags) which may assist them with reintegration into society (Prinjha et al., 2016). Sexual activity with a catheter is very rarely discussed by the clinicians and patients were often embarrassed to ask or request further information (Prinjha & Chapple, 2013; Sweeney et al., 2007; Wilde & Cameron, 2003). It is important for patients, particularly those who are socially active, to be included in decisions and should have a choice relating to the different types of catheters and drainage systems (Sweeney et al., 2007; Wilde & Cameron, 2003). Research indicates that clean intermittent self-catheterisation (CISC) should be encouraged where possible (Gonzalez Chiappe et al., 2016) and suprapubic catheters may be more suitable for sexually active patients (Chapple et al., 2015). Before inserting an indwelling catheter, the choice of CISC for bladder drainage should be considered for patients who are capable to perform self-catheterisation. The suitability of CISC is often limited as many patients who require catheters have poor hand dexterity or have a disability.