Indwelling urinary catheters play a very important part in urology. However, their use is accompanied by a considerable increase in the risk of nosocomial urinary tract infections. The pathophysiological cause is ascribed to pathogens that adhere to the catheter surface, proliferate and produce a biofilm. In addition to aseptic techniques, modification of the catheter material to confer antimicrobial activity plays an essential part in the prevention of catheter-related urinary tract infections. The antimicrobial efficacy of silver against gram-positive and gram-negative bacteria is well known and amply shown in vitro. The efficacy of silver-impregnated catheters is critically dependent on both the chemical structure of the incorporated silver and the way the silver has been combined with the basic catheter material. Hence, clinical studies on silver-modified catheters have so far given inconsistent results. The new technology of the Erlanger silver catheter offers the opportunity of an effective reduction in catheter-related infections.
InformationA 2-year-old girl was admitted to hospital because of urinary stasis.The girl had been born of an uncomplicated full-term pregnancy and delivery, with a birth weight of 3.5 kg. Her early growth and development were normal. She was in excellent health until 2 weeks before admission, when dysuria and frequency developed. Five days before admission, a physician diagnosed cystitis and prescribed trimethoprim-sulphamethoxazole, without improvement of the symptoms. There was no history of allergy or of genito-urinary problems. The family lived in the country and the girl had contact with cats, cows and pigs. The family had not travelled within the preceding 2 years. Her three brothers, two sisters and parents were well and there was no family history of allergy.The temperature was 37.3 ~ C. On physical examination the vital signs were normal and the child appeared mildly ill. Bilateral cervical and inguinal lymph nodes, aI1 less than 1 cm, were palpated. The head, neck, lungs, and heart were normal. After catheterization of the distended bladder the abdomen was normal. The extremities and genitalia were normal. Neurological examination was negative.The urine was normal and negative for ova, cysts, trophozoides and parasites. Three stool specimens showed no ova or parasites, and stool cultures were negative. The haematocrit was 34.1%, white cell count 8900/btl (20% neutrophils, 14% eosinophils, 62% lymphocytes, 3% monocytes, and 1% basophils), and platelet count 522 000 bt/l. ESR was 40 mm/h. Examination of the bone marrow demonstrated 10% eosinophils. Prothrombin and partial thromboplastin times were normal, as were values for urea nitrogen, glucose, bilirubin, electrolytes, protein, albumin, globulin and lactate dehydrogenase. An ultrasonographic examination of the pelvis showed a mass arising from the bladder (Fig. 1). CT Scan of the pelvis confirmed the ultrasonographic finding (Fig. 2).At cystoscopy the bladder was extensively involved with what appeared to be an invasive bladder tumour with erythematous and ulcerated areas. Biopsies were obtained, but were not diagnostic. Gross haematuria developed. An operation with complete resection of the tumour was performed. Fig. 1 Sonogram of the bladder showing a bladder mass Fig.2 CT of pelvis showing a tumour arising from the bladder
In contrast to ureterosigmoidostomy no reliable clinical data exist for tumor risk in different forms of urinary diversion using isolated intestinal segments.In 44 German urological departments, operation frequencies, indications, patient age, and operation dates of the different forms of urinary diversion, operated between 1970 and 2007, could be registered. The secondary tumors up to 2009 were registered as well and related to the numbers of the different forms of urinary diversions resulting in tumor prevalences.In 17,758 urinary diversions 32 secondary tumors occurred. The tumor risk in ureterosigmoidostomy (22-fold) and cystoplasty (13-fold) is significantly higher than in other continent forms of urinary diversion such as neobladders or pouches (p<0.0001). The difference between ureterosigmoidostomy and cystoplasty is not significant, nor is the difference between ileocecal pouches (0.14%) and ileal neobladders (0.05%) (p=0.46). The tumor risk in ileocecal (1.26%) and colonic neobladders (1.43%) is significantly higher (p=0.0001) than in ileal neobladders (0.5%). Of the 16 tumors that occurred following ureterosigmoidostomy, 16 (94%) developed directly at the ureterocolonic borderline in contrast to only 50% following urinary diversions via isolated intestinal segments.From postoperative year 5 regular endoscopic controls of ureterosigmoidostomies, cystoplasties, and orthotopic (ileo-)colonic neobladders are necessary. In ileocecal pouches, regular endoscopy is necessary at least in the presence of symptoms or should be performed routinely at greater intervals. Following neobladders or conduits, only urethroscopies for urethral recurrence are necessary.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.