Prevention of Urinary Infection Following Major Vaginal Surgery

The Effect of Chlorhexidine Irrigation of the Bladder in the Rat

“…The reports by Paterson eta/. ( 1 960), McFadyen and Simmons (1968) and Pearman (1971) of haematuria after instillation of chlorhexidine diacetate or digluconate into the bladder suggested severe irritation of the bladder mucosa. This hypothesis has now been confirmed in rat bladder mucosa where irrigations of chlorhexidine digluconate 1 : 5,000 and 1 : 10,000 for periods of 6 to 48 hours produced erosive cystitis in a high percentage of cases.…”

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The instillation of an aqueous solution of chlorhexidine into the bladder at the end of catheterisation has been shown to reduce the incidence of infection associated with this procedure (Paterson, Barr and MacDonald, 1960;Gillespie et al, 1962). However, haematuria has been reportcd in some patients after the frequent use of aqueous solutions of chlorhexidine digluconate 1 : 5,000 (McFadyen and Simmons, 1968;Pearman, 1971) or chlorhexidine diacetate 1 : 5,000 prepared from the concentrate (Paterson et al, 1960). It was therefore decided to study the effect of chlorhexidine irrigation of the rat bladder using the digluconate salt which is the form recommended for irrigation of the human bladder (Rubbo and Gardner, 1965;British Pharmacopoeia, 1973).

Materials and MethodsInsertion of Catheter into Rat's Bladder.

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Recurrent urinary tract infections in patients with incomplete bladder emptying: is there a role for intravesical therapy?

“…In his prospective study, the use of chlorhexidine reduced the risk of postoperative UTI in patients requiring catheterization from 70% to 13.5% (30). Initial reports were encouraging, and multiple studies demonstrated reduced rates of UTI using this method (31,32). Chlorhexidine also compared favorably to alternative bladder irrigation solutions.…”

“…While low serum levels of chlorhexidine were found in some patients, this did not meet the threshold of toxicity and no bladder damage was noted on cystoscopy. Unfortunately, further analysis showed an unacceptable rate of hematuria in patients with long-term use and examination of rat models exposed to intravesical chlorhexidine revealed erosive cystitis (31,35). Reducing the concentration of chlorhexidine prevented cystitis, but yielded insufficient bactericidal activity (36).…”

Urinary Tract Infection and Wound Infection in Kidney Transplant Patients

“…In the majority of series it has been shown that the infection takes place via the urinary catheter (Kass and Schneidermann, 1957;Brehmer and Madsen, 1972). Following a single catheterisation, the risk of infection is 2 % to 4 % (Kass, 1957) but with catheter drainage of 2 to 3 days duration, a frequency of infection has been found of 52% to 88% (Paterson, Barr and MacDonald, 1960;McFayden and Simmons, 1968). By employing a careful aseptic technique of catheterisation, disinfection of the urethra with chlorhexidine gel and periodic flushing of the bladder with chlorhexidine, as well as use of closed drainage, it is possible to reduce the frequency of infection to one third (Gillespie et af., 1962;Clark and Crossley, 1973;Gillespie et ul., 1967).…”