Iatrogenic Urethral Injuries: A Comprehensive Guide to Prevention and Best Practices in Catheterization | Chapter 8 | Newer Frontiers IN Urology

Catheterisation is required for 12–16% of inpatients at any given time. The paramedical support crew, junior medical officers, or trainee intern doctors are typically the ones carrying out this treatment. Urethral catheter insertion is a common procedure done in hospital-admitted patients. Iatrogenic urethral injuries are one of the common preventable complications related to urological procedures. Patients with urethral injury present with frank bleeding from the urethra. The bleeding may sometimes be so severe that it may even occasionally present with urosepsis or hemodynamic instability. We describe a case of iatrogenic urethral injury post-catheterisation, following which the patient returned to the ER in shock with an incorrectly positioned catheter. The patient was resuscitated and managed with suprapubic diversion and a perineal compression tamponade. The patient recovered well and voided normally eventually. An orientation program outlining the techniques for catheterisation and the precautions to be taken before inflating the balloon and during catheter insertion is crucial to minimizing this potentially preventable morbidity since most catheterisations are performed by interns, the paramedical support team, or nursing staff. It is advisable to provide education to patients who require self-catheterisation due to detrusor underactivity or stricture urethra self-calibration. Patients who are paraplegic, and need regular bladder emptying have to exert greater caution, especially if the urethra is insensate. A few learning points are to be borne in mind before insertion of the catheter, which if properly followed, can minimize catheterisation-associated morbidity and ensure patient wellness. In order to reduce iatrogenic urethral injuries caused by catheterization, it is the duty of the urologists and senior surgeons to instruct the junior nursing staff and interns on urethral catheterization practices.

 

Author (s) Details

Pradhyumna Koushik
Department of Urology & Renal transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

Nakul Aher
Department of Urology & Renal transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Velmurugan Palaniyandi
Department of Urology & Renal transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Hariharasudhan Sekar
Department of Urology & Renal transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

Sriram Krishnamoorthy
Department of Urology & Renal transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/mono/978-93-49238-86-2/CH8

Brief Overview of Melanoma of the Urinary Bladder: A Review of the Literature | Chapter 6 | Research Trends and Challenges in Medical Science Vol. 1

Background: Melanomas of the urinary bladder and urethra are rare.  Aims: To review the literature on the disease.  Methods: Various Internet databases were used to identify reported cases of the disease.  Results: Less than 30 cases of primary melanoma of the urinary bladder and urethra have been reported in the literature and they have been associated with melanosis and commonly with metastases. The lesions may be primary or metastatic with no gender preference. The diagnostic features include pigmented raised lesions which histologically exhibit spindled or epithelioid cells, necrosis, mitotic figures, and atypical melanocytes. Immunohistochemically they stain positively with S100; HMB45; and other melanocyte markers, but negatively with Keratin and Vimentin. The treatment involves excision and possibly IL-2. The prognostic factors include size and depth of invasion as well as metastatic lesions.  Conclusions: Less than 30 cases (about 24 cases) of the disease have been reported. There are also reports of metastatic melanomas of the urinary bladder emanating from primary melanomas originating elsewhere. Diagnosis of the primary disease is based upon the histological appearance of the lesion, positive staining with S100 and HMB45, and evidence of absence of melanoma elsewhere. Primary melanoma of the bladder is usually a fatal lesion.

Author(s) Details
Mr. Anthony Kodzo-Grey Venyo,
Department of Urology, North Manchester General Hospital, Delaunays Road, Manchester, UK.

View Book :- http://bp.bookpi.org/index.php/bpi/catalog/book/181

Brief Overview of Clear Cell Adenocarcinoma of the Urethra: Review of the Literature | Chapter 4 | Research Trends and Challenges in Medical Science Vol. 1

Background: Clear cell adenocarcinoma of the urethra (CCAU) is extremely rare and a number of clinicians may be unfamiliar with its diagnosis and biological behaviour.  Aims: To review the literature on CCAU.  Methods: Various internet databases were used.  Results/Literature Review: (i) CCAU occurs in adults and in women in the great majority of cases. (ii) It has a particular association with urethral diverticulum, which has been present in 56% of the patients; is indistinguishable from clear cell adenocarcinoma of the female genital tract but is not associated with endometriosis; and probably does not arise by malignant transformation of nephrogenic adenoma. (iii) It is usually, readily distinguished from nephrogenic adenoma because of greater cytological a-typicality and mitotic activity and does not stain for prostate-specific antigen or prostatic acid phosphatase. (iv) It has been treated by anterior exenteration in women and cystoprostatectomy in men and at times by radiotherapy; chemotherapy has rarely been given. (v) CCAU is aggressive with low 5-year survival rates. (vi) There is no consensus opinion of treatment options that would improve the prognosis.  Conclusions: Few cases of CCAU have been reported. Urologists, gynecologists, pathologists, and oncologists should report cases of CCAU they encounter and enter them into a multicentric trial to determine the best treatment options that would improve the prognosis.

Author (s) Details

Anthony Kodzo-Grey Venyo
Department of Urology, North Manchester General Hospital, Delaunays Road, Manchester, UK.

View Book :- http://bp.bookpi.org/index.php/bpi/catalog/book/181