This study evaluated 59 cats that underwent perineal urethrostomy surgery for feline lower urinary tract disease (FLUTD) at a university veterinary clinic. Early complications within 4 weeks of surgery occurred in 25.4% of cats, most commonly urethral stricture formation. Late complications after at least 4 months included recurring urinary tract infections in 28.2% of cats. Despite frequent complications, 32.2% of cats had no long-term issues, though recurring FLUTD symptoms still occurred in 23% of cats. Overall, the surgery provided a good quality of life for most cats, according to their owners.
Introduction: Vescicovaginal fi stulae, most of all as consequences of prolonged neglected obstructed labor, occur mainly in low income countries. Fistulas have a devastating impact on affected women and their families from physical, social and economic point of view. Methods: We collected data of patients admitted to the Urology Department of Maputo Central Hospital from 2004 to 2013. We conducted a descriptive analysis of the collected data as yet available.
A clinical study of intussusception in childreniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Introduction: Vescicovaginal fi stulae, most of all as consequences of prolonged neglected obstructed labor, occur mainly in low income countries. Fistulas have a devastating impact on affected women and their families from physical, social and economic point of view. Methods: We collected data of patients admitted to the Urology Department of Maputo Central Hospital from 2004 to 2013. We conducted a descriptive analysis of the collected data as yet available.
A clinical study of intussusception in childreniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Correction and Management of Total Uterine Prolapse in A Crossbred Cowiosrjce
Uterine prolapse is a common obstetrical problem, which adversely affects productive and
reproductive performance of cattle by affecting postpartum return to estrus, conception rate and calving
interval and the incidence of uterine prolapse as 42.9% among various obstetrical problems in cattle. In this
study total uterine prolapse, replacement of everted organ of uterine proplase was done manually following
proper precautionary measures. In this case of uterine prolapse was completely recovered.
The cystic diseases in various organs were observed in the anatomy and OBG depaartment, in that
the polycystic disease of ovary was very common compared to all other organs cystic diseases.
Running head PICOT AND LITERATURE SEARCH 1.docxtodd581
Running head: PICOT AND LITERATURE SEARCH 1
PICOT and Statement Literature Search
Student’s Name: Yeni Hernandez
Date: 7/22/2018
Course: NRS-433V
PICOT and Statement Literature Search
Nursing Practice Problem
Doctors use urinary catheters to empty urine from patients who have impaired urinary system. Such patients might suffer from kidney failure due to pressure exerted on their kidneys, this is dangerous and can permanently damage their kidneys. The Urinary catheters, however, may cause potential complications on the patients. Research carried on BMC Urology shows that most patients end up suffering from urinary tract infections (UTI) after the use of indwelling urinary catheters. Other complications such as kidney damage, injury to the urethra, bladder stones, and blood in the urine, septicemia and allergic reactions may arise from the usage of the urinary catheter (Feneley, Hopley, & Wells., 2015).
Picot Statement
Prognosis/Prediction: For pediatric patients 65 years and older (P), how does the use of catheters for much longer time (I) compared to the use of indwelling catheters for shorter time(C) influence the risk of Catheter-associated urinary infections(O) during the first ten weeks of indwelling catheter usage(T)?
Most patients who are placed in indwelling catheters for more than the expected time have had the risk of developing urinary tract infections, allergic reactions and others experience challenges in their kidneys.
What are some of the practical methods used to ensure that catheter-related diseases are reduced?
This study aims to make sure that indwelling urethral catheters (IDC) are carried out in a manner that minimizes risks to infection and trauma (Conway & Larson, 2011).
1st study
Feneley, R. C., Hopley, I. B., & Wells, P. N. (2015). Urinary catheters: history, current status, adverse events and research agenda. Journal of Medical Engineering & Technology, 39(8), 459-470. doi:10.3109/03091902.2015.1085600
I chose this study because the there is a qualitative analysis of the article and the scale of the burden of urinary incontinence. Statistical data collected from the year 2006 to 2007 recorded millions of people in England with consistent problems, and in the year 2011, the number of patients had increased than the previous year. Studies show urinary infections have wider effects on the older generation, and those over 85 years of age suffered most, followed by those with over 65 years of age. Challenges emerge while an attempt is made to care for the old people and patients affected.
One study reveals that US nursing homes that received 420 admissions had 39% of patients experiencing a daytime urinary inconsistency most of them aged 65 years and above (Feneley, Hopley, & Wells., 2015).Clinicians often choose Catheterization as the last option due to high chances of urinary tract infections. In 2002, US had incidences of advance events of catheter induced_ infections occurring and causing deat.
Running head PICOT AND LITERATURE SEARCH 1.docxglendar3
Running head: PICOT AND LITERATURE SEARCH 1
PICOT and Statement Literature Search
Student’s Name: Yeni Hernandez
Date: 7/22/2018
Course: NRS-433V
PICOT and Statement Literature Search
Nursing Practice Problem
Doctors use urinary catheters to empty urine from patients who have impaired urinary system. Such patients might suffer from kidney failure due to pressure exerted on their kidneys, this is dangerous and can permanently damage their kidneys. The Urinary catheters, however, may cause potential complications on the patients. Research carried on BMC Urology shows that most patients end up suffering from urinary tract infections (UTI) after the use of indwelling urinary catheters. Other complications such as kidney damage, injury to the urethra, bladder stones, and blood in the urine, septicemia and allergic reactions may arise from the usage of the urinary catheter (Feneley, Hopley, & Wells., 2015).
Picot Statement
Prognosis/Prediction: For pediatric patients 65 years and older (P), how does the use of catheters for much longer time (I) compared to the use of indwelling catheters for shorter time(C) influence the risk of Catheter-associated urinary infections(O) during the first ten weeks of indwelling catheter usage(T)?
Most patients who are placed in indwelling catheters for more than the expected time have had the risk of developing urinary tract infections, allergic reactions and others experience challenges in their kidneys.
What are some of the practical methods used to ensure that catheter-related diseases are reduced?
This study aims to make sure that indwelling urethral catheters (IDC) are carried out in a manner that minimizes risks to infection and trauma (Conway & Larson, 2011).
1st study
Feneley, R. C., Hopley, I. B., & Wells, P. N. (2015). Urinary catheters: history, current status, adverse events and research agenda. Journal of Medical Engineering & Technology, 39(8), 459-470. doi:10.3109/03091902.2015.1085600
I chose this study because the there is a qualitative analysis of the article and the scale of the burden of urinary incontinence. Statistical data collected from the year 2006 to 2007 recorded millions of people in England with consistent problems, and in the year 2011, the number of patients had increased than the previous year. Studies show urinary infections have wider effects on the older generation, and those over 85 years of age suffered most, followed by those with over 65 years of age. Challenges emerge while an attempt is made to care for the old people and patients affected.
One study reveals that US nursing homes that received 420 admissions had 39% of patients experiencing a daytime urinary inconsistency most of them aged 65 years and above (Feneley, Hopley, & Wells., 2015).Clinicians often choose Catheterization as the last option due to high chances of urinary tract infections. In 2002, US had incidences of advance events of catheter induced_ infections occurring and causing deat.
ABSTRACT- Urinary tracts stone diseases are one of the most common afflictions of modern society and it has
witnessed much advancement in its management. Keeping in view various aspects of management we carried out a
comparatively newer study called Transperitoneal Ureterolithotomy. This study was carried out to evaluate Laparoscopic
Transperitoneal Ureterolithotomy (TPUL) as a viable option to open surgical ureterolithotomy, Laparoscopic
Retroperitoneal Ureterolithotomy (RPUL) & endoscopic urology and to assess its place in the spectrum of various surgical
interventions for ureteric calculi in a tertiary care center. This study was conducted on 25 selected patients of a single large
impacted calculus of size more than 10mm in upper and middle ureter. It was observed that conversion to open
ureterolithotomy was observed in 4 cases and excessive bleeding in one case. No major perioperative complications were
seen. The procedure has definitely shown decreased post-operative discomfort, decreased requirement of post-operative
analgesia, better cosmesis, early return to work and less morbidity.
Key-words- Transperitoneal ureterolithotomy (TPUL), Retroperitoneal ureterolithotomy (RPUL), Extracorporeal
shockwave lithotripsy (ESWL), Open surgical ureterolithotomy
Uterine prolapse (also called descensus or procidentia) means the uterus has descended from its normal position in the pelvis farther down into the vagina.Cervicopexy is fertility conserving surgical management of prolapse.
A child with a large bladder stone a case reportHayrettin Ozturk
A child with a large bladder stone: A case report
Hulya Ozturk, Emine Dagistan, Ugur Uyeturk
Ped Urol Case Rep 2014;1(4):22-28
DOI: 10.14534/PUCR.201446417
Abstract
Study was conducted to record prevalence of gastrointestinal parasites of cat. A total of 100 fecal samples from cat (50 from
male and 50 from female) were collected and examined for the presence of GIT parasites. Samples were collected and
transported for the laboratory diagnosis. Animal data such as age, sex, and breed were recorded. Results of the present study
revealed that 24% cats found positive for the gastrointestinal parasites. The percentage of infection was found higher in female
cats (28%) than males (20%). The prevalence in adults and kitten was recorded as 21.42% and 30% respectively. Dipylidium
caninum was found more prevalent with the infection rate of 9% followed by Toxocara cati, Aeluroslonglun obstrusus, Taenia
taeniaeformis and Paragonimus kellikotti with the infection rate of 5, 5, 3 and 2% respectively.
Key words: Cat, Felus catus, GIT parasites, Prevalence
Correction and Management of Total Uterine Prolapse in A Crossbred Cowiosrjce
Uterine prolapse is a common obstetrical problem, which adversely affects productive and
reproductive performance of cattle by affecting postpartum return to estrus, conception rate and calving
interval and the incidence of uterine prolapse as 42.9% among various obstetrical problems in cattle. In this
study total uterine prolapse, replacement of everted organ of uterine proplase was done manually following
proper precautionary measures. In this case of uterine prolapse was completely recovered.
The cystic diseases in various organs were observed in the anatomy and OBG depaartment, in that
the polycystic disease of ovary was very common compared to all other organs cystic diseases.
Running head PICOT AND LITERATURE SEARCH 1.docxtodd581
Running head: PICOT AND LITERATURE SEARCH 1
PICOT and Statement Literature Search
Student’s Name: Yeni Hernandez
Date: 7/22/2018
Course: NRS-433V
PICOT and Statement Literature Search
Nursing Practice Problem
Doctors use urinary catheters to empty urine from patients who have impaired urinary system. Such patients might suffer from kidney failure due to pressure exerted on their kidneys, this is dangerous and can permanently damage their kidneys. The Urinary catheters, however, may cause potential complications on the patients. Research carried on BMC Urology shows that most patients end up suffering from urinary tract infections (UTI) after the use of indwelling urinary catheters. Other complications such as kidney damage, injury to the urethra, bladder stones, and blood in the urine, septicemia and allergic reactions may arise from the usage of the urinary catheter (Feneley, Hopley, & Wells., 2015).
Picot Statement
Prognosis/Prediction: For pediatric patients 65 years and older (P), how does the use of catheters for much longer time (I) compared to the use of indwelling catheters for shorter time(C) influence the risk of Catheter-associated urinary infections(O) during the first ten weeks of indwelling catheter usage(T)?
Most patients who are placed in indwelling catheters for more than the expected time have had the risk of developing urinary tract infections, allergic reactions and others experience challenges in their kidneys.
What are some of the practical methods used to ensure that catheter-related diseases are reduced?
This study aims to make sure that indwelling urethral catheters (IDC) are carried out in a manner that minimizes risks to infection and trauma (Conway & Larson, 2011).
1st study
Feneley, R. C., Hopley, I. B., & Wells, P. N. (2015). Urinary catheters: history, current status, adverse events and research agenda. Journal of Medical Engineering & Technology, 39(8), 459-470. doi:10.3109/03091902.2015.1085600
I chose this study because the there is a qualitative analysis of the article and the scale of the burden of urinary incontinence. Statistical data collected from the year 2006 to 2007 recorded millions of people in England with consistent problems, and in the year 2011, the number of patients had increased than the previous year. Studies show urinary infections have wider effects on the older generation, and those over 85 years of age suffered most, followed by those with over 65 years of age. Challenges emerge while an attempt is made to care for the old people and patients affected.
One study reveals that US nursing homes that received 420 admissions had 39% of patients experiencing a daytime urinary inconsistency most of them aged 65 years and above (Feneley, Hopley, & Wells., 2015).Clinicians often choose Catheterization as the last option due to high chances of urinary tract infections. In 2002, US had incidences of advance events of catheter induced_ infections occurring and causing deat.
Running head PICOT AND LITERATURE SEARCH 1.docxglendar3
Running head: PICOT AND LITERATURE SEARCH 1
PICOT and Statement Literature Search
Student’s Name: Yeni Hernandez
Date: 7/22/2018
Course: NRS-433V
PICOT and Statement Literature Search
Nursing Practice Problem
Doctors use urinary catheters to empty urine from patients who have impaired urinary system. Such patients might suffer from kidney failure due to pressure exerted on their kidneys, this is dangerous and can permanently damage their kidneys. The Urinary catheters, however, may cause potential complications on the patients. Research carried on BMC Urology shows that most patients end up suffering from urinary tract infections (UTI) after the use of indwelling urinary catheters. Other complications such as kidney damage, injury to the urethra, bladder stones, and blood in the urine, septicemia and allergic reactions may arise from the usage of the urinary catheter (Feneley, Hopley, & Wells., 2015).
Picot Statement
Prognosis/Prediction: For pediatric patients 65 years and older (P), how does the use of catheters for much longer time (I) compared to the use of indwelling catheters for shorter time(C) influence the risk of Catheter-associated urinary infections(O) during the first ten weeks of indwelling catheter usage(T)?
Most patients who are placed in indwelling catheters for more than the expected time have had the risk of developing urinary tract infections, allergic reactions and others experience challenges in their kidneys.
What are some of the practical methods used to ensure that catheter-related diseases are reduced?
This study aims to make sure that indwelling urethral catheters (IDC) are carried out in a manner that minimizes risks to infection and trauma (Conway & Larson, 2011).
1st study
Feneley, R. C., Hopley, I. B., & Wells, P. N. (2015). Urinary catheters: history, current status, adverse events and research agenda. Journal of Medical Engineering & Technology, 39(8), 459-470. doi:10.3109/03091902.2015.1085600
I chose this study because the there is a qualitative analysis of the article and the scale of the burden of urinary incontinence. Statistical data collected from the year 2006 to 2007 recorded millions of people in England with consistent problems, and in the year 2011, the number of patients had increased than the previous year. Studies show urinary infections have wider effects on the older generation, and those over 85 years of age suffered most, followed by those with over 65 years of age. Challenges emerge while an attempt is made to care for the old people and patients affected.
One study reveals that US nursing homes that received 420 admissions had 39% of patients experiencing a daytime urinary inconsistency most of them aged 65 years and above (Feneley, Hopley, & Wells., 2015).Clinicians often choose Catheterization as the last option due to high chances of urinary tract infections. In 2002, US had incidences of advance events of catheter induced_ infections occurring and causing deat.
ABSTRACT- Urinary tracts stone diseases are one of the most common afflictions of modern society and it has
witnessed much advancement in its management. Keeping in view various aspects of management we carried out a
comparatively newer study called Transperitoneal Ureterolithotomy. This study was carried out to evaluate Laparoscopic
Transperitoneal Ureterolithotomy (TPUL) as a viable option to open surgical ureterolithotomy, Laparoscopic
Retroperitoneal Ureterolithotomy (RPUL) & endoscopic urology and to assess its place in the spectrum of various surgical
interventions for ureteric calculi in a tertiary care center. This study was conducted on 25 selected patients of a single large
impacted calculus of size more than 10mm in upper and middle ureter. It was observed that conversion to open
ureterolithotomy was observed in 4 cases and excessive bleeding in one case. No major perioperative complications were
seen. The procedure has definitely shown decreased post-operative discomfort, decreased requirement of post-operative
analgesia, better cosmesis, early return to work and less morbidity.
Key-words- Transperitoneal ureterolithotomy (TPUL), Retroperitoneal ureterolithotomy (RPUL), Extracorporeal
shockwave lithotripsy (ESWL), Open surgical ureterolithotomy
Uterine prolapse (also called descensus or procidentia) means the uterus has descended from its normal position in the pelvis farther down into the vagina.Cervicopexy is fertility conserving surgical management of prolapse.
A child with a large bladder stone a case reportHayrettin Ozturk
A child with a large bladder stone: A case report
Hulya Ozturk, Emine Dagistan, Ugur Uyeturk
Ped Urol Case Rep 2014;1(4):22-28
DOI: 10.14534/PUCR.201446417
Abstract
Study was conducted to record prevalence of gastrointestinal parasites of cat. A total of 100 fecal samples from cat (50 from
male and 50 from female) were collected and examined for the presence of GIT parasites. Samples were collected and
transported for the laboratory diagnosis. Animal data such as age, sex, and breed were recorded. Results of the present study
revealed that 24% cats found positive for the gastrointestinal parasites. The percentage of infection was found higher in female
cats (28%) than males (20%). The prevalence in adults and kitten was recorded as 21.42% and 30% respectively. Dipylidium
caninum was found more prevalent with the infection rate of 9% followed by Toxocara cati, Aeluroslonglun obstrusus, Taenia
taeniaeformis and Paragonimus kellikotti with the infection rate of 5, 5, 3 and 2% respectively.
Key words: Cat, Felus catus, GIT parasites, Prevalence
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdf
uretor en gatos.pdf
1. INTRODUCTION
Disorders of the feline lower urinary tract
encompass a heterogeneous group of con-
ditions, collectively referred to as feline
lower urinary tract disease (FLUTD). Pre-
vious studies have estimated the annual
incidence of FLUTD to be between 0·5
and 1 per cent in Britain and the USA
(Willeberg 1984, Lawler and others 1985).
Irrespective of the cause, the most com-
mon clinical signs of FLUTD are haema-
turia, dysuria, stranguria, pollakiuria,
inappropriate urination and urethral
obstruction (Kalkstein and others 1999a,
Osborne and others 2000).
Recognised causes of FLUTD include
bacterial, fungal or parasitic urinary
tract infection (UTI), uroliths, urethral
crystal and/or matrix plugs, congenital
or acquired anatomical abnormalities,
iatrogenic or traumatic injuries, and
neoplasia (Kalkstein and others 1999b,
Osborne and others 2000). Idiopathic
FLUTD is diagnosed when an under-
lying disorder is not found, and remains
the most common cause of FLUTD
(Kalkstein and others 1999b, Osborne and
others 2000).
Potential causes of idiopathic FLUTD
have been appraised in recent years but
the precise aetiopathogenesis remains
unclear. Sterile struvite (magnesium
ammonium phosphate) uroliths and
crystals were a frequent finding in
both obstructive and non-obstructive
cases of FLUTD up until the mid-1980s
(Osborne and others 2000). The subse-
quent increased use of manufactured
diets designed to reduce the formation
of struvite crystalluria by limiting magne-
sium content and decreasing urine pH
resulted in a diminished incidence of
struvite uroliths and an increased inci-
dence of calcium oxalate uroliths by the
mid-1990s (Osborne and others 2000,
Lekcharoensuk and others 2002).
Urethral obstruction or stenosis in male
cats can be a sequela of any cause of
FLUTD and occurs predominantly in the
narrow distal portion of the urethra
(Osborne and others 1996). Irrespective of
cause, initial treatment must focus on the
restoration of urethral patency and urine
flow. Non-surgical techniques, including
penile massage and retrograde urethral
flushing, can be very effective in dislodging
intraluminal plugs and uroliths. Further
medical management may include treat-
ment of UTI, dietary recommendations
for the dissolution of urocystoliths and/or
crystals, and prevention of their reforma-
tion (Kalkstein and others 1999c, Osborne
and others 2000).
Male cats suffering from distal urethral
disease, including recurrent urethral
obstruction from intraluminal plugs,
obstruction that cannot be relieved by
catheterisation, and urethral strictures,
trauma or neoplasia, can benefit from
surgical procedures designed to create a
permanent opening of the pelvic urethra
(Hauptmann 1984). The most commonly
performed procedure is perineal urethros-
tomy, which was first described by Wilson
t
M. BASS, J. HOWARD*, B. GERBER†
AND M. MESSMER
Journal of Small Animal Practice (2005)
46, 227–231
Retrospective study of indications for
and outcome of perineal urethrostomy
in cats
JOURNAL OF SMALL ANIMAL PRACTICE • VOL 46 • MAY 2005 227
Clinic for Small Animal Surgery,
†Clinic for Small Animal Internal
Medicine, University of Zurich,
Winterthurerstrasse 260,
8057 Zurich, Switzerland
*Department of Clinical Veterinary
Medicine, Clinic for Small Animal
Internal Medicine, University of Bern,
Länggassstrasse 128,
3012 Bern, Switzerland
OBJECTIVES: To evaluate indications for and outcome of perineal
urethrostomy in cats.
METHODS: The medical records of 59 cats that had undergone
perineal urethrostomy were evaluated. Short-term follow up
information (for a period of four weeks following surgery) was
available for all of the cats. Long-term follow up information
(for a period of at least four months) was available for 39 cats.
RESULTS: Early complications occurred in 25·4 per cent of cats
and late complications were observed in 28·2 per cent of cats.
The most frequent late complication was recurring bacterial
urinary tract infection.
CLINICAL SIGNIFICANCE: Despite frequent complications and
recurring signs of lower urinary tract disease, 32·2 per cent
of the cats had a disease-free long-term outcome (mean four
years, median 3·9 years), and 88·6 per cent of clients
interviewed thought that their cats had a good quality of life
after surgery.
Retrospective study of indicati 4/27/05 5:43 PM Page 227
2. 228 JOURNAL OF SMALL ANIMAL PRACTICE • VOL 46 • MAY 2005
and Harrison in 1971. This technique
involves mobilisation of the wide pelvic
urethra and creation of a new stoma by
suturing the urethral mucosa to the
perineal skin, and amputating the narrow
penile urethra (Wilson and Harrison 1971,
Griffin and others 1989).
Complications following perineal ure-
throstomy include haemorrhage from erec-
tile tissue, wound dehiscence, urine leakage
into the perineal tissue, stricture, bacterial
UTI, urinary incontinence, perineal hernia,
urine-scald dermatitis and urethrorectal
fistula (Smith and Schiller 1978, Haupt-
mann 1984, Osborne and others 1996).
Although many of these complications are
uncommon or rare, recurring bacterial
UTI frequently is a long-term postoperative
problem (Osborne and others 1996).
This study aimed to determine the true
prevalence of short- and long-term com-
plications as a result of perineal urethros-
tomy, performed at the University of
Zurich, and to identify trends in patient
selection or postoperative management
that might have influenced the outcome.ll
MATERIALS AND METHODS
The medical records of all cats undergoing
perineal urethrostomy at the Small Animal
Clinic of the University of Zurich between
November 1991 and October 2001 were
reviewed. All surgeries were performed
by residents or faculty members using
the technique described by Wilson and
Harrison (1971). Postoperative treatment
consisted of the use of opiate analgesics
(0·006 mg/kg buprenorphine or 0·4
mg/kg butorphanol) given intravenously
for three days, an Elizabethan collar
for 10 days and antibiotics for three
weeks. Sutures (Polypropylene 5-0; John-
son & Johnson) were removed 10 days
following surgery. In cases of correct-
ive surgery after stricture formation,
the pelvic urethra was further mobilised
and the mucosa was sutured to the skin.
All corrective surgeries were performed
by a faculty member.
Antibiotic selection for cats in which
bacterial culture revealed growth was based
on sensitivity testing. In addition, an
appropriate diet for the prevention of
urolith formation was prescribed for all
cats in which mineral analysis of crystals or
uroliths was performed. Prescription Diet
Feline c/d (Hill’s) was prescribed for the
prevention of struvite crystal and urolith
formation and Prescription Diet Feline k/d
(Hill’s) was fed for the prevention of cal-
cium oxalate urolith formation. A moist
diet was recommended for all of the other
cats.
Data collected included signalment,
clinical signs and preoperative diagnosis
based on the history and physical exam-
ination findings, as well as further in-
vestigative tests including urinalysis,
bacteriological urine culture, and urolith
or urethral plug mineral analysis. Follow-
up data were collected by telephone inter-
views with pet owners and referring
veterinarians and were divided into two
sets: those pertaining to the initial four-
week period following surgery (early
complications) and those collected at
the end of the study period, which was at
least four months post-surgery (late
complications). These data included the
occurrence and nature of complications
or disorders referable to the lower urinary
tract, medication and dietary changes
instigated after surgery, and client satisfac-
tion with the surgical outcome. Owners
were asked if they were satisfied or dissatis-
fied with the surgical outcome and
whether they considered their cat’s quality
of life following surgery to be good,
acceptable or poor.
Statistical differences in the numbers of
cats with recurring uroliths between that
did and did not receive dietary manage-
ment were investigated using Fisher’s exact
test and chi-squared analysis. Fisher’s exact
test determined statistical differences in
the numbers of early-complication stric-
ture formations between surgeries per-
formed by faculty members and those
performed by residents. The level of signif-
icance was set at 5 per cent (P<0·05).
RESULTS
Records were available for 59 male cats that
underwent perineal urethrostomy during
the study period. Of these, 54 cats (91·5 per
cent) had been castrated before the onset of
signs of FLUTD. The mean age was 5·9
years (range 1·2 to 14·8 years). Breeds repre-
sented were domestic short- or longhair
(37 cats), Persian (20 cats), Siamese (one
cat) and Maine coon (one cat).
With the exception of one cat, in which
catheterisation of the urethra proved
impossible on the first day of
hospitalisation, all cats had been treated
conservatively for urethral obstruction on
at least one previous occasion, and perineal
urethrostomy was performed following
short-term management in hospital. On
presentation, cats were either suffering
from recurring obstructive FLUTD or had
been treated for recurring obstructive
disease with only short-term success by
referring veterinarians. Some cats treated
immediately before referral were not con-
sidered to have urethral obstruction on
presentation, and underwent perineal ure-
throstomy to prevent future obstructions.
In addition, 19 cats (32 per cent) received
preoperative medical treatment consisting
of antibiotics and/or a calculolytic diet.
Preoperative clinical signs included
dysuria in 46 cats (78 per cent), urethral
obstruction in 36 cats (61 per cent),
haematuria in 20 cats (34 per cent), pol-
lakiuria in 12 cats (20 per cent) and
stranguria in 11 cats (19 per cent). The
duration of preoperative clinical signs
ranged from one to 1170 days (mean 103
days, median 14 days). Preoperative prob-
lems recorded were obesity (four cats),
purulent self-inflicted perineal wounds
(two cats), urinary bladder rupture (two
cats), peritonitis caused by suspected urine
leakage following cystocentesis and subse-
quent reobstruction (one cat), and fever
(one cat).
The most common preoperative diag-
noses were urolithiasis and bacterial UTI
(Table 1). Urine culture revealed bacterial
growth in 11 of 35 samples (31 per cent)
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3. JOURNAL OF SMALL ANIMAL PRACTICE • VOL 46 • MAY 2005 229
submitted. The average age of cats diag-
nosed with UTI was 6·8 years. The bac-
teria cultured were Escherichia coli (five
cases), Staphylococcus species (four cases),
Streptococcus species (one case) and Entero-
bacter species (one case). Mineral analysis,
performed on urethral and/or bladder
uroliths or crystals in 32 cats, revealed stru-
vite uroliths (15 cats), struvite crystals
(nine cats), calcium oxalate uroliths (six
cats), ammonium urate uroliths (one cat)
and non-mineral organic material (one
cat). Of those uroliths that were predomi-
nantly struvite, additional calcium oxalate
and ammonium urate elements each were
found in one case.
Sixteen early complications (within
four weeks of surgery) were noted in 15 of
59 cats (25 per cent) (Table 2). The most
common of these was urethral stricture
formation at the mucocutaneous junction
of the stoma. Of 16 surgeries performed by
a faculty member, one case of stricture for-
mation as an early complication occurred.
Of the remaining 43 surgeries performed
by a resident supervised by a faculty mem-
ber, six cats suffered stricture formation.
No statistical difference (P=0·661) in stric-
ture formation was found between surg-
eries performed by residents and those
performed by faculty members.
Of the cats with complications, one
died during anaesthesia for reasons unre-
lated to FLUTD, and one was euthanased
due to uroperitonitis and sepsis. In addi-
tion to surgical and post-surgical com-
plications, two cats experienced a
self-limiting recurrence of idiopathic
FLUTD that could not be attributed to
the surgical procedure.
Data for 39 cats were available over a
period greater than four weeks and for at
least four months following surgery (late
complications). This follow-up period
ranged from 0·32 to 9·6 years (mean 4·2
years, median 4·2 years). Of the remaining
20 cats, two had died in the early postoper-
ative period. One of these cats died two
weeks after surgery for unknown reasons.
FLUTD symptoms had not recurred prior
to death. The other cat died following a
road traffic accident three weeks after
surgery. The remaining 18 cats were lost to
follow-up one month after surgery.
Late complications observed were bac-
terial UTI and stricture formation. These
occurred at least once in 11 of 39 cats (28
per cent) (Table 3). Nine cats (23 per
cent), with an average age of 4·8 years
(median 4·9 years), suffered bacterial UTI.
This was symptomatic in all but two cases
in which urine culture revealed bacteria
despite a lack of clinical signs of FLUTD.
Six of these nine cats had more than one
occurrence of bacterial UTI. Of these,
between two and 10 infections per cat were
observed over a period ranging from 43 to
90 months, and 33 infections were
recorded in total. The overall incidence of
UTI for all nine cats was one infection per
14·3 cat months.
One of the nine cats with recurrent
UTI (two episodes within six months) was
euthanased at the owner’s request because
of this problem. Two cats (5 per cent)
developed stricture formation. One of
these cats had suffered stricture formation
in the early postoperative period and had
undergone corrective surgery. This cat was
euthanased at the owner’s request follow-
ing the second stricture four months after
surgery. All of the remaining six cats with
strictures as early complications enjoyed a
complication-free long-term follow-up
period after surgical revision. The second
cat, with stricture formation in the long-
term period (seven months postopera-
tively), had experienced wound dehiscence
in the early postoperative period. The
stricture was surgically revised, after which
the cat had two self-limiting episodes of
idiopathic FLUTD within two months of
surgery.
In addition to late complications, nine
of 39 cats (23 per cent) had recurring
FLUTD. Four of 39 cats (10 per cent)
were diagnosed with at least one episode of
idiopathic FLUTD during the follow-up
period. Urolithiasis was documented in
five cats (13 per cent) and consisted of
three cases of struvite and two cases of cal-
cium oxalate urolithiasis. Uroliths recurred
in one of 12 cats that had been fed a diet
prescribed to prevent urolith formation
following perineal urethrostomy. The
owners of the remaining 19 cats that were
Complications
Stricture 6
UTI 2
Stricture and UTI 1
Sepsis 2
Wound dehiscence 1
Perineal leakage of urine 1
Cellulitis 1
Death during anaesthesia 1
15 (25·4)
Recurrence of iFLUTD 2 (3·4)
No complications or
recurrence 42 (71·2)
UTI Urinary tract infection, iFLUTD Idiopathic feline lower
urinary tract disease
Outcome Number of
cats (%)
Table 2. Short-term outcome of
perineal urethrostomy in 59 cats
Complications
UTI 9
Stricture 2
11 (28·2)
Recurrence of LUTD
Urolithiasis 5
iFLUTD 4
9 (23·1)
No complications
or recurrence 19 (48·7)
UTI Urinary tract infection, LUTD Lower urinary tract
disease, iFLUTD Idiopathic feline lower urinary tract
disease
Outcome Number of
cats (%)
Table 3. Long-term outcome of
perineal urethrostomy in 39 cats
Urethral uroliths or crystals 31 (52·2)
Urethral non-mineral plug 1 (1·7)
Bacterial urinary tract infection 11 (18·6)
Idiopathic FLUTD 7 (11·9)
Urinary bladder uroliths or crystals 5 (8·5)
Urinary bladder rupture 2 (3·4)
Perineal skin infection 2 (3·4)
FLUTD Feline lower urinary tract disease
Diagnosis Number of
cats (%)
Table 1. Preoperative diagnoses of
lower urinary tract disease in 59 cats
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4. 230 JOURNAL OF SMALL ANIMAL PRACTICE • VOL 46 • MAY 2005
originally presented with crystals or
uroliths had discontinued the prescribed
diet because of poor acceptance by the cats.
In this group, uroliths recurred in four
cases.
No statistical difference in urolith
recurrence (Fisher’s exact test P=0·64, chi-
squared test P=0·467) was found between
the group that was fed prescription diets
and the group that was fed commercial
non-prescription food.
Of the 15 cats that had died or were
euthanased by the end of the study period,
11 (73 per cent) succumbed for reasons
unrelated to urinary tract disease.
Of 35 cat owners who were asked about
their satisfaction with the outcome of
surgery, two were dissatisfied and 33 (94
per cent) were satisfied. In addition, 31
clients (88·6 per cent) thought their cats
had a very good quality of life and two (6
per cent) thought their cats had only an
acceptable quality of life, due to unrelated
diseases such as asthma and stomatitis. The
remaining two clients described the quality
of life of their cats in the postoperative
period as poor. One of these cats was
euthanased because of recurring UTI and
one due to recurring urethral stricture.
DISCUSSION
Complications of perineal urethrostomy
have been described and documented in
several reports (Smith and Schiller 1978,
Hauptmann 1984, Osborne and others
1996). However, large case studies examin-
ing the outcome of cats undergoing this
procedure have not been undertaken.
Signalment and preoperative clinical
signs were similar to those previously
described in cats deemed to be candidates
for perineal urethrostomy (Griffin and Gre-
gory 1992, Osborne and others 2000). The
frequency of various uroliths was consistent
with reported frequencies for the study
period (Osborne and others 2000). In the
present study, 11 of 35 preoperative urine
samples showed bacterial growth and the
average age of cats with UTI was only 6·8
years. Bacterial UTI is an infrequent find-
ing in young and middle-aged cats
and occurs in approximately 3 per cent of
cats presented with FLUTD (Kruger and
others 1991). In contrast, up to 40 per cent
of cats over 10 years of age that are pre-
sented with FLUTD have positive bacterial
cultures (Bartges and Barsanti 2000). Pre-
disposing factors for UTI include the use of
urethral catheters (Griffin and Gregory
1992). Given that most of the cats in the
present study had been catheterised in the
preoperative period, it is possible that many
of these infections were catheter-related.ll
Previous studies have found a high
frequency of idiopathic FLUTD in both
obstructive and non-obstructive lower uri-
nary tract disease (Kruger and others 1991,
Osborne and others 2000). Perineal ure-
throstomy has been advocated for cats with
recurrent obstructive idiopathic disease,
despite the fact that FLUTD may recur
without obstruction of the distal urethra
(Kruger and Osborne 1995, Kalkstein and
others 1999a, Osborne and others 2000).
A preoperative diagnosis of idiopathic
FLUTD was made in only 12 per cent
of cats in the present study. However,
cats diagnosed with UTI in this study
may have had idiopathic FLUTD and
secondary catheter-related infections.
Stricture formation was the most fre-
quently observed early complication in
this study. Although this must be consid-
ered a serious complication necessitating
surgical correction, eight of nine cats
treated for stricture enjoyed a complica-
tion-free long-term outcome. Only one cat
suffered a second stricture, which was con-
sidered to be, in part, due to severe pre-
operative urethral trauma. Stricture of the
stoma has previously been described
within the first 12 weeks of surgery (Smith
and Schiller 1978). These authors found
that the incidence of stricture formation
following perineal urethrostomy using the
technique described by Wilson and Harri-
son (1971) was considerably lower than
that observed following any of three other
evaluated techniques (11·5 versus 25 to 50
per cent). They postulated that surgeon
inexperience, postoperative use of urethral
catheters and the animal’s grooming of the
surgical site all contributed to an increased
risk of stricture formation.
In the present study, all cats wore an
Elizabethan collar pending suture removal
and no cat was catheterised postopera-
tively. Surgeons with widely varying levels
of experience performed the surgeries. No
statistical difference in stricture formation
was found between cats operated on by a
faculty member and those operated on by
residents. However, the one cat with stric-
ture formation operated on by a faculty
member was also the animal suffering from
severe preoperative urethral trauma. A sta-
tistical difference between surgeon experi-
ence and outcome may have been masked
if faculty members operated on animals in
which surgery was perceived to be more
difficult. Stricture formation was reported
in seven of 59 cases (11·9 per cent) in the
early postoperative period (within four
weeks of surgery), which is consistent
with the incidence reported by Smith and
Schiller (1978).
Previous studies found that between 17
and 57 per cent of cats that underwent
perineal urethrostomy developed UTI
(Smith and Schiller 1978, Gregory 1987,
Osborne and others 1991, 1996, Griffin
and Gregory 1992). During the long-term
follow-up period in the present study, 23
per cent of cats developed UTI and 15 per
cent had more than one episode. Given the
young age of these cats (mean 4·8 years)
and the high frequency of recurring infec-
tions, this finding corroborates an existing
relationship between perineal urethros-
tomy and risk of UTI. Furthermore, signs
of FLUTD were not observed in all cats
with documented UTI, and urine cultures
were not performed on a regular basis in
symptom-free animals. Therefore, the fre-
quency of UTI could be higher than data
from this study suggest.
Uncommon complications, including
wound dehiscence, cellulitis and perineal
leakage of urine, were each observed in
only one cat in this study. This corrobo-
rates findings of other studies, in which
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