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Standard Versus Hydrophilic Catheterization in the Adjuvant Treatment of Patients With Superficial Bladder Cancer
0022-5347/05/1735-1598/0 THE JOURNAL OF UROLOGY® Copyright © 2005 by AMERICAN UROLOGICAL ASSOCIATION
Vol. 173, 1598 –1600, May 2005 Printed in U.S.A.
DOI: 10.1097/01.ju.0000157347.41249.c5
Urological Survey INFECTION AND INFLAMMATION OF THE GENITOURINARY TRACT Standard Versus Hydrophilic Catheterization in the Adjuvant Treatment of Patients With Superficial Bladder Cancer L. CINDOLO, E. A. PALMIERI, R. AUTORINO, L. SALZANO University, Naples, Italy
AND
V. ALTIERI, Department of Urology, Federico II
Urol Int, 73: 19 –22, 2004 Permission to Publish Abstract Not Granted Comparison of Topical Anesthetics and Lubricants Prior to Urethral Catheterization in Males: A Randomized Controlled Trial J. SIDERIAS, F. GUADIO AND A. J. SINGER, Department of Emergency Medicine, Stony Brook University and Medical Center, Stony Brook, New York Acad Emerg Med, 11: 703–706, 2004 Although male urethral catheterization in the emergency department (ED) is both common and painful, few studies have evaluated the use of topical anesthesia prior to catheterization. OBJECTIVES: To determine whether pretreatment of the urethra with topical lidocaine reduces the pain associated with urethral catheterization. METHODS: This was a prospective, double-blind, randomized clinical trial of 36 alert, cooperative male adult patients requiring urethral catheterization, without allergies to the study medications or contraindications to their use, from a suburban university-based ED. Patients in the experimental group had topical lidocaine 2% gel injected in their urethras, whereas control patients received intraurethral lubrication only. Standardized catheterization with a no. 16 Foley was performed followed by pain assessment. The primary outcome measured was pain of catheterization on a 100-mm visual analog scale. Other outcomes included ease of insertion and procedural bleeding. RESULTS: The authors evaluated 36 patients evenly distributed between study groups. Mean age was 62 years (range 22– 85). Compared with controls, patients pretreated with lidocaine experienced significantly less pain of catheterization (38 ⫹/⫺ 28 mm vs. 58 ⫹/⫺ 30 mm; mean difference 20 mm; 95% confidence interval [95% CI] ⫽ 0.4 to 32; p ⫽ 0.04) and less pain of injection (23 ⫹/⫺ 17 mm vs. 40 ⫹/⫺ 25 mm; mean difference 17 mm; 95% CI ⫽ 3 to 32 mm; p ⫽ 0.02). There were no differences in the number of attempts and incidence of adverse events between the groups. CONCLUSIONS: Use of topical lidocaine gel reduces the pain associated with male urethral catheterization in comparison with topical lubricants only. Editorial Comment: These 2 articles address the issue of comfort in male catheterization. The bottom line is that lidocaine lubricant and hydrophilic catheters decrease the discomfort of urethral catheterization in men. This effect can be important, especially in first catheterizations when anxiety is highest and the clinical tone for compliance with treatment is set. Cindolo et al found that post-catheterization infection was decreased with hydrophilic catheters. Richard E. Berger, M.D. Studying the Quality of Life and Life Satisfaction Among Persons With Spinal Cord Injury Undergoing Urinary Management B. BRILLHART, Arizona State University, College of Nursing, Tempe, Arizona Rehabil Nurs, 29: 122–126, 2004 Permission to Publish Abstract Not Granted Editorial Comment: Quality of life (QOL) in 230 patients with spinal injury was unrelated to type of urinary treatment but was better in those without skin problems due to urinary leakage. QOL was related to ability to work, attend school and participate in activities, and lack of skin problems due to urinary leakage. Although preservation of renal function is, indeed, important, a method of urinary drainage that allows maximization of activities and prevents leakage will improve patient QOL. Richard E. Berger, M.D. 1598
Vol. 173, 1598 –1600, May 2005 Printed in U.S.A.
DOI: 10.1097/01.ju.0000157347.41249.c5
Urological Survey INFECTION AND INFLAMMATION OF THE GENITOURINARY TRACT Standard Versus Hydrophilic Catheterization in the Adjuvant Treatment of Patients With Superficial Bladder Cancer L. CINDOLO, E. A. PALMIERI, R. AUTORINO, L. SALZANO University, Naples, Italy
AND
V. ALTIERI, Department of Urology, Federico II
Urol Int, 73: 19 –22, 2004 Permission to Publish Abstract Not Granted Comparison of Topical Anesthetics and Lubricants Prior to Urethral Catheterization in Males: A Randomized Controlled Trial J. SIDERIAS, F. GUADIO AND A. J. SINGER, Department of Emergency Medicine, Stony Brook University and Medical Center, Stony Brook, New York Acad Emerg Med, 11: 703–706, 2004 Although male urethral catheterization in the emergency department (ED) is both common and painful, few studies have evaluated the use of topical anesthesia prior to catheterization. OBJECTIVES: To determine whether pretreatment of the urethra with topical lidocaine reduces the pain associated with urethral catheterization. METHODS: This was a prospective, double-blind, randomized clinical trial of 36 alert, cooperative male adult patients requiring urethral catheterization, without allergies to the study medications or contraindications to their use, from a suburban university-based ED. Patients in the experimental group had topical lidocaine 2% gel injected in their urethras, whereas control patients received intraurethral lubrication only. Standardized catheterization with a no. 16 Foley was performed followed by pain assessment. The primary outcome measured was pain of catheterization on a 100-mm visual analog scale. Other outcomes included ease of insertion and procedural bleeding. RESULTS: The authors evaluated 36 patients evenly distributed between study groups. Mean age was 62 years (range 22– 85). Compared with controls, patients pretreated with lidocaine experienced significantly less pain of catheterization (38 ⫹/⫺ 28 mm vs. 58 ⫹/⫺ 30 mm; mean difference 20 mm; 95% confidence interval [95% CI] ⫽ 0.4 to 32; p ⫽ 0.04) and less pain of injection (23 ⫹/⫺ 17 mm vs. 40 ⫹/⫺ 25 mm; mean difference 17 mm; 95% CI ⫽ 3 to 32 mm; p ⫽ 0.02). There were no differences in the number of attempts and incidence of adverse events between the groups. CONCLUSIONS: Use of topical lidocaine gel reduces the pain associated with male urethral catheterization in comparison with topical lubricants only. Editorial Comment: These 2 articles address the issue of comfort in male catheterization. The bottom line is that lidocaine lubricant and hydrophilic catheters decrease the discomfort of urethral catheterization in men. This effect can be important, especially in first catheterizations when anxiety is highest and the clinical tone for compliance with treatment is set. Cindolo et al found that post-catheterization infection was decreased with hydrophilic catheters. Richard E. Berger, M.D. Studying the Quality of Life and Life Satisfaction Among Persons With Spinal Cord Injury Undergoing Urinary Management B. BRILLHART, Arizona State University, College of Nursing, Tempe, Arizona Rehabil Nurs, 29: 122–126, 2004 Permission to Publish Abstract Not Granted Editorial Comment: Quality of life (QOL) in 230 patients with spinal injury was unrelated to type of urinary treatment but was better in those without skin problems due to urinary leakage. QOL was related to ability to work, attend school and participate in activities, and lack of skin problems due to urinary leakage. Although preservation of renal function is, indeed, important, a method of urinary drainage that allows maximization of activities and prevents leakage will improve patient QOL. Richard E. Berger, M.D. 1598