定期膀胱鏡輔助膀胱清潔有助於減少存留導尿管相關尿路感染
楊旻鑫1、黃玉慧2,3、 謝佐宜1,3、陳文榮1,3、王紹全1,3、陳順郎1,3
中山醫學大學附設醫院 1泌尿科 中山醫學大學 2醫學系
Regular cystoscopy-assisted bladder toilet is beneficial in catheter-associated urinary tract infection
Min-Hsin Yang1, Yu-Hui Huang2,3, Tuzo-Yi Hsieh1,3, Wen-Jung Chen1,3, Shao- Chuan Wang1,3, Sung-Lang Chen1,3,
1Department of Urology, 2Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan
3School of Medicine, Chung Shan Medical University, Taichung, Taiwan
Purpose: The aim of this study was to investigate the effect of regular cystoscopy assisted bladder debris evacuation on catheter associated urinary tract infection.
Materials and Methods: A total of 35 patients underwent long term urethra catheterization due to neurogenic (spinal cord injury, pelvic surgery and diabetes) origins and failed to practice clean intermittent catheterization by themselves or caregivers were enrolled and followed-up for at least 2 years. They received urethra catheter change program every 21-28 days. Cystoscopy assisted bladder debris evacuation (bladder toilet) was undergone every other change catheter course. Thirty-two patients also with long term catheterization underwent only change urethra catheter were compared as controls. UTI events were traced by medical chart and patient interview during follow-up. Major UTI definition was episode that cause patient admission or significant pyresis (>38’C). Minor UTI was turbid urine, ordered urine or deep colored urine and new onset of voiding problems, kidney or bladder discomfort and autonomic dysreflexia without other causes in spinal cord injured (SCI) patients.
Results: Bladder toilet group consisted of 10 SCI, 8 frail elder, 9 CVA with bed ridden and 8 status post pelvic surgery and R/T patients. Urethra catheter change only group was composed of 6 SCI, 6 frail elder, 5 CVA with bed ridden, 10 pelvic surgery and R/T and 5 dementia patients. There were 25 males and 10 females in bladder toilet group and 20 males and 12 females in control (No significant difference in genders between two groups, p=0.44). Bladder toilet group presented with less major UTIs than control group, however the difference was not significant (p=0.73). Bladder toilet group actually decreased minor UTIs frequency comparing with control group (p=0.039).
Conclusion: CAUTI rate was decreased with carefully evacuated bladder debris and post void residual. Regular cystoscopy assisted bladder toilet is beneficial in CAUTI.