Thomas Arun Z, Giri Subhasis K, Meagher David, Creagh Tom
Department of Urology and Renal Transplantation, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland.
BJU Int. 2009 Oct;104(8):1109-12. doi: 10.1111/j.1464-410X.2009.08494.x. Epub 2009 Mar 10.
To examine the magnitude of potentially avoidable iatrogenic complications of male urethral catheterization (UC) within a tertiary-care supra-regional teaching hospital, and to evaluate risk factors and subjective feeling of interns in our institution on the adequacy of training on UC.
Male UC-related morbidities were retrospectively identified from our computerized inpatient urology consultation system over a 1-year period from July 2006 to June 2007. Relevant medical records were also reviewed. An anonymous questionnaire was used for the subjective assessment of interns about their training on UC. The primary outcome measures were the prevalence of urethral trauma secondary to UC by a non-urological team member in non-urological departments, risk factors and intern-perceived adequacy of practical and theoretical training on UC during their intern year, and finally the supervision of interns during first UC.
Of 864 urological consultations, 51 (6%) were related to complications arising from male UC during the 1-year period. The most common indication for UC was monitoring urinary output for acute medical illness (34/51, 67%). The most common complication was urethral trauma (35/51, 67%). The balloon was accidentally inflated in the urethra in six patients (12%). Of the 51 cases of UC-related morbidity, 38 (74%) resulted from interns performing UC, and of these 28 (73%) occurred during the first 6 months of internship. Overall, 76% of interns felt that their practical training was none or inadequate; 52% (26/50) did not receive any supervision during their first UC.
UC-related iatrogenic morbidity is not uncommon even in a tertiary-care teaching hospital. This study identified that interns receive inadequate training on UC. Finally, most of the complications are potentially avoidable and can be prevented by adopting a proper technique of catheterization. Adequate training and supervision of medical students and interns can achieve this.
在一家三级区域教学医院中，研究男性尿道插管（UC）潜在可避免的医源性并发症的严重程度，并评估本院实习医生关于UC培训充分性的风险因素和主观感受。
从2006年7月至2007年6月的1年时间里，通过我们的计算机化住院泌尿外科会诊系统回顾性确定男性UC相关的发病率。同时查阅相关病历。使用匿名问卷对实习医生关于UC培训进行主观评估。主要观察指标为非泌尿外科科室非泌尿外科团队成员进行UC继发尿道创伤的患病率、风险因素以及实习医生在实习期间对UC实践和理论培训的自我感觉充分性，最后是首次UC期间对实习医生的监督情况。
在864次泌尿外科会诊中，1年期间有51次（6%）与男性UC引起的并发症有关。UC最常见的指征是监测急性内科疾病的尿量（34/51，67%）。最常见的并发症是尿道创伤（35/51，67%）。6例患者（12%）气囊意外在尿道内膨胀。在51例UC相关发病病例中，38例（74%）是实习医生进行UC导致的，其中28例（73%）发生在实习的前6个月。总体而言，76%的实习医生觉得他们的实践培训没有或不充分；52%（26/50）在首次UC期间没有得到任何监督。
即使在三级教学医院，UC相关的医源性发病也并不少见。本研究发现实习医生接受的UC培训不足。最后，大多数并发症是潜在可避免的，采用正确的插管技术可预防。对医学生和实习医生进行充分培训和监督可实现这一点。
