Naser-Tavakolian Aurash, Masterson John M, Dallmer Jeremiah, Bresee Catherine, Zaliznyak Michael, Zhao Hanson, Sandhu Sandeep, Garcia Maurice M
Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Biostatistics Shared Resources, Cedars-Sinai Samuel Oschin Comprehensive Cancer Center, Los Angeles, CA, USA.
J Surg Res (Houst). 2023;6(3):317-322. doi: 10.26502/jsr.10020316. Epub 2023 Sep 19.
Reconstructive urologists often place both a urethral and suprapubic catheter intraoperatively to prevent extravasation of undrained urine across anastomosis sutures. As no consensus exists on which catheter drains the bladder more completely, many surgeons leave one catheter to gravity drainage and cap the other postoperatively. We sought to identify differences in catheter urine outflow during dual bladder drainage with suprapubic and urethral catheters in postoperative urology patients.
Urine output (UOP) from transgender men who underwent Stage II Phalloplasty with urethral lengthening was retrospectively reviewed. Both 16 French urethral and suprapubic catheters were placed to gravity drainage postoperatively. Urine output from each catheter was recorded separately, twice daily. Mixed model regression modeling tested for differences in urine output by time of day (day/night) and activity status (Bedrest: Postop Day 0-2, Ambulatory: Postop Day 3+).
The aggregate number of 12-hour shift urine output observations was 250 (125 for urethral and 125 for suprapubic catheters) across 14 inpatients. Suprapubic catheters had a mean 410 ml higher output than urethral catheters per 12-hour shift (p=0.002; 95% CI: 185, 636 ml). During daytime, Suprapubic catheters demonstrated higher UOP than urethral catheters per 12-hour shift (Estimated Difference: 464 ml; p=0.002; 95% CI: 211, 718 ml). During nighttime, a similar phenomenon was observed (Estimated Difference: 356 ml; p=0.009; 95% CI: 104, 606 ml). When comparing mean UOP from each catheter during the Bedrest Phase, suprapubic catheters averaged an estimated 295 ml higher UOP compared to urethral catheters per 12-hour shift with a trend toward statistical significance (p=0.052; 95% CI -3, 594 ml). During the Ambulatory Phase, mean suprapubic catheter UOP was an estimated 472 ml higher than urethral catheters per 12-hour shift (p=0.009; 95% CI 142, 802 ml).
Simultaneous bladder drainage with urethral and suprapubic catheters shows greater drainage from the suprapubic catheter (35% vs 65%). When using two catheters, both can be placed to gravity to maximize bladder drainage as the suprapubic catheter can drain residual urine not adequately drained by the urethral catheter.
重建泌尿外科医生常在术中同时放置尿道导管和耻骨上导管，以防止未引流尿液经吻合缝线外渗。由于对于哪种导管能更彻底地引流膀胱尚无共识，许多外科医生术后将一根导管留作重力引流，另一根则封堵。我们试图确定泌尿外科术后患者使用耻骨上导管和尿道导管进行双膀胱引流时，导管尿液流出量的差异。
回顾性分析接受二期阴茎延长术的变性男性的尿量（UOP）。术后将16法式尿道导管和耻骨上导管均留作重力引流。每天两次分别记录每个导管的尿量。混合模型回归建模测试了按一天中的时间（白天/夜晚）和活动状态（卧床休息：术后第0 - 2天，活动：术后第3天及以后）划分的尿量差异。
14名住院患者12小时轮班尿量观察总数为250次（尿道导管125次，耻骨上导管125次）。耻骨上导管每12小时轮班的平均尿量比尿道导管高410毫升（p = 0.002；95%置信区间：185，636毫升）。白天，耻骨上导管每12小时轮班的尿量高于尿道导管（估计差异：464毫升；p = 0.002；95%置信区间：211，718毫升）。夜间也观察到类似现象（估计差异：356毫升；p = 0.009；95%置信区间：104，606毫升）。比较卧床休息阶段每个导管的平均尿量时，耻骨上导管每12小时轮班的平均尿量比尿道导管估计高295毫升，有统计学意义的趋势（p = 0.052；95%置信区间 - 3，594毫升）。在活动阶段，耻骨上导管每12小时轮班的平均尿量比尿道导管估计高472毫升（p = 0.009；95%置信区间142，802毫升）。
尿道导管和耻骨上导管同时进行膀胱引流时，耻骨上导管的引流效果更佳（35%对65%）。使用两根导管时，两根导管均可留作重力引流以最大化膀胱引流，因为耻骨上导管可引流尿道导管未充分引流的残余尿液。
