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Expert Review

Lowering Urinary Tract Infections Associated with Urethral Procedures

Urology 2015

Questions and Answers 2/3 – Obstetrician / Gynecologist’s Perspective

Wynne I. Leung, BSc, MD, FRCSC
Obstetrics and Gynaecology, Rockyview Hospital
Clinical Assistant Professor, University of Calgary, Calgary, Alberta

3 Q’s & A’s

Q. For endourethral procedures, is it attractive to employ gels with both antimicrobial and lubricating properties to reduce a pro-inflammatory insult to the urethral mucus membrane?

A. The use of gels for introducing a Foley catheter or any other device into the urethra may be attractive, but it is an empirical practice. There are no well-controlled trials to compare gels with different properties or to compare gels to no gel, but there is a rationale for lubrication to improve patient comfort as well as a rationale for employing a gel with antimicrobial properties to reduce risk of introducing microorganisms into the urinary tract. It can be speculated that lubrication will reduce friction on the mucosal lining of the urethra, a potential risk for modifying host defenses to infection. This may be of even greater benefit to the delicate mucosa in postmenopausal women. It is often difficult to avoid vagina flora contaminating an endourethral procedure in females; a gel with antimicrobial properties is a reasonable strategy within other steps to prevent UTI.

Q. Gels with anesthetic activity would be expected to improve the experience for patients undergoing endourethral procedures but could these gels also ease insertion and thereby preserve the integrity of the mucus membrane?

A. Again, there is a rationale for empirical use of a lubricating gel with anesthetic activity to improve patient comfort. The value of a gel that includes a mild topical anesthetic to reduce risk of injury to the mucosa, thereby reducing risk of UTI, has not been evaluated objectively, so no definitive answer can be provided regarding clinical benefit, but such an approach may be reasonable for the potential benefits added to the primary objective of improving patient comfort. My experience of endourethral procedures in an awake patient is largely limited to pregnant and post-partum women experiencing difficulty voiding. A lubricating gel in itself would help preserve the integrity of the mucosa and also decrease discomfort, but the additional comfort from a mild topical anesthetic would be of benefit in these situations.

Q. For patients who perform self-catheterization, can lubrication gels that combine antisepsis and anesthesia improve the experience as well as be part of a strategy to reduce infection risk?

A. Many patients performing self-catheterization are likely to prefer a lubricating gel for its role in easing insertion of the device. Patients may also gravitate toward a gel that offers topical analgesia to reduce discomfort and appreciate the potential of antimicrobial action to reduce risk of UTI. Caution would be advised to patients on the use of anesthetic gels in self-catheterization. First, sensory feedback is useful to insert the catheter in the correct location and at the correct angle. Lack of sensation in a person who is not completely familiar with the procedure may lead to unintentional urethral injury. A lubricating gel that also has antimicrobial properties would be more attractive in this setting as the anatomic location of the urethra can make it difficult to maintain a sterile field and still manipulate the catheter properly. Clinical trials are needed to advocate these gels on an evidence basis, but in certain circumstances patients may find reassurance in lubricating gels with properties that offer additional potential benefits.

Disclaimer

The information and opinions expressed herein are those of the participants and do not necessarily reflect those of Xfacto Communications Inc. or the sponsor. The distribution of this meeting report was made possible through industry support under written agreement that ensures editorial independence. The content is for educational purposes and should not be taken as an endorsement of any products, uses or doses. Physicians should consult the appropriate monograph before prescribing any drugs. Distribution, reproduction, alteration of this program is strictly prohibited without written consent of Xfacto Communications Inc. Copyright 2021. All rights reserved. The Medical XchangeTM

Chapter 1: Reducing UTIs Associated with Urethral Procedures: Concepts and Strategies

Urinary tract infections (UTIs) are a common iatrogenic complication of diagnostic and therapeutic procedures involving urethral manipulation, such as catheterization or cystoscopy. Due to the potential for UTIs to incur additional healthcare costs, adversely affect outcome, and diminish patient satisfaction, steps to reduce risk are warranted in both males and females. Simple steps surrounding the performance of endourethral procedures, such as employing antimicrobial prophylaxis and minimizing injury and trauma to the urethral endothelium through lubricants and anaesthesia, offer opportunities to reduce the risk of infection over that provided by standard infection control practice alone. Many of these steps are well known but applied inconsistently. In performing diagnostic or therapeutic procedures involving the urethra, rigorously implemented UTI risk reduction assures high standards of quality of care.

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Questions and Answers 3/3 – Surgeon’s Perspective

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