RESUMO
Background To assess the effectiveness and harms of music to reduce anxiety and pain in cystoscopy. Methods We searched MEDLINE (OVID), EMBASE, LILACS and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to nowadays. We included clinical trials, involving the assessment of the effect of music in cystoscopy. The primary outcomes were pain and anxiety measured by any scale and the secondary outcomes were length of stay, physiological parameters (blood pressure or heart rate) and adverse effects. Cochrane Collaboration tool was used to assess the risk of bias. We performed the statistical analysis in R and reported information about mean difference (MD) with 95% CI. Heterogeneity was evaluated using the I2 test. Results We included six studies in our qualitative and quantitative analysis. Five studies used a flexible cystoscope and the other one performed the procedure with a rigid cystoscope. Music was played during the procedure in five studies, while the other was before it. All studies compared music vs. no intervention. Almost all items were assessed as low risk of bias; however, the allocation concealment was unclear in all the studies. We found a MD of -1.33 (95% CI -2.45 to -0.21) (I2=97.2%) favoring music for pain and a MD of -8.42 (95% CI -15.02, -1.82) (I2=99.6%) was found, favoring music for anxiety. Conclusions Playing music might be an effective intervention that lowers pain and anxiety in patients who undergo cystoscopy.
Assuntos
Transtornos de Ansiedade/terapia , Cistoscopia/efeitos adversos , Musicoterapia , Manejo da Dor , Transtornos de Ansiedade/etiologia , Transtornos de Ansiedade/fisiopatologia , Transtornos de Ansiedade/psicologia , Pressão Sanguínea , Estudos de Avaliação como Assunto , Frequência Cardíaca , Humanos , Dor/etiologia , Dor/fisiopatologia , Dor/psicologia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
The aim of the study was to determine the risk of urinary tract infection (UTI) following rigid cystoscopy in outpatients with positive urine culture and antibiotic treatment compared to outpatients with negative urine culture and without antibiotic prophylaxis. A prospective pilot study in two groups of patients was conducted in a third-level hospital in Cali, Colombia. Group 1 comprised asymptomatic patients with positive urine culture and group 2 were asymptomatic patients with sterile urine. UTI and urosepsis were assessed after seven and 30 days. Eighty-nine patients, 13 from group 1 and 76 from group 2, were followed up in this pilot study. General incidence of UTI at the seventh or 30th day was 4.5% (4/89). There were no statistically significant differences in risk of UTI or urosepsis at the seventh or 30th day between the two groups. The risk of UTI following rigid cystoscopy in outpatients with positive urine culture and antibiotic treatment did not differ significantly from the risk in outpatients with negative urine culture without antibiotic prophylaxis at day 7 and 30.
Assuntos
Cistoscopia/efeitos adversos , Hospitais Universitários , Pacientes Ambulatoriais , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Adolescente , Adulto , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Colômbia/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Urinárias/diagnósticoRESUMO
BACKGROUND: Flexible cystoscopy is a common test in clinical practice done with or without antibiotic prophylaxis. AIM: To evaluate the efficacy of antibiotic prophylaxis with ciprofloxacin to reduce the incidence of urinary infection. MATERIAL AND METHODS: Prospective, non-randomized observational study that included 60 patients divided into two groups. Group 1 received prophylactic ciprofloxacin 500 mg, one hour prior to the procedure and group 2 did not receive prophylaxis. The presence of bacteriuria, symptoms or signs of urinary infection or attending Emergency rooms or primary care for these symptoms were recorded during the seven days after the cystoscopy. RESULTS: In groups 1 and 2, four and one patients had a positive urine culture, respectively. Only one patient in group 1 consulted in primary care for symptoms. No significant differences in symptoms or signs of urinary infection between groups were observed. CONCLUSIONS: In this group of patients, antibiotic prophylaxis with ciprofloxacin 500 mg prior to cystoscopy had no benefit.
Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Bacteriúria/prevenção & controle , Ciprofloxacina/uso terapêutico , Cistoscopia/efeitos adversos , Infecções Urinárias/prevenção & controle , Idoso , Bacteriúria/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Urinárias/microbiologiaRESUMO
Background: Flexible cystoscopy is a common test in clinical practice done with or without antibiotic prophylaxis. Aim: To evaluate the efficacy of antibiotic prophylaxis with ciprofloxacin to reduce the incidence of urinary infection. Material and Methods: Prospective, non-randomized observational study that included 60 patients divided into two groups. Group 1 received prophylactic ciprofloxacin 500 mg, one hour prior to the procedure and group 2 did not receive prophylaxis. The presence of bacteriuria, symptoms or signs of urinary infection or attending Emergency rooms or primary care for these symptoms were recorded during the seven days after the cystoscopy. Results: In groups 1 and 2, four and one patients had a positive urine culture, respectively. Only one patient in group 1 consulted in primary care for symptoms. No significant differences in symptoms or signs of urinary infection between groups were observed. Conclusions: In this group of patients, antibiotic prophylaxis with ciprofloxacin 500 mg prior to cystoscopy had no benefit.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Bacteriúria/prevenção & controle , Ciprofloxacina/uso terapêutico , Cistoscopia/efeitos adversos , Infecções Urinárias/prevenção & controle , Bacteriúria/microbiologia , Estudos Prospectivos , Infecções Urinárias/microbiologiaRESUMO
OBJECTIVE: To estimate the efficacy of antibiotic prophylaxis to prevent urinary tract infection in patients (both gender) who undergo a cystoscopy with sterile urine. MATERIALS AND METHODS: Search strategy (January 1980-December 2013) in Medline via PubMed, CENTRAL, and EMBASE. Additionally, we searched databases for registered trials and conference abstracts, as well as reference lists of systematic reviews and included studies. Seven published randomized clinical trials (January 1, 1980 to December 31, 2013) were included in quantitative analyses with no language restrictions. Two independent reviewers collected data. Risk of bias was evaluated with the Cochrane Collaboration tool. We performed a fixed effect analyses due to statistical homogeneity. The primary outcome was urinary tract infection and the secondary was asymptomatic bacteriuria. The effect measure was the risk difference (RD) with 95% confidence interval. The planned interventions were: Antibiotic vs placebo; Antibiotic vs no intervention and Antibiotic vs any other intervention. RESULTS: 3038 patients were found in seven studies. For the primary outcome, we included 5 studies and we found a RR 0.53 CI95% (0.31, 0.90) and a RD-0.012 CI95% (-0.023,-0.002), favoring antibiotic prophylaxis. For asymptomatic bacteriuria we included 6 studies and we found a RR 0.28 CI95% (0.20, 0.39) and a RD-0.055 CI95% (-0.07,-0.039), was found favoring prophylaxis. According to GRADE evaluation, we considered moderate quality of evidence for both outcomes. The subgroup analysis showed that only two studies were classified as having low risk of bias: Cam 2009 and Garcia-Perdomo 2013. They showed no statistical differences (RD-0.009 CI95% -0.03, 0.011). CONCLUSIONS: Based on studies classified as low risk of bias, we found moderate evidence to not recommend the use of antibiotic prophylaxis to prevent urinary tract infection and asymptomatic bacteriuria in patients who undergo cystoscopy with sterile urine in an ambulatory setting.
Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Cistoscopia/efeitos adversos , Infecções Urinárias/prevenção & controle , Idoso , Cistoscopia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Viés de Publicação , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Infecções Urinárias/tratamento farmacológicoRESUMO
To estimate the efficacy of antibiotic prophylaxis to prevent urinary tract infection in patients (both gender) who undergo a cystoscopy with sterile urine.
Search strategy (January 1980-December 2013) in Medline via PubMed, CENTRAL, and EMBASE. Additionally, we searched databases for registered trials and conference abstracts, as well as reference lists of systematic reviews and included studies. Seven published randomized clinical trials (January 1, 1980 to December 31, 2013) were included in quantitative analyses with no language restrictions. Two independent reviewers collected data. Risk of bias was evaluated with the Cochrane Collaboration tool. We performed a fixed effect analyses due to statistical homogeneity. The primary outcome was urinary tract infection and the secondary was asymptomatic bacteriuria. The effect measure was the risk difference (RD) with 95% confidence interval. The planned interventions were: Antibiotic vs placebo; Antibiotic vs no intervention and Antibiotic vs any other intervention.
3038 patients were found in seven studies. For the primary outcome, we included 5 studies and we found a RR 0.53 CI95% (0.31, 0.90) and a RD-0.012 CI95% (-0.023,-0.002), favoring antibiotic prophylaxis. For asymptomatic bacteriuria we included 6 studies and we found a RR 0.28 CI95% (0.20, 0.39) and a RD-0.055 CI95% (-0.07,-0.039), was found favoring prophylaxis. According to GRADE evaluation, we considered moderate quality of evidence for both outcomes. The subgroup analysis showed that only two studies were classified as having low risk of bias: Cam 2009 and García-Perdomo 2013. They showed no statistical differences (RD-0.009 CI95% -0.03, 0.011).
Based on studies classified as low risk of bias, we found moderate evidence to not recommend ...
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Cistoscopia/efeitos adversos , Infecções Urinárias/prevenção & controle , Cistoscopia/métodos , Viés de Publicação , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Infecções Urinárias/tratamento farmacológicoRESUMO
OBJECTIVE: To prospectively evaluate self-reported pain levels associated with diagnostic cystoscopy. MATERIALS AND METHODS: Patients who underwent diagnostic cystoscopy and subsequently graded their pain level during the procedure were enrolled. Pain was graded on a Likert visual analog scale (VAS) of 1-10 where 0 = no pain and 10 = excruciating unbearable pain. Local lidocaine gel 2% was used as intraurethral lubricant. RESULTS: Data from 1320 consecutive cystoscopies (929 males, 391 females, age range 15-93 years) between 6/2009-1/2010 were analyzed. This was the first cystoscopy for 814 patients. The overall mean VAS was 2.74 ± 1.51 (range 0-9) for rigid cystoscopy and 2.48 ± 1.53 (range 0-10) for flexible cystoscopy (P = 0.004). The reported mean pain level for first-time cystoscopy was significantly higher than that for repeat cystoscopy (2.8 ± 1.6 vs. 2.2 ± 1.4, P < 0.001), regardless of gender or type of cystoscope. Men reported significantly higher pain levels than women 2.6 ± 1.5 vs. 2.4 ± 1.4 (P < 0.04). The highest mean pain level was reported by men (3.4 ± 1.6) and women (2.5 ± 1.6) for rigid cystoscopy compared to flexible cystoscopy (2.5 ± 1.4 and 1.1 ± 1.9, respectively, P < 0.001). Pain levels > 5 were reported in 75 (5.7%) cystoscopies. CONCLUSIONS: Cystoscopy was not associated with distressing levels of pain. Pain levels during first cystoscopies were higher than those for repeated ones. Using a flexible cystoscope is associated with a lower pain level in both men and women and it should be used for both genders.
Assuntos
Cistoscopia/efeitos adversos , Medição da Dor/métodos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/uso terapêutico , Cistoscópios , Cistoscopia/instrumentação , Feminino , Géis , Humanos , Lidocaína/uso terapêutico , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Autorrelato , Fatores Sexuais , Fatores de Tempo , Adulto JovemRESUMO
Objective To prospectively evaluate self-reported pain levels associated with diagnostic cystoscopy. Materials and Methods Patients who underwent diagnostic cystoscopy and subsequently graded their pain level during the procedure were enrolled. Pain was graded on a Likert visual analog scale (VAS) of 1-10 where 0 = no pain and 10 = excruciating unbearable pain. Local lidocaine gel 2% was used as intraurethral lubricant. Results Data from 1320 consecutive cystoscopies (929 males, 391 females, age range 15-93 years) between 6/2009-1/2010 were analyzed. This was the first cystoscopy for 814 patients. The overall mean VAS was 2.74 ± 1.51 (range 0-9) for rigid cystoscopy and 2.48 ± 1.53 (range 0-10) for flexible cystoscopy (P = 0.004). The reported mean pain level for first-time cystoscopy was significantly higher than that for repeat cystoscopy (2.8 ± 1.6 vs. 2.2 ± 1.4, P < 0.001), regardless of gender or type of cystoscope. Men reported significantly higher pain levels than women 2.6 ± 1.5 vs. 2.4 ± 1.4 (P < 0.04). The highest mean pain level was reported by men (3.4 ± 1.6) and women (2.5 ± 1.6) for rigid cystoscopy compared to flexible cystoscopy (2.5 ± 1.4 and 1.1 ± 1.9, respectively, P < 0.001). Pain levels > 5 were reported in 75 (5.7%) cystoscopies. Conclusions Cystoscopy was not associated with distressing levels of pain. Pain levels during first cystoscopies were higher than those for repeated ones. Using a flexible cystoscope is associated with a lower pain level in both men and women and it should be used for both genders. .
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Cistoscopia/efeitos adversos , Medição da Dor/métodos , Fatores Etários , Anestésicos Locais/uso terapêutico , Cistoscópios , Cistoscopia/instrumentação , Géis , Lidocaína/uso terapêutico , Análise Multivariada , Autorrelato , Fatores Sexuais , Fatores de TempoAssuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ácido Aminolevulínico , Carcinoma/diagnóstico , Cistoscopia/métodos , Fluorescência , Neoplasias da Bexiga Urinária/diagnóstico , Administração Intravesical , Algoritmos , Ácido Aminolevulínico/administração & dosagem , Ácido Aminolevulínico/efeitos adversos , Carcinoma/cirurgia , Cistoscopia/efeitos adversos , Intervalo Livre de Doença , Método Duplo-Cego , Placebos , Prognóstico , Neoplasias da Bexiga Urinária/cirurgiaRESUMO
PURPOSE: Personnel at the New Mexico Department of Health investigated a Pseudomonas aeruginosa outbreak potentially associated with outpatient cystoscopy performed by a urologist during January 1 to April 22, 2007. MATERIALS AND METHODS: We compared infection rates with baseline rates, reviewed infection control procedures and performed environmental sampling at the urologist office. We also performed a case-control study. Cases had blood or urine cultures positive for P. aeruginosa during January 1 to April 22, 2007. Controls had blood or urine cultures ordered through the same laboratory. Clinical and environmental isolates were typed by pulsed field gel electrophoresis. RESULTS: A total of 23 case-patients were identified, including 17 with urinary tract infections alone, 2 with bacteremia alone and 4 with urinary tract infections plus bacteremia. Seven case-patients experienced P. aeruginosa infection after cystoscopy was performed by this urologist. On multivariate analysis cystoscopy done by this urologist was the strongest risk factor for positive P. aeruginosa culture (OR 46.5, 95% confidence limits 3.1, 705). Recent hospitalization, having a urinary catheter and age 75 years or older were also independently associated with case status. Multiple breaches in cystoscope reprocessing procedures were identified. The urologist cystoscope was culture positive for P. aeruginosa. All 4 available clinical isolates from patients in whom cystoscopy was done by this urologist had pulsed field gel electrophoresis patterns identical to those of specimens from the cystoscope. The implementation of proper reprocessing methods terminated the outbreak. CONCLUSIONS: Our investigation implicated a contaminated cystoscope as the likely source of these infections. Health care personnel who disinfect cystoscopes should follow manufacturer recommendations and guidelines on reprocessing flexible endoscopes. The development of cystoscope specific guidelines might promote increased compliance with correct reprocessing procedures.
Assuntos
Cistoscópios/microbiologia , Cistoscopia/estatística & dados numéricos , Surtos de Doenças/estatística & dados numéricos , Infecções por Pseudomonas/epidemiologia , Pseudomonas aeruginosa/isolamento & purificação , Distribuição por Idade , Idoso , Estudos de Casos e Controles , Intervalos de Confiança , Cistoscopia/efeitos adversos , Cistoscopia/métodos , Contaminação de Equipamentos , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , New Mexico/epidemiologia , Razão de Chances , Infecções por Pseudomonas/etiologia , Valores de Referência , Distribuição por SexoAssuntos
Humanos , Masculino , Feminino , Candida albicans/isolamento & purificação , Candida/isolamento & purificação , Pielonefrite/parasitologia , Cistite/parasitologia , Candidíase/diagnóstico , Candida albicans/patogenicidade , Candida/patogenicidade , Pielonefrite/etiologia , Cistite/etiologia , Urina/parasitologia , Causalidade , Obstrução Uretral/complicações , Bexiga Urinaria Neurogênica/complicações , Hiperplasia Prostática/complicações , Diabetes Mellitus/complicações , Cateterismo Urinário/efeitos adversos , Cistoscopia/efeitos adversos , Manejo de EspécimesRESUMO
Eighty-one consecutive flexible cystoscopic examinations were performed on 69 patients with spinal cord injury (SCI) at the time of their urodynamic study. The indications for cystoscopy included hematuria, recurrent urinary tract infections, symptoms of bladder outlet obstruction, the presence of an intraurethral sphincter stent requiring evaluation, neurogenic vesical dysfunction requiring endourodynamic study (cystometrogram through the working port of the flexible cystoscope), or bladder calculi. Flexible cystoscopy was accomplished in all patients, whether lying supine or seated in a wheelchair (N = 16). Only 6 of 39 patients with previous episodes of autonomic dysreflexia became hypertensive during cystoscopy. When a urodynamic catheter could not be inserted, the flexible cystoscope was particularly useful in defining the urethral anatomy or obstruction and in performing endourodynamic evaluation. The only complication was the development of febrile urinary tract infection in four patients. The flexible cystoscope is a valuable tool in the urodynamic laboratory caring for patients with SCI and is effective for use in endourodynamics, especially when patient positioning or catheter placement is difficult. The procedure is well tolerated, causes minimal stimulation leading to the development of autonomic dysreflexia, and provides accurate cystometric data.