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PURPOSE

The technique of active urinary endoscopic vacuum therapy (uEVT) is described. The surgical technique is demonstrated in detail with the help of a video of the operation, which is available online. Vesical fistulas are a rare complication following rectal surgery. The EVT technique is a novel method for the treatment of gastrointestinal leakage. This endoscopic procedure has been adapted to treat a large bladder defect after abdomino-perineal resection of the rectum with urine flowing out of the perineal wound.

MATERIALS AND METHODS

A new open-pore film drainage (OFD) catheter with an external diameter of only a few millimeters was developed and constructed from a very thin open-pore double-layered film and a drainage tube. The OFD was inserted into the bladder by means of flexible endoscopy and channeled out through a suprapubic incision. Continuous suction was applied with an electronic vacuum pump to actively drain the urine completely. A passive catheter drainage of urine from the renal pelvis via a transurethral single J stent was carried out simultaneously during the complete duration of treatment. The healing process was monitored during and after therapy via intravesical endoscopy.

RESULTS

The application of continuous negative pressure via the OFD resulted in total collapse of the bladder. The urine in the bladder was actively and permanently drained through the OFD. Urine leakage from the perineal wound stopped immediately after induction of suction. The bladder defect healed after 18 days of treatment with uEVT. After therapy and removal of the catheters, the patient had normal micturition.

CONCLUSION

A novel small-bore OFD was developed for EVT. The OFD technique allows for endoscopic application of negative pressure in the bladder. This first successful experience proves uEVT to be a potent interventional alternative in the treatment of bladder defects.

Based on experimental work, a practical definition of inelastic material is provided and some superior effects concerning an improvement of the venous haemodynamics are emphasised in this article. In contrast to elastic compression, this material can narrow the veins in the upright position and to exert beneficial haemodynamic effects by abolishing reflux and improving the venous pump. The main disadvantages are the fact that proper application is not easy and that these inelastic bandages lose pressure quickly. Most inelastic bandages are applied with a pressure that is too low. Training courses in which the sub-bandage pressure can be checked by adequate measuring instruments may improve this situation. Self-applied Velcro® devices where the pressure can be measured by the patient using simple measuring aids provided by some companies may be a valuable alternative. The patient feels which pressure is beneficial and can readjust the system whenever it is getting loose. Newly developed pumps are also of increasing interest.

Compression therapy is a key component in the effective management of people with lower limb problems associated with venous, lymphatic and fat disorders such as lipoedema. Individuals with lymphoedema, venous ulceration and lipoedema often require long-term compression therapy to prevent and manage problems such as chronic ulceration and skin changes, persistent swelling and shape distortion. There are challenges in achieving acceptable, safe, effective and cost-efficient compression therapy choices. Adjustable, compression-wrap devices incorporating hook-and-loop systems present new opportunities for improving treatment outcomes, supporting patient independence and selfmanagement in the use of compression therapy.

Introduction

• Pressure ulcers have been on the NHS agenda for over 10 years (Porter 2015) and yet pressure ulcer occurrence continues to challenge healthcare providers (Fletcher 2015)

• As part of the East Lancashire Hospitals NHS Trusts commitment to provide “Safe Personal and Effective Care” a steering group was set up to drive pressure ulcer prevention and reduce avoidable harm

• Over the financial year the 1395 electronic incident forms were completed by clinical staff to report pressure ulcers

• The challenge we set as an organisation at the end of the previous year was to look at new pressure ulcer incident reports, check accuracy and build a picture of the numbers of pressure ulcers that had occurred under our care

Conclusion

Having a clearer picture of how many pressure ulcers we are seeing has helped when looking at resources required to manage these. Knowing where these pressure ulcers are happening has helped provide focus for education and support within the Trust and has driven collaboration with the clinical commissioning groups to support work with care homes and care agencies. Staff are more engaged when they know the discussions about prevention and the extent of the problem include more accurate numbers and that the data shows progress made. The next stage is to look at the pressure ulcers we see that didn’t occur under our care and see were these are happening and what