Obstetrics & Gynaecology

Bladder dysfunction and urinary incontinence is a common and socially distressing condition.  Accurate routine assessment of bladder residual volume should be readily available in an Obs and Gynae department.  Urethral catheterisation of the female bladder remains the 'gold standard' for the measurement of residual bladder volume (mainprize et al 1989).  The BladderScan^® portable hand-held utrasound bladder volume instrument offers a safe non-invasive method of measuring volumes of urine in the bladder and herald as the new positive standard of care, being used as a ward or bedside management diagnostic tool.

Many types of voiding problems may be encountered. On the Labor and Delivery floor a woman may require the BladderScan^® to evaluate the need for catheterization. This may also be true in the Post Partum period. Similar circumstances may be found in postoperative gynecologic patients.

In the outpatient setting, voiding complaints may range from complaints of retention to urinary urgency, frequency, and painful bladder symptoms.

The BladderScan^® is not only useful in the determination of urinary retention, but may prove vital in demonstrating to patients that they successfully emptied their bladder in circumstances of frequent voiding. The BladderScan^® is also useful in evaluating complaints of incontinence and in evaluating the patient with recurrent urinary tract infection.

• Indications & Applications
• Cost Analysis
• Key Clinical Messages
• Literature

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Indications / Applications

Indications for the use of the BladderScan at Obstetrics / Gynecology

• Patient with a risk of urinary retention
• Patient after removal of an indwelling foley catheter
• Patient after removal of a Super Pubic catheter.
• Patient with a possible obstruction of the urinary tract
• Patient after spinal/epidural/general anesthesia
• Patient post-operative
• Patient who requires bladder re-training following surgery or bladder dysfunction
• ·  

Benefits for the user of BaldderScan^® include;

• Reduces use of unnecessary catheterisations
• Reduces use of unnecessary disposables
• Non-invasive
• Reduces incidence of urinary tract infection and associated costs
•  Easy to use
• Saves staff time
• Cost-effective
• Eliminates unnecessary trauma to patients
•  Non-real time allows focussed scanning
•  In house product training is aligned to KSF requirements
• Can be used by any healthcare practitioner and applied to their clinical environment
•  All products, accessories and consumables can be purchased through NHS Logistics On-Line

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Cost Analysis

	Hospital - Cost Justification- Monthly Financed.pdf
	Hospital - Cost Justification-6100.pdf
	Hospital - Cost Justification-Multiple.pdf

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Key Clinical Messages

Garibaldi R.A. (1995 Overview article)
Hospital Acquired Urinary Tract Infections
Whilst this is not a specific paper for Obs & Gyne, it very clearly indicates that women, who have been catheterised, are more likely to have meatal colonization with enteric bacteria, which may result in the formation of a urinary tract infection. (Approximately 70% of catheterised females contracted a UTI as a result of bacteria surrounding the catheter, migrating into the bladder.) It also discusses that the reason why there is a higher UTI frequency in females is due to the anatomical differences in the length of the female urethra, to the male urethra, therefore creating a shorter, easier route in order to facilitate bacterial entry into the bladder.

Pruim E.J. et.al. (1999, ECNA Utrecht)
Non-Invasive Bladder Volume Assessment on the Recovery Ward
The study results show that BladderScan™ is an easy to use , non-invasive way of ensuring that your patient is not within the (retention) danger zone with non invasive ultrasound measurement causing little or no discomfort. Use of the protocol, instead of time limit or palpatation means less or even no unnecessary catheterisations and therefore is an improvement in quality of patient care. Using BladderScan™ is cost effective

Greig J.D. et.al. (1998 Surgical Endoscopy)
Comparison of manual and ultrasonographic evaluation of bladder size in patients prior to laparoscopy.
Pre-operative voiding does not guarantee bladder emptying. Manual examination does not detect bladder enlargement reliably in the obese patient. Ultrasonography may improve patient selection for catheterisation

Sizmur F. et.al. (1998 ICS Abstract)
Investigation of Post Partum residual bladder volumes. Primiparous and multiparous women with operative and normal deliveries and the influence of epidural anesthesia.
This study showed that there was no symptomatic or clinical evidence of retention of urine in any of the women studied despite a significant number 118 (77%) having residual volumes of greater than 150mls. Large numbers of post partum women appear to have significant residual volumes and the long term implications of this awaits further investigation

Demaria F. et.al. (2002 IUGA Abstract)
Efficiency of BladderScan™ (BVI 3000) for evaluation of urinary retention volume 2 hours post partum. Prospective study of 100 patients.
Few studies have examined the the volume or urinary retention post-partum, in this study 100 patients were tested over a two month period. The mean of 4 ultrasound measures were compared with catheterised volumes. Urine retention volume was not found to be correlated with age, parity, epidural analgesia, transfusion volume, duration of labour, instrumental extraction or weight or cranial perimeter of the newborn. The utilisation of BladderScan™ postpartum appears reliable as a means of evaluating urinary retention volume after delivery. More than half the patients had a retention volume > 500 ml., which raises the issue of its role as a potential cause of subsequent urinary handicap.

Ismael S. et.al. (2001 Abstract ICS Seoul Korea)
The Prevalence of silent postpartum retention of urine.
Symptomatic retention of urine is a well known postpartum complication. The aim of this study was to access the prevalence of silent postpartum retention of urine. Silent postpartum retention of urine occurred in a significant percentage (37% having residual urine > 150 ml).

Newman D. (1997 Editorial NIH Bethesda)
How much society pays for urinary incontinence.
Urinary incontinence (UI), the unwanted loss or leakage of urine, imposes a financial burden on individuals, their families, healthcare organizations and society. However, given that UI remains grossly underreported, the true costs of incontinence may be higher than predicted. If prevalence and cost per treatment remain constant, predicted 5 percent increases in the aging population by the year 2000 will cause the total costs of UI approach $ 29.3 billion.

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Urogynaecology Literature References

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