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1.
The incidence of encrustation
Among 52 patients with diseases like benign prostatic enlargement, stricture urethra, neurogenic bladder and others, the encrustation was present in 32 patients.
Total no. of patients | 52 |
Benign prostatic enlargement | 26 |
Stricture urethra | 22 |
Neurogenic bladder and others | 4 |
Total patients with encrustation | 32 (61.5%) |
Benign prostatic enlargement | 15 (58%) |
Stricture urethra | 14 (63.6%) |
Neurogenic bladder and others | 3 (75%) |
Figure 1 shows incidence of catheter encrustation overall and in various diseases. Catheter encrustation was found to be unrelated to the primary disease for which the patient was catheterised. Result was not statistically significant (p value > 0.05).
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2.
Mode of catheterisation
Among 52 patients, 36 had trans-urethral catheter and 16 had supra-pubic catheter. Figure 2 shows that the incidence of encrustation was found to be almost equal in both types of catheterisation. The trans-urethral type had 61% and supra-pubic type had 62.5% of encrustation of the catheters. Statistically, the result was found to be not significant (p value > 0.05).
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3.
Physical activity of the patient
The physical activity of the patient was found to have significant effect on the development of encrustation of the catheter. Figure 3 suggests that incidence of encrustation was less in physically active patients with catheter compared to hospitalised, bedridden patients. Out of 52, 11 were hospitalised for their disease. The encrustation was found to be more common in bedridden patients (91%) when compared to physically active patients (53.6%). Statistically, result was found to be significant (p value < 0.05).
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4.
Total duration of catheterisation
Total duration of catheterisation among patients was 1 month to 1 year. Sixteen patients were on catheter drainage for more than 6 months and were changing the catheter every 15 days. As shown in Fig. 4, incidence of encrustation in those patients (69%) was not significantly increased when compared to patients who were on catheterisation for period less than 6 months (58.3%). Statistically, result was found to be not significant (p value > 0.05).
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5.
Frequency of changing the catheter
The presence of encrustation was found to be directly proportional to the duration of keeping the catheter. Figure 5 shows that encrustation was more common in patients having a single catheter for more than 30 days (86%) when compared to patients having of particular catheter for a shorter period less than 30 days (43.3%). Statistically, the result was significant (p value < 0.05).
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6.
Clarity of urine
Among 52, 13 had turbid urine. The patients with turbid urine had 92.3% encrustation when compared to patients with clear urine who had only 51% encrustation as suggested in Fig. 6. Statistically, the result was significant (p value < 0.05). Patients with turbid urine also had positive culture for micro-organisms.
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7.
pH of urine
The pH of urine was found to be an important factor. Among 52 patients, 24 had pH > 6. Figure 7 illustrates that, among these 24 patients, 22 (92%) had encrustation. In remaining 28 patients with urine pH < 6, 10 (38%) had encrustation in the catheter. The result was statistically significant (p value < 0.05). Majority of patients with alkaline urine has positive urine culture for urea splitting organisms. Most of the patients with acidic urine had negative urine culture or positive culture for non-urea splitting organisms.
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8.
Specific gravity of urine
The urine specific gravity of patients was found to be in normal range (1.005–1.020). No relationship was noted between the specific gravity and presence of encrustation. In our study, all patients had normal serum creatinine level and showed normal specific gravity and hence no relationship with encrustation.
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9.
Urine culture for micro-organisms
Among 52, 38 patients had positive culture for bacteria in the urine; 28 had positive culture for urea splitting organisms like proteus and klebsiella, and 15 had positive culture with non-urea splitting organism like E. coli. Figure 8 shows relationship between positive bacterial culture and catheter encrustation.
The incidence of encrustation was more in patients with positive urine culture especially with urea splitting bacteria. Figure 9 shows that among the 28 patients with positive urine culture for urea splitting organisms, 27 (96%) had encrustation. Among the 15 patients with positive culture for non-urea splitting organisms, 10 (66.7%) had encrustation. Among 9 patients with negative culture, only 1 (11%) had encrustation. Statistically, the result was significant (p value < 0.05).
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10.
Serum calcium, phosphorus and uric acid
All patients had normal levels of serum calcium, phosphorus and uric acid. No relationship was found between serum levels and presence of encrustation in our study.
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11.
Composition of the encrusted material
The chemical analysis of crust showed the following substances.
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Calcium
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Phosphate
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Oxalate
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Carbonate
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Ammonium
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Magnesium