Suprapubic Bladder Aspiration (SBA) is commonly used for febrile children to obtain a urine sample to investigate pyrexia. We describe a case when it was used to avoid hospital transfer and overuse of medications for a patient who could not be catheterised due to pre-existing phimosis. Our patient was 92 years old and deteriorated over 5 days. His PPC/PPD was home. He was well supported in the community but had troublesome agitation in the last day of life. On examination he was pulling at his groin and a palpable bladder confirmed urinary retention. Three community professionals attempted urinary catheterisation without success. Midazolam 2.5 mg was given subcutaneously three times throughout the day with little effect. Reluctantly the family requested hospice admission due to his agitation and carer fatigue. After two further attempts to catheterise the patient at the hospice, we sought advice from the Urology team who suggested attempting SBA to avoid transfer to hospital. We obtained consent from the patient’s next of kin who agreed that the patient would prefer to remain at the hospice and would accept the small risks associated with the intervention. We marked 2–4 centimetres above the midline pubic symphysis, cleaned the skin and laid sterile towels. Four millilitres of 1% lidocaine (25-gauge needle) were used to infiltrate the skin and soft tissues. Under negative pressure we inserted a 21-gauge needle until urine was aspirated. We removed ~350 millilitres of urine with sequential 50 millilitre syringes. The insertion site was subsequently bandaged. The patient remained settled for his remaining time and did not require any additional pro re nata medications for agitation. He died comfortably 6 hours later. While Suprapubic Bladder Aspiration is not a first choice to manage painful urinary retention in agitated dying patients it could be considered when other methods have failed.

This study evaluated the association of urinary nitrate concentrations with cognition in older subjects enrolled in the NHANES study. We also explored whether associations between urinary nitrate and cognition were modified by cardiovascular risk, vitamin D status and vitamin C intake. Two NHANES cycles were merged (2011-2012 and 2013-2014) and a total of 1,015 adults aged 60-80 (69.4 ± 0.3) years were included. Cognition was assessed using the Word List Learning, Word List Recall, Animal Fluency and the Digit Symbol Substitution tests. Urinary nitrate was analysed using electrospray tandem mass spectrometry. Urinary nitrate concentrations were not associated with cognitive performance on any of the cognitive tests. Associations were also not significant in subjects at greater risk for cognitive impairment (i.e. high cardiovascular risk and non-optimal vitamin D status). Longitudinal analyses are needed to explore the associations of urinary nitrate concentrations with dietary nitrate intake and cognitive function.

Purpose: It has been suggested that cognitive impairment may occur following transurethral resection of the prostate (TURP) operations due to the effects of anaesthesia or hyponatraemia or both. The aim of the study was to investigate whether TURP was associated with long-term memory complaints or cognitive impairment. Method. Patients who had received a TURP or transurethral resection of a bladder tumour (TURT) in the previous 10 months were sent a questionnaire on memory problems and mood. Seventy-six TURP patients and 38 TURT patients returned the completed questionnaires. A sample of each patient group (30 TURP, 29 TURT) was assessed on standardized tests of cognitive abilities. Results: There was no significant difference between the TURP and TURT patients on the Everyday Memory Questionnaire completed by themselves or by a family member (p > 0.05). On formal cognitive testing there were no significant differences between the groups, except on the overall grading of the Kendrick Assessment Scales of Cognitive Ageing, in which TURP patients performed at a significantly lower level than TURT patients. Conclusions: The results suggest that patients are no more likely to complain of memory problems following a TURP than with any other operative procedure. There was a slight difference in cognitive abilities but this did not indicate significant impairment of cognitive function. © 2004 Taylor & Francis Ltd.