Suprapubic

bmjcombine · 07-08-2003, 10:30 AM

My son has a suprapubic tube and it has worked well. In the past year it has started to turn blue and smell after about two weeks. Any ideas on how to control the smell?

crags · 07-08-2003, 01:44 PM

daily cleaning and disinfection of all tubes/bag, discard on a regular, but realistic basis

daily bathing and warm soap and water cleansing of the catheter and surrounding skin

SCI-Nurse · 07-08-2003, 05:04 PM

This is sometimes associated with fungal infection or colonization. What does your urologist say?

(KLD)

Wise Young · 07-08-2003, 06:00 PM

bmjcombine,

I kid you not but what you are describing is formally called the "purple urine bag syndrome". It is a result of accumulated dyes produced by some bacteria. Treatment for this depends on whether there are signs of systemic infection associated with the bacterial colonization (i.e. fever, etc.). Because probably nobody will believe me that this is a true medical condition, I attach several recent abstracts from the medical literature.

Wise.

• Al-Jubouri MA and Vardhan MS (2001). A case of purple urine bag syndrome associated with Providencia rettgeri. J Clin Pathol 54:412. Summary:

• Coquard A, Martin E, Jego A, Capet C, Chassagne PH, Doucet J and Bercoff E (1999). Purple urine bags: a geriatric presentation of lower urinary tract infection. J Am Geriatr Soc 47:1481-2. Summary:

• Corporaal S and Leemhuis MP (2002). [Diagnostic image (104) Purple discoloration of the urine bag]. Ned Tijdschr Geneeskd 146:1686. Summary: In a 65-year-old woman who had a suprapubic catheter for nine years, purple urine bag syndrome was diagnosed. Medisch Centrum Leeuwarden, locatie MCL Zuid, afd. Interne Geneeskunde, Leeuwarden.

• de Bruyn G, Eckman CD and Atmar RL (2002). Photo quiz. Purple discoloration in a urinary catheter bag. Clin Infect Dis 34:210, 285-6. Summary: Internal Medicine Residency Program, Baylor College of Medicine, Houston, USA. gdebruyn@fhcrc.org

• Ihama Y and Hokama A (2002). Purple urine bag syndrome. Urology 60:910. Summary: Ohama Hospital II, Okinawa, Japan.

• Ishida T, Ogura S and Kawakami Y (1999). [Five cases of purple urine bag syndrome in a geriatric ward]. Nippon Ronen Igakkai Zasshi 36:826-9. Summary: We report five cases of purple urine bag syndrome (PUBS). All the patients were women and they had been bed-ridden for a long period due to cerebrovascular diseases. They tended to be constipated as a result of habitual use of laxatives. Indicanuria was proven in the all urinary samples from the patients. The four assessable urinary cultures showed Proteus mirabilis contamination. Total days without evacuation per month in patients with PUBS and control subjects (5 catheterized subjects without PUBS) were 16.5 +/- 3.7 and 6.8 +/- 4.8, respectively (mean +/- SD), showing a significant difference (p < 0.05). In each case, this syndrome was not considered to have affected their clinical course. We concluded that it is unnecessary to treat patients with PUBS aggressively. Control of evacuation and urological sanitation are important in these patients. Department of Internal Medicine, National Hokkaido Daiichi Hospital.

• Johansson S and Schonebeck J (2000). [A case report. The phenomenon with the purple catheter bag]. Lakartidningen 97:4142-3. Summary: Kirurgiska kliniken, Ljungby lasarett.

• Mantani N, Ochiai H, Imanishi N, Kogure T, Terasawa K and Tamura J (2003). A case-control study of purple urine bag syndrome in geriatric wards. J Infect Chemother 9:53-7. Summary: The clinical background of purple urine bag syndrome (PUBS) has not yet been well characterized. In previous reports, clinical, biochemical, or bacteriological analyses were carried out using urine or bacteria from a limited number of patients. Other than one report, we are not aware of any case-control studies that compared the clinical, biochemical, or bacteriological background between patients with and without PUBS. To examine the risk of PUBS, we carried out a case-control study. Twenty-six patients, in three long-term care wards, who had been catheterized for more than 3 months with the same types of balloon catheters and who had the same type of disposable plastic urine bags were enrolled as the PUBS-positive case group (14 patients; 2 men and 12 women), and as the PUBS-negative control group (12 patients; 4 men and 8 women) were enrolled. The data for urine tests (pH, sugar, protein, leukocyte counts, and bacterial yields and species) were compared for the two groups. A relatively higher prevalence of PUBS was observed in female and alkaline-urine-producing patients. Bacteriological studies, using fresh urine collected through the catheter, showed that the bacterial counts were significantly higher, by 1 to 2 logs, in most samples from the case group than those from the control group (P = 0.012). Although a total of 66 bacterial strains, belonging to 12 separate species, were isolated from the urine accumulated in bags, no causative relationship between bacterial species and PUBS was observed. These data suggest that a higher bacterial yield in urine acts as the most important factor in PUBS, in combination with other facilitating factors, such as female-specific ones and the alkaline condition of urine. Department of Integrated Japanese Oriental Medicine, Faculty of Medicine, Gunma University School of Medicine, 3-39-15 Showa-machi, Maebashi 371-8511, Japan. nmantani@showa.gunma-u.ac.jp

• Ollapallil J, Irukulla S and Gunawardena I (2002). Purple urine bag syndrome. ANZ J Surg 72:309-10. Summary: Department of Surgery, Alice Springs Hospital, Alice Springs, Northern Territory, Australia. jacob.jacob@nt.gov.au

• Robinson J (2003). Purple urinary bag syndrome: a harmless but alarming problem. Br J Community Nurs 8:263-6. Summary: Patients who are not catheterized may notice a discolouration in their urine or faeces, either occasionally or continually. Such discolouration can usually be put down to waste materials caused by medication or food. However, a comment often made by nurses who see catheterized patients is, 'My patient's drainage bag has turned purple'. Patients with this condition can show no underlying urine infection. It is also noticeable that the longer the drainage bag is used, the deeper the colour purple becomes. Over a period of time this discolouration then impregnates their catheter. This condition also produces a strong odour, and as air temperature increases, so does the smell. This condition is known as purple urinary bag syndrome or PUBS. Continence Advisory Service, Morecambe Bay Primary Health Care Trust NHS, Morecambe.

• Roggla G, Kapiotis S and Fahrner A (2002). A case of purple urine bag syndrome (PUBS). Wien Klin Wochenschr 114:306. Summary: Abteilung fur Innere Medizin, AKH Neunkirchen, Peischingerstrasse 19, A-2620 Neunkirchen, Austria. roeggla.interne@khneunkirchen.at

• Yanagawa Y, Andoh T and Shimamura T (2003). [Detection of new pigments related to purple urine bag syndrome]. Kansenshogaku Zasshi 77:10-7. Summary: It is well known that participation of two kinds of pigments, indigo blue and indigo red, are concerned with purple urine bag syndrome (PUBS). However, there is no research which describes the participation of other pigments. We separated three new kinds of red pigments, other than indigo blue and indigo red, from four patients with PUBS. One of the pigments was not visible to the naked eye and appeared only when an ultraviolet ray was irradiated. The appearance patterns of indigo blue, indigo red and the three new red pigments were in complete agreement in two cases, but differed in the other two cases. Moreover, bacteria isolated from the urine were cultured in an indican-added alkaline liquid media (pH9), 80% or more bacteria produced purple pigments. In case 1, from deep-colored pigments, each bacterium produced both indigo blue and indigo red, although new pigments could not be observed in the in vitro media. Department of Clinical Laboratory, Eisei Hospital.

Sue Pendleton · 07-14-2003, 08:39 AM

Uhuh, where's the methyl blue? Old chemical attack in the milk carton sounds like to me.

Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

07-08-2003, 10:30 AM	#1
bmjcombine Junior Member Join Date: Aug 2001 Location: Portland, Oregon Posts: 6	Suprapubic My son has a suprapubic tube and it has worked well. In the past year it has started to turn blue and smell after about two weeks. Any ideas on how to control the smell?

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07-08-2003, 01:44 PM	#2
crags Senior Member Join Date: May 2002 Posts: 1,024	daily cleaning and disinfection of all tubes/bag, discard on a regular, but realistic basis daily bathing and warm soap and water cleansing of the catheter and surrounding skin

07-08-2003, 05:04 PM	#3
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,515	This is sometimes associated with fungal infection or colonization. What does your urologist say? (KLD)

07-08-2003, 06:00 PM	#4
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 37,988	bmjcombine, I kid you not but what you are describing is formally called the "purple urine bag syndrome". It is a result of accumulated dyes produced by some bacteria. Treatment for this depends on whether there are signs of systemic infection associated with the bacterial colonization (i.e. fever, etc.). Because probably nobody will believe me that this is a true medical condition, I attach several recent abstracts from the medical literature. Wise. • Al-Jubouri MA and Vardhan MS (2001). A case of purple urine bag syndrome associated with Providencia rettgeri. J Clin Pathol 54:412. Summary: • Coquard A, Martin E, Jego A, Capet C, Chassagne PH, Doucet J and Bercoff E (1999). Purple urine bags: a geriatric presentation of lower urinary tract infection. J Am Geriatr Soc 47:1481-2. Summary: • Corporaal S and Leemhuis MP (2002). [Diagnostic image (104) Purple discoloration of the urine bag]. Ned Tijdschr Geneeskd 146:1686. Summary: In a 65-year-old woman who had a suprapubic catheter for nine years, purple urine bag syndrome was diagnosed. Medisch Centrum Leeuwarden, locatie MCL Zuid, afd. Interne Geneeskunde, Leeuwarden. • de Bruyn G, Eckman CD and Atmar RL (2002). Photo quiz. Purple discoloration in a urinary catheter bag. Clin Infect Dis 34:210, 285-6. Summary: Internal Medicine Residency Program, Baylor College of Medicine, Houston, USA. gdebruyn@fhcrc.org • Ihama Y and Hokama A (2002). Purple urine bag syndrome. Urology 60:910. Summary: Ohama Hospital II, Okinawa, Japan. • Ishida T, Ogura S and Kawakami Y (1999). [Five cases of purple urine bag syndrome in a geriatric ward]. Nippon Ronen Igakkai Zasshi 36:826-9. Summary: We report five cases of purple urine bag syndrome (PUBS). All the patients were women and they had been bed-ridden for a long period due to cerebrovascular diseases. They tended to be constipated as a result of habitual use of laxatives. Indicanuria was proven in the all urinary samples from the patients. The four assessable urinary cultures showed Proteus mirabilis contamination. Total days without evacuation per month in patients with PUBS and control subjects (5 catheterized subjects without PUBS) were 16.5 +/- 3.7 and 6.8 +/- 4.8, respectively (mean +/- SD), showing a significant difference (p < 0.05). In each case, this syndrome was not considered to have affected their clinical course. We concluded that it is unnecessary to treat patients with PUBS aggressively. Control of evacuation and urological sanitation are important in these patients. Department of Internal Medicine, National Hokkaido Daiichi Hospital. • Johansson S and Schonebeck J (2000). [A case report. The phenomenon with the purple catheter bag]. Lakartidningen 97:4142-3. Summary: Kirurgiska kliniken, Ljungby lasarett. • Mantani N, Ochiai H, Imanishi N, Kogure T, Terasawa K and Tamura J (2003). A case-control study of purple urine bag syndrome in geriatric wards. J Infect Chemother 9:53-7. Summary: The clinical background of purple urine bag syndrome (PUBS) has not yet been well characterized. In previous reports, clinical, biochemical, or bacteriological analyses were carried out using urine or bacteria from a limited number of patients. Other than one report, we are not aware of any case-control studies that compared the clinical, biochemical, or bacteriological background between patients with and without PUBS. To examine the risk of PUBS, we carried out a case-control study. Twenty-six patients, in three long-term care wards, who had been catheterized for more than 3 months with the same types of balloon catheters and who had the same type of disposable plastic urine bags were enrolled as the PUBS-positive case group (14 patients; 2 men and 12 women), and as the PUBS-negative control group (12 patients; 4 men and 8 women) were enrolled. The data for urine tests (pH, sugar, protein, leukocyte counts, and bacterial yields and species) were compared for the two groups. A relatively higher prevalence of PUBS was observed in female and alkaline-urine-producing patients. Bacteriological studies, using fresh urine collected through the catheter, showed that the bacterial counts were significantly higher, by 1 to 2 logs, in most samples from the case group than those from the control group (P = 0.012). Although a total of 66 bacterial strains, belonging to 12 separate species, were isolated from the urine accumulated in bags, no causative relationship between bacterial species and PUBS was observed. These data suggest that a higher bacterial yield in urine acts as the most important factor in PUBS, in combination with other facilitating factors, such as female-specific ones and the alkaline condition of urine. Department of Integrated Japanese Oriental Medicine, Faculty of Medicine, Gunma University School of Medicine, 3-39-15 Showa-machi, Maebashi 371-8511, Japan. nmantani@showa.gunma-u.ac.jp • Ollapallil J, Irukulla S and Gunawardena I (2002). Purple urine bag syndrome. ANZ J Surg 72:309-10. Summary: Department of Surgery, Alice Springs Hospital, Alice Springs, Northern Territory, Australia. jacob.jacob@nt.gov.au • Robinson J (2003). Purple urinary bag syndrome: a harmless but alarming problem. Br J Community Nurs 8:263-6. Summary: Patients who are not catheterized may notice a discolouration in their urine or faeces, either occasionally or continually. Such discolouration can usually be put down to waste materials caused by medication or food. However, a comment often made by nurses who see catheterized patients is, 'My patient's drainage bag has turned purple'. Patients with this condition can show no underlying urine infection. It is also noticeable that the longer the drainage bag is used, the deeper the colour purple becomes. Over a period of time this discolouration then impregnates their catheter. This condition also produces a strong odour, and as air temperature increases, so does the smell. This condition is known as purple urinary bag syndrome or PUBS. Continence Advisory Service, Morecambe Bay Primary Health Care Trust NHS, Morecambe. • Roggla G, Kapiotis S and Fahrner A (2002). A case of purple urine bag syndrome (PUBS). Wien Klin Wochenschr 114:306. Summary: Abteilung fur Innere Medizin, AKH Neunkirchen, Peischingerstrasse 19, A-2620 Neunkirchen, Austria. roeggla.interne@khneunkirchen.at • Yanagawa Y, Andoh T and Shimamura T (2003). [Detection of new pigments related to purple urine bag syndrome]. Kansenshogaku Zasshi 77:10-7. Summary: It is well known that participation of two kinds of pigments, indigo blue and indigo red, are concerned with purple urine bag syndrome (PUBS). However, there is no research which describes the participation of other pigments. We separated three new kinds of red pigments, other than indigo blue and indigo red, from four patients with PUBS. One of the pigments was not visible to the naked eye and appeared only when an ultraviolet ray was irradiated. The appearance patterns of indigo blue, indigo red and the three new red pigments were in complete agreement in two cases, but differed in the other two cases. Moreover, bacteria isolated from the urine were cultured in an indican-added alkaline liquid media (pH9), 80% or more bacteria produced purple pigments. In case 1, from deep-colored pigments, each bacterium produced both indigo blue and indigo red, although new pigments could not be observed in the in vitro media. Department of Clinical Laboratory, Eisei Hospital.

07-14-2003, 08:39 AM	#5
Sue Pendleton Moderator Join Date: Jul 2001 Location: Wisconsin USA Posts: 9,172	Uhuh, where's the methyl blue? Old chemical attack in the milk carton sounds like to me. Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."