Nathan Manabat

A bad design from my clinical experience is the JJ stent. It’s used in areas like urology in order to relieve the passageways from obstruction like stones. It takes place in the operating room during procedures in order to drain the kidney, and it is brought out by the nurses, kept in a sterile field, and is used and requested by the surgeon when needed. When given the stent, the surgeon inserts the stent into the patient in order to reach the bladder and urethra. When used, it was observed by a camera that there is irritation along the bladder end, causing irritation inside the bladder, which can lead to urinary symptoms. While the bladder end is causing irritation, the kidney end was experiencing no issues. This was seen by the surgeons who routinely use this device, and they want to keep the patient in the best condition possible after the procedure, so when the patient, the person for whom the stent is for, results in irritation from the stent, it raises concern for the doctors.

For this week, a big portion of the primary data collected was conducted in the clinic setting and involved collecting urine samples from male and female patients for urinalysis. The observations from these data was that it was difficult to obtain reliable results of urine samples, especially for women, due to contamination and due to making a mess when moving the pee midstream.

The secondary research that was conducted from the primary observation was about the effectiveness of a midstream catch, and if that provides a better sample for urinalysis. In the article done by Carl Llor in 2023, the review was done with samples a midstream clean catch, midstream urine catch without cleaning, and first-void urine in symptomatic adult women with a suspecting UTI. These different methods were evaluated by their contamination rates and their diagnostic accuracy of the resulting cultures. The results of this study stated that there was no consistent evidence suggesting the differences in diagnostic accuracy or the percentage of samples, since the evidence strength was low. This is significant because it does not provide sufficient evidence about which method of urine collection is the best, so from the results of this paper, there can still be a goal of optimizing the urine collection process in order to get a more accurate sample.

A commercial product related to this is the Colli-Pee device from the company DNAgenotek. This device is described as a user friendly and as an easy to use device for urine collection for men and women. It is also described as a collection of first-void urine, in which the company describes the volume of that collection as the first 20 mL to 30mL of urine flow.

Need for JJ stent optimization for bladder irritation.

Revised Card from JJ stent. The components revised involved the need statement having a more specific patient demographic, as using patients in general was too broad of a term for this specific need. It also involved a more specific design requirement for the JJ stent since after more observation, the kidney end of the stent had resulted in no issues. For the TAM change, it was changed for how much stents get used per year, because as per peer review, it was more realistic to calculate the number used as the there can be leftover stents that are bought and not used within that year.

Maria listened as Dr. Jones instructed her to “Wipe front to back, spread the lips of your vagina, then pee the first 80-90% of it into the toilet, and after move the cup to your stream in order to collect the sample.” She then nodded in understanding.

After she went to the restroom, Maria washed her hands, balanced the container on the sink, and began cleaning herself front to back. Holding the cup in one hand and spreading her labia with the other felt awkward; she wasn’t sure she cleaned well enough.

Starting to urinate into the toilet, Maria tried to time the midstream collection but feared she caught some of the initial flow. Maria’s stream wasn’t what she expected it to be, and urine splashed onto her fingers, and some got on the toilet and on the floor. She pulled it away before the stream ended, then capped it, accidentally touching the inside of the lid.

After washing her hands again, she returned the sample, hoping she’d done it correctly. Later, Dr. Jones reviewed the results and told Maria the sample showed bacterial contamination, so the sample couldn’t be used and Maria would need to repeat the sample again.

This storyboard helps to demonstrate the difficulty of urine collection for female patients, as not only is it awkward for females to catch their urine midstream, is it also more difficult and messy due to their anatomy.