Urethral Catheterization

1. See Also
   1. Self Intermittent Urinary Catheterization
2. Indications for long-term indwelling catheterization
   1. Refractory Bladder outlet obstruction
   2. Neurogenic Bladder with Urinary Retention
   3. Complications of Incontinence
      1. Refractory skin breakdown
      2. Palliative Care for terminally ill
      3. Patient preference
3. Indications for short-term catheterization
   1. Urologic or pelvic surgery
   2. Acute Urinary Retention (trial voiding at 14 days)
   3. Urinary output monitoring in critically ill
4. Contraindication: Signs of Urethral trauma
   1. If trauma, perform genital and rectal exam first
   2. Blood at meatus
   3. Scrotal hematoma
   4. High riding Prostate
5. Complications of longterm catheterization
   1. See Urinary Catheter associated Urinary Tract Infection
      1. Urosepsis
      2. Bacteriuria
         1. Single intermittent catheterization: 20% of elderly
         2. Bacteriuria occurs in most patients in 2-3 weeks
   2. Chronic renal inflammation
   3. Pyelonephritis
   4. Nephrolithiasis
   5. Cystolithiasis
6. Alternatives to Indwelling Urinary Catheters
   1. Intermittent catheterization (dysfunctional voiding)
      1. Spinal cord injury
      2. Nursing Home residents
      3. Surgery
         1. Hip Fracture repair
         2. Total abdominal Hysterectomy
   2. External Catheter (Condom catheter)
      1. Incontinent men without obstructive uropathy
      2. More comfortable than indwelling catheters
      3. Lower Incidence of bacteruria
      4. Skin breakdown may occur
   3. Suprapubic Catheterization (short-term post-operative)
      1. Lower infection risk
      2. Improved comfort and convenience
      3. Risks
         1. Cellulitis
         2. Hematoma or leakage at puncture site
         3. Urethral prolapse
7. Catheter Characteristics
   1. Catheter Material
      1. Latex: Long-term catheterization
      2. Silastic: Short-term catheterization or Latex Allergy
   2. Minocycline and Rifampin impregnated catheters
      1. May reduce bacteriuria for up to 2 weeks
      2. Reference
         1. Darouiche (1999) Urology 54:976-81
   3. Catheter size
      1. Narrowest, softest efective tube
         1. Range: 12F (smallest) to 18F (largest)
         2. Most common: 14F to 16F
      2. Balloon size: 5 ml balloon with 5-10 ml fluid
8. Management: Urinary Tract Infection
   1. See Urinary Catheter associated Urinary Tract Infection
   2. See Prevention of Urinary Catheter associated UTI
9. Management: General
   1. Urinary Catheter Blockage
      1. Maximize patient hydration
      2. Consider Methanamine preparations to prevent blockage
      3. Consider Bladder irrigation
      4. Change catheter before expected time to obstruction
      5. Change catheter if no urine flow in 4 to 8 hours
      6. Evaluate for UTI for more frequent catheter blockage
   2. Urinary Catheter leakage
      1. Do not increase catheter diameter
      2. Evaluate for catheter blockage (above)
      3. Evaluate for Urinary Catheter associated UTI
      4. Consider Bladder Antispasmodic
10. References
    1. Cravens (2000) Am Fam Physician 61(2): 369-76
    2. Walsh (1998) Campbell's Urology, Saunders, p. 159-62