Current Trends in the Management of Difficult Urinary Catherizations

Abstract

Routine urinary catheter placement may cause trauma and poses a risk of infection. Male catheterization, in particular, can be difficult, especially in patients with enlarged prostate glands or other potentially obstructive conditions in the lower urinary tract. Solutions to problematic urinary catheterization are not well known and when difficult catheterization occurs, the risk of failed catheterization and concomitant complications increase. Repeated and unsuccessful attempts at urinary catheterization induce stress and pain for the patient, injury to the urethra, potential urethral stricture requiring surgical reconstruction, and problematic subsequent catheterization. Improper insertion of catheters also can significantly increase healthcare costs due to added days of hospitalization, increased interventions, and increased complexity of follow-up evaluations. Improved techniques for catheter placement are essential for all healthcare personnel involved in the management of the patient with acute urinary retention, including attending emergency physicians who often are the first physicians to encounter such patients. Best practice methods for blind catheter placement are summarized in this review. In addition, for progressive clinical practice, an algorithm for the management of difficult urinary catheterizations that incorporates technology enabling direct visualization of the urethra during catheter insertion is presented. This algorithm will aid healthcare personnel in decision making and has the potential to improve quality of care of patients.

A prospective audit on the effect of training and educational workshops on the incidence of urethral catheterization injuries

“…Hence, education and awareness regarding this could possibly avoid future incidents.A large number of the iatrogenic UC injuries occurred in the emergency department. Wilette et al 12 constructed a difficult catheterization algorithm for emergency medicine doctors to recognize possible difficulties, such as high bladder neck, enlarged prostate, and urethral stricture, to enable timely urological input. There is also an overall lack of knowledge of special catheters that can be used in this setting, such as coude-tipped catheters.…”

Tips and Tricks for Difficult Urethral Catheterization

“…This situation induces pain for the patient and uses to lesion the urethra creating false passages which may do impossible blind urethral catheterization and will obligate to place a suprapubic catheter or to perform an optically helped passage with a rigid or flexible cystoscope. Moreover, posterior healing of this lesions may create a urethral stricture or other definitive problems requiring surgical reconstruction (3,6,8). If unsuccessful, repeated attempts with the same catheter are usually done, Catheterization with a different size or consistency probe (typically larger or harder) may be attempted or another more experienced healthcare worker may help in the process.…”

“…Only nurses or emergency physicians properly trained, and with a clear strategy to face the situation, may repeat blind catheterization. If nobody fulfills this characteristic, a urologist has to be requested to decide about any new attempt of blind catheterization or to perform endoscopic maneuvers (3,4,6,7). Little is taught about difficult catheterization during nurse training which is more focused to prevent urinary infection by cleaning properly external genitalia or to create a close urinary circuit.…”

“…Repeated unsuccessful attempts at urinary catheterization induce stress and pain for the patient, injury to the urethra, potential urethral stricture requiring surgical reconstruction, and problematic subsequent catheterization. Improper insertion of catheters also can significantly increase healthcare costs due to added days of hospitalization, surgica l interventions, and increased complexity of follow-up evaluations (4,5,6,7,8). During university training, nurses and physicians are taught to perform standard catheterization focusing on prevention of urinary infection but almost no information is given about how to face difficulties when placing a urethral catheter.…”

Potential pitfalls of computed tomography scan causing misdiagnosis of bladder perforation

“…However, many complications with indwelling catheters in the bladder have been reported, such as infection, periurethral abscess, bladder stones, and injury to the urethra, hemorrhage, and epididymo-orchitis [1][2][3]. Male catheterization can be difficult, especially in patients with enlarged prostate glands or other potentially obstructive conditions in the lower urinary tract [3]. Perforation of the urinary bladder due to an indwelling urinary catheter is a rare but life-threatening complication, and usually requires an emergent operation [4,5].…”