Influence of Drainage Conditions on Mucosal Bladder Damage By Indwelling Catheters: II. Histological Study

Abstract

A previous study demonstrated a strong but short-lasting suction through the catheter eyes by a hydro-dynamically generated negative pressure fluctuation terminating bladder evacuation in some frequently occurring circumstances of indwelling catheter drainage. This report regards the biological effect. Fifteen successive evacuations on such drainage conditions in each of 4 anesthetized pigs were followed by cystectomy and histological examination. All bladders presented small swollen areas, histologically showing localized mucosal elevations dominated by edema of lamina propria and submucosa, occasionally with urothelial thinning or defects. Drainage with suction prevented in 3 animals caused normal bladders. The changes were similar to those following hydro-statical suction and much like those of the "polypoid cystitis" so commonly occurring with indwelling catheters. This suggests both types of suction by ordinary drainage as a major pathogenetic factor in the latter condition. The clinical significance and the occurrence during regimes of straight drainage or intermittent clamping are discussed.

Establishment and Characterization of UTI and CAUTI in a Mouse Model

“…It has been demonstrated that human urinary catheterization causes histological and immunological changes in the bladder due to mechanical stress that results in a robust inflammatory response, exfoliation, edema of the lamina propria and submucusa, urothelial thinning, and mucosal lesion of the urothelium and kidney 35,36 . Additionally, the catheter provides a surface for bacterial attachment thereby creating an environment utilized by several species to cause CAUTI.…”

Long-Term Clean Intermittent Catheterization, Chronic Inflammation and Cancer: A Case Report and Review

“…Local mechanical trauma and chronic irritation of the bladder epithelium from indwelling catheters, like schistosomiasis, are believed to promote the development of bladder cancer due to the induction of epithelial hyperplasia [8]. This trauma can be due to pressure damage from the catheter tip as the bladder drains and collapses around the catheter or from suction damage as the bladder wall is aspirated into the drainage eyelets [9][10][11]. Not only does this constant irritation promote a much localized chronic inflammatory response, but the mechanical trauma associated with long-term catheterization has been demonstrated to create alterations in histological architecture hypothesized to provide a route for both local spread and distant metastasis [8,12].…”

Urinary Catheter Coating Modifications: The Race against Catheter-Associated Infections

“…Another issue arises from the media itself, it was discovered that in mice and humans, urinary catheterization causes physical trauma to the lining of the bladder, inducing an inflammatory response and consequently, changing the bladder environment [66,125,[163][164][165][166]. As part of the inflammatory response, serum proteins are released and accumulated into the bladder and deposited onto the urinary catheter [64][65][66]150,167].…”