Traditional Foley Drainage Systems—Do They Drain the Bladder?

Garcia, Maurice M.; Gulati, Shelly; Liepmann, Dorian; Stackhouse, G. Bennett; Greene, Kirsten L.; Stoller, Marshall L.

doi:10.1016/j.juro.2006.08.101

Cited by 38 publications

(30 citation statements)

References 9 publications

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“…A dynamic regularly flushed system is replaced by one which leaves a stagnant sump of infected residual urine within the bladder amounting to a volume of around 100 ml. 50 A continuous-culture system is thus established in which bacterial communities can flourish, and in case of P. mirabilis infections, provides urease with the opportunity to generate the alkaline conditions and precipitate the apatite and struvite crystals. Additional problems are caused by damage to the mucosal surface of the bladder by the catheter tip and balloon.…”

Section: Discussionmentioning

confidence: 99%

The encrustation and blockage of long-term indwelling bladder catheters: a way forward in prevention and control

2010

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Objectives: To review the literature showing that understanding how Foley catheters become encrusted and blocked by crystalline bacterial biofilms has led to strategies for the control of this complication in the care of patients undergoing long-term indwelling bladder catheterization. Methods: A comprehensive PubMed search of the literature published between 1980 and December 2009 was made for relevant articles using the Medical Subject Heading terms 'biofilms', 'urinary catheterization', 'catheter-associated urinary tract infection' and 'urolithiasis'. Papers on catheterassociated urinary tract infections and bacterial biofilms collected during 40 years of working in the field were also reviewed. Results: There is strong experimental and epidemiological evidence that infection by Proteus mirabilis is the main cause of the crystalline biofilms that encrust and block Foley catheters. The ability of P. mirabilis to generate alkaline urine and to colonize all available types of indwelling catheters allows it to take up stable residence in the catheterized tract in bladder stones and cause recurrent catheter blockage. Conclusion: The elimination of P. mirabilis by antibiotic therapy as soon as it appears in the catheterized urinary tract could improve the quality of life for many patients and reduce the current expenditure of resources when managing the complications of catheter encrustation and blockage. For patients who are already chronic blockers and stone formers, antibiotic treatment is unlikely to be effective owing to the resistance of cells in the crystalline biofilms. Strategies such as increasing fluid intake with citrated drinks could control the problem until bladder stone removal can be organized.

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Section: Discussionmentioning

confidence: 99%

The encrustation and blockage of long-term indwelling bladder catheters: a way forward in prevention and control

2010

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“…In contrast to normal micturition and flushing of the urethra at regular intervals, the catheter allows for continuous bladder drainage as urine accumulates, which is not of sufficient volume or force to effectively flush the urinary tract. The design of the traditional Foley catheter and draining tubing also causes retention of 10–100 ml of urine within the bladder, providing a reservoir for bacteria to replicate (21). The urothelium is only 3 to 4 cell layers thick, and is easily damaged during rushed or multiple attempts to place a catheter (22).…”

Section: Host Interactionsmentioning

confidence: 99%

Pathogenesis of Proteus mirabilis Infection

2018

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Proteus mirabilis, a Gram-negative rod-shaped bacterium most noted for its swarming motility and urease activity, frequently causes catheter-associated urinary tract infections (CAUTI) that are often polymicrobial. These infections may be accompanied by urolithiasis, development of bladder or kidney stones due to alkalinization of urine from urease-catalyzed urea hydrolysis. Adherence of the bacterium to epithelial and catheter surfaces is mediated by 17 different fimbriae, most notably MR/P fimbriae. Repressors of motility are often encoded by these fimbrial operons. Motility is mediated by flagella encoded on a single contiguous 54 kb chromosomal sequence. On agar plates, P. mirabilis undergoes a morphological conversion to a filamentous swarmer cell expressing hundreds of flagella. When swarms from different strains meet, a line of demarcation, a “Dienes line”, develops due to the killing action of each strain’s type VI secretion system. During infection, histological damage is caused by cytotoxins including hemolysin and a variety of proteases, some autotransported. The pathogenesis of infection, including assessment of individual genes or global screens for virulence or fitness factors has been assessed in murine models of ascending UTI or CAUTI using both single-species and polymicrobial models. Global gene expression studies carried out in culture and in the murine model have revealed the unique metabolism of this bacterium. Vaccines, using MR/P fimbria and its adhesin, MrpH, have been shown to be efficacious in the murine model. A comprehensive review of factors associated with urinary tract infection is presented, encompassing both historical perspectives and current advances.

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“…Patients with bladder outlet obstruction may be subject to neurologic denervation of the smooth muscles of the bladder because of prolonged increased intravesical pressure, which may lead to increased stimulation of afferent receptors, resulting in marked irritation 16 . Changes in the urethra and bladder found on cystourethroscopy in our patients were considered minimal.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, residual urine accumulates below the orifice. Tubing segments of the Foley can also coil and form air locks 16 . The reduced length of the CymActive I.U.C.…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of a patient‐controlled bladder management system for treating urinary retention in men

Homan¹,

Dmochowski

Cochran³

et al. 2015

Neurourology and Urodynamics

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Aims The CymActive Bladder Management System (BMS) is a self-retaining, intraurethral catheter with a patient-controlled magnetic valve that allows cyclical bladder filling and emptying, without external appliances. We determined the safety and efficacy of the BMS in men with urinary retention who required catheterization for more than 7 days. Methods Men requiring continuous drainage, bladder capacity less than 300 mL, history of prostatic or urethral surgery, or urethral length outside of defined limits, were excluded. Data were collected from patient diaries and weekly visits during catheterization for up to 30 days. The primary composite endpoint assessed four outcomes: placement; post-void residual volume (PVR) of 75 mL or less; adverse device-related events requiring early removal; and removal. Results Nine of 23 patients met all four criteria: 8 of 18 non-neurogenic (7 / 11 prior Foley users and 1 / 7 without Foley experience), and 1 of 5 neurogenic (SCI) patients. Secondary outcomes in non-neurogenic patients included: 17 / 18 successful insertions; of these, 16 / 17 average PVR of 75 mL; successful valve openings and closings ≥ 95% of more than 1400 voids; minimal leakage. Four of five SCI patients discontinued within 7 days. Cystourethroscopy after removal revealed no marked inflammation or mucosal changes. Conclusions This pilot study demonstrated the BMS is potentially useful, convenient, and safe for appropriate patients. A follow-up study will better define the characteristics of patients who benefit from this device and examine whether the use of antimuscarinic agents improves outcomes.

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Traditional Foley Drainage Systems—Do They Drain the Bladder?

Cited by 38 publications

References 9 publications

The encrustation and blockage of long-term indwelling bladder catheters: a way forward in prevention and control

The encrustation and blockage of long-term indwelling bladder catheters: a way forward in prevention and control

Pathogenesis of Proteus mirabilis Infection

Safety and efficacy of a patient‐controlled bladder management system for treating urinary retention in men

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