Urinary catheterization

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In medicine, urinary catheterization is "employment or passage of a catheter into the urinary bladder (urethral catheterization) or kidney (ureteral catheterization) for therapeutic or diagnostic purposes.[1]

Complications

Urinary tract infection

Regarding short-term catheterization:

  • Antiseptic impregnated catheters reduce urinary tract infections according to a systematic review by the Cochrane Collaboration.[2]
  • "Condom catheters is less likely to lead to bacteriuria, symptomatic UTI, or death than the use of indwelling catheters. This protection is especially apparent in men without dementia" according to a randomized controlled trial.[3]
  • Suprapubic catheters "have advantages over indwelling catheters in respect of bacteriuria, recatheterisation and discomfort."[4]

Regarding long-term catheterization and prevention of urinary tract infections:

  • It is not clear what type of catheterization is best according to at systematic review by the Cochrane Collaboration.[5]
  • It is not clear what methods of intermittent catheterization are best according to at systematic review by the Cochrane Collaboration.[6]

Removal of urinary catheters

For more information, see: urinary retention.

From the patient care standpoint, if the patient has had an indwelling catheter for a significant period of time, bladder retraining may be advisable before removal. This consists of two cycles of clamping the tube for two hours and releasing it for five minutes, to help restore bladder muscle tone. Since the act of removal often stimulates a strong urge to void, the patient should be given a bedpan or urinal before starting to remove the catheter. [7]

A policy of using of intermittent catheterisation for postoperative patients was "associated with a lower risk of bacteriuria than indwelling urethral catheterisation, but might be more costly...limits catheterisation to those people who definitely need it."[4]

Retained volumes of more than 900 ml reduced chance of successful removal of the catheter.[8]

Regarding how long to wait until a voiding without catheter trial, "a tendency for later removal to be associated with fewer short-term voiding problems, but increasing risk of urinary tract infection, more dissatisfaction and longer hospital stay" according to a systematic review by the Cochrane Collaboration.[9]

Removing the catheter at midnight might be the most effective determinant according to a systematic review by the Cochrane Collaboration.[9]

Alfuzosin 10 mg per day may help[10][11][12] whereas alfuzosin SR 5mg once daily did not help.[13] Tamsulosin, though less well studied, might have less effect on blood pressure.[14]

Intermittent clamping of catheters is of uncertain benefit.[15]

References

  1. ↑ Anonymous (2024), Urinary catheterization (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. ↑ Schumm K, Lam TB (2008). "Types of urethral catheters for management of short-term voiding problems in hospitalized adults: a short version Cochrane review". Neurourology and urodynamics 27 (8): 738–46; discussion 747–8. DOI:10.1002/nau.20645. PMID 18951451. Research Blogging.
  3. ↑ Saint S, Kaufman SR, Rogers MA, Baker PD, Ossenkop K, Lipsky BA (July 2006). "Condom versus indwelling urinary catheters: a randomized trial". Journal of the American Geriatrics Society 54 (7): 1055–61. DOI:10.1111/j.1532-5415.2006.00785.x. PMID 16866675. Research Blogging.
  4. ↑ 4.0 4.1 Niël-Weise BS, van den Broek PJ (2005). "Urinary catheter policies for short-term bladder drainage in adults". Cochrane Database Syst Rev (3): CD004203. DOI:10.1002/14651858.CD004203.pub2. PMID 16034924. Research Blogging.
  5. ↑ Jahn P, Preuss M, Kernig A, Seifert-Hühmer A, Langer G (2007). "Types of indwelling urinary catheters for long-term bladder drainage in adults". Cochrane database of systematic reviews (Online) (3): CD004997. DOI:10.1002/14651858.CD004997.pub2. PMID 17636782. Research Blogging.
  6. ↑ Moore KN, Fader M, Getliffe K (2007). "Long-term bladder management by intermittent catheterisation in adults and children". Cochrane database of systematic reviews (Online) (4): CD006008. DOI:10.1002/14651858.CD006008.pub2. PMID 17943874. Research Blogging.
  7. ↑ Bass LS et al. (1994), Manual of Critical Care Procedures, Springhouse, ISBN 0-87434-691-6, p. 425
  8. ↑ Taube M, Gajraj H (February 1989). "Trial without catheter following acute retention of urine". Br J Urol 63 (2): 180–2. PMID 2641206. [e]
  9. ↑ 9.0 9.1 Griffiths R, Fernandez R (2007). "Strategies for the removal of short-term indwelling urethral catheters in adults". Cochrane Database Syst Rev (2): CD004011. DOI:10.1002/14651858.CD004011.pub3. PMID 17443536. Research Blogging.
  10. ↑ McNeill SA, Hargreave TB (June 2004). "Alfuzosin once daily facilitates return to voiding in patients in acute urinary retention". J. Urol. 171 (6 Pt 1): 2316–20. PMID 15126812. [e]
  11. ↑ McNeill SA, Hargreave TB, Roehrborn CG (January 2005). "Alfuzosin 10 mg once daily in the management of acute urinary retention: results of a double-blind placebo-controlled study". Urology 65 (1): 83–9; discussion 89–90. DOI:10.1016/j.urology.2004.07.042. PMID 15667868. Research Blogging.
  12. ↑ McNeill SA, Daruwala PD, Mitchell ID, Shearer MG, Hargreave TB (October 1999). "Sustained-release alfuzosin and trial without catheter after acute urinary retention: a prospective, placebo-controlled". BJU Int. 84 (6): 622–7. PMID 10510105. [e]
  13. ↑ Shah T, Palit V, Biyani S, Elmasry Y, Puri R, Flannigan GM (October 2002). "Randomised, placebo controlled, double blind study of alfuzosin SR in patients undergoing trial without catheter following acute urinary retention". Eur. Urol. 42 (4): 329–32; discussion 332. PMID 12361896. [e]
  14. ↑ Buzelin JM, Fonteyne E, Kontturi M, Witjes WP, Khan A (October 1997). "Comparison of tamsulosin with alfuzosin in the treatment of patients with lower urinary tract symptoms suggestive of bladder outlet obstruction (symptomatic benign prostatic hyperplasia). The European Tamsulosin Study Group". Br J Urol 80 (4): 597–605. PMID 9352699. [e]
  15. ↑ Fernandez RS, Griffiths RD (2005). "Clamping short-term indwelling catheters: a systematic review of the evidence". J Wound Ostomy Continence Nurs 32 (5): 329–36. PMID 16234728. [e]
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