What is the most common indication for male indwelling urethral catheterisation?
Akanmode AM1, Ekabua JJ2, Eketunde AO3*, Osanoto AS4, Acholonu CU1 and Origbemisoye AM5 Show
1Clarendon Health Department, Ministry of Health & Wellness, Jamaica 2Windsor University School of Medicine, Caribbean 3Public Health, University of Massachusetts, Lowell, USA 4Department of Human Anatomy and Embryology, University of Health Sciences, Antigua and Barbuda 5Department of General Surgery, May Pen General Hospital, Jamaica *Correspondence: Adenike O Eketunde, Public Health, University of Massachusetts, Lowell, USA Received on 20 August 2020; Accepted on 17 September 2020; Published on 24 September 2020 Copyright © 2020 Akanmode A. This is an open accessarticle and is distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. AbstractThe physiologic process of micturition plays an essential role in the
ability of the human body Keywordscatheterization, catheters, bladder, urinary retention AbbreviationsBPH: benign prostatic hyperplasia; CBI: continuous bladder irrigation Brief History of Catheters“Kathiénai,” which translates as “to thrust into,” was used by the Greeks to describe catheters. The history of bladder catheterization extends way back to 1500 BC, as recorded by an early Egyptian papyrus, transurethral bronze tubes, straws & reeds were used to relieve urinary retention. Al-Zahrawi (Albucasis), the great Arab-Andalusian surgeon also described the use of flexible silver tubes with multiple side holes for more comfortable transurethral relief of urinary retention. Other early civilizations, such as the Chinese, also fashioned various transurethral devices to relieve urinary retention [1]. The famous inventor Benjamin Franklin (1706–1790) devised a helical silver wired tube rubbed with fat for his brother. The latter had urinary retention due to bladder stones. In the 18th century, catheters made from rubber were developed, but this had a drawback initially as such catheters were weak at body temperatures and were notorious for leaving rubber debris within the bladder. With the advent of rubber vulcanization technique by Charles Goodyear in 1844, rubber catheters became more durable and resilient [2]. Dr Frederic Foley introduced a latex balloon catheter, which is currently known as Foley catheter has undergone various modifications for modern-day medical use. At the same time, Charles French, a Parisian surgical instrument maker, devised the French (Fr) scale used to illustrate the external diameter of a catheter [3]. Urethral CathetersThe dwell time concept applies to urethral catheter use. Catheters can be inserted into the bladder for a short duration, such as an in and out immediate drainage of urinary retention or attached to a collection device for urinary output measurements during surgical procedures. Catheters can also be inserted for a longer duration or left indwelling when dealing with patients with chronic urinary retention [4]. There are three major types of urinary catheters:
Catheter Parameters
It is best to inflate the balloon with sterile water or, as per the manufacturer’s recommendation, the use of air, regular water, and saline is not appropriate. Saline can crystallize in the inflating balloon or within the channels, thus posing a problem when trying to retrieve the catheter [5]. Relevant Anatomy and PhysiologyThe urinary system in humans comprises of a pair of kidneys, the ureters, the vesicular bladder, and the urethra. For this article, the focus is on the bladder and the urethra. Bladder AnatomyThe human bladder is in the extraperitoneal area, and it lies posterior to the pubic symphysis. It is a muscular and distensible organ whose shape is varying based on its content and those of the surrounding organs. The bladder is divided into four major parts [6]:
The bladder wall is structurally made up of 3 components, namely:
Bladder PhysiologyThe bladder structurally acts as a storage location for urine until the central nervous system initiates the micturition reflex. The bladder capacity is one that relatively changes with increasing age. The approximate bladder volume for children can be calculated with the formula (years of age + 2) × 30 ml. In adults, the average bladder can hold between 300–400 ml of urine. With increasing bladder volume, there is increased pressure on the walls of the bladder. The wall pressure range of 5–15 mmHg elicits bladder fullness sensations, which is transmitted to the spinal cord to stimulate the micturition reflex [8]. Urethral Anatomy and PhysiologyThe urethra is a long hollow muscular tube that serves to convey urine and other waste from the vesical bladder to the external urethral orifice, which is located at the tip of the glans penis. The urethral also serves to convey semen produced during ejaculation similarly. The urethral is approximately 18–22 cm long in males and about 4 cm long in females. For this purpose of this article, our focus is on the male urethra anatomy and physiology. The urethra is composed of 3 significant segments:
Excellent knowledge of the urethral and bladder anatomy is essential for a successful bladder catheterization procedure. Indications for Bladder CatheterizationThe evidence for bladder catheterization can be broadly sub-divided into therapeutic and diagnostic indications [3, 5, 10]. Therapeutic indications for urethral catheterization:
Diagnostic indications for urethral catheterization:
Contraindications to CatheterizationUrethral injury: the only absolute contraindication to the insertion of a urinary catheter in males is the presence of a traumatic injury to the lower urinary tract, such as a urethral tear. History of saddle type accident or pelvic injuries during motor vehicle accidents or other causes coupled with examination findings of a high riding or a boggy prostate, hematoma at the perineum, or the classic presence of blood at the urethral meatus should warrant a high index of suspicion for a urethral injury. A retrograde urogram is usually performed when any suspicion of urethral injury is raised [14]. EquipmentThere are various types of equipment used to facilitate a successful urethral catheterization, while most facilities have a single-use commercial catheterization set, others don’t, and the individual pieces of instruments listed below can also be assembled for catheterization.
PersonnelUrethral catheterization is a relatively simple procedure; minimal help is required by the procedural assistant to ensure a successful procedure. Preparation
Technique
Special Scenarios
Removal of Urethral CatheterRemoving a urethral catheter is a relatively simple procedure; with the aid of an empty syringe, the catheter balloon is deflated, and the catheter gradually retracted. If significant pain and discomfort catheter balloon is encountered, the clinician should be alert for the possibility of a non-deflating urethral catheter. The most common cause of non-deflating catheters is the crystallization of saline within the catheter channels or a fault at the level of the valve mechanism. To remove non-deflating catheters, follow the guidelines [20]:
ComplicationsUrethral catheterization is associated with few possible complications such as [23, 24]:
Enhancing Healthcare OutcomesAs general medical practitioners in private/outpatient settings, the use of urethral catheters is not as frequent as those found inpatient admitted to the hospital. However, the continual and routine catheter management in patients who have been deemed to require an indwelling catheter is usually undertaken by the general practitioners [25]. Regardless of the clinical setting, i.e., inpatient vs outpatient, the appropriate skills, knowledge, and techniques discussed above should be utilized when passing a urethral catheter. Even though urinary catheterization has become a routine procedure, urinary catheter use should be abstained from when plausible [26]. The use of clean intermittent catheterization is of more significant benefit to the patient over long-term indwelling catheterization. While it is unavoidable that some patients will require the use of long-term indwelling urethral catheters, the routine cleansing of the perineal area and the catheter has not been shown to reduce the incidence of bacteremia. Irrespective of the type either intermittent long-term, the risk of bacteremia still exists, but more for patients with a long-term indwelling catheter. The routine antibiotics use in patients with urethral catheters is advised against; the patient should only be treated when the infection is symptomatic or polymicrobial in etiology. A routine periodic renal scan or cystoscopy may be indicated for patients with an indwelling catheter for over 10 years. These categories of patients are at an increased risk of renal complications and bladder cancer. Once the decision to place a urethral catheter has been made, conscious efforts focusing on standard hygienic practices should be practiced minimizing any problems associated with catheter management. The physical and psychological burden of prolonged catheter use, especially for those with indwelling urinary catheters, is significant, and it negatively affects the patient’s QoL. For patients with acute urinary retention (AUR) ameliorable to surgery, such should be scheduled faster to reduce numerous potential complications and burdens linked with prolonged catheter use. A cordial and patient-centered inter-professional relationship among healthcare providers such as general surgeons, urologists, nursing practitioners, and the general physician will bring about the best patient outcome [27]. Important Message
References
What are the indications for an indwelling urinary catheter?Patient has acute urinary retention or bladder outlet obstruction.. Need for accurate measurements of urinary output in critically ill patients.. Perioperative use for selected surgical procedures:. What is the most commonly used indwelling catheter?Foley catheters are the most common type of indwelling catheter. They feature two separate channels (called lumens): one for draining urine, and one for inflating the balloon tip with sterile water to keep the catheter in place.
What is the most common problem associated with indwelling catheter use?Urinary tract infections (UTIs)
UTIs caused by using a catheter are one of the most common types of infection that affect people staying in hospital. This risk is particularly high if your catheter is left in place continuously (an indwelling catheter).
Why is male catheterisation higher risk?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.
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