Lower Urinary Tract Catheterization
BY: Intern Kunal Bhandari
History
• The Earliest known record of Catheterization is from 1500 BCE
• In 16th Century, use of an indwelling wax and cloth catheter was documented.
• In 1855, Jean Francois Reybard’s invented Self retaining Catheter.
• In 1929 Dr. Frederic Foley Developed the modern balloon-based rubber
catheter with a inflatable rubber balloon.
• Silicon Catheters were developed in 1968 which reduced urethritis,
encrustation ad infection.
Male Urethra
• It is about 18 to 20 cm long.
• Anterior urethra is approximately 16cm.
• It is further subdivided into Penile urethra, Bulbar urethra and the
Fossa navicularis.
• Posterior urethra is 4cm long.
• It is also further sub-divided into Preprostatic or bladder neck,
Prostatic and membranous urethra.
Female Urethra
• It is approximately 4cm in length and is present with in anterior
vagina.
Indication for Lower Urinary Tract Catheterization
Diagnostic
Therapeutic
• Sterile acquisition of Urine for Culture
• Urine output monitoring in case of
Acute kidney Injury or sepsis
• Urethral or bladder injury
• Urodynamic studies to measure post
void residual, to fill the bladder
during measurement.
• To collect cytology when there is
suspicion of urothelial cancer.
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•
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Benign Prostatic Hyperplasia
Clot retention
Urethral strictures
Urinary retention and Urinary
Incontinence
• During major surgery to drain the bladder
and monitor urine output.
Contraindications
Absolute Contraindications
• Suspected or confirmed Urethral injury
• H/O bladder neck closure or repair
Relative Contraindications
• Recent Urethral surgery or Urethral stricture
• Patient with an artificial urinary sphincter (AUS)
Technique of Urethral Catheterization
Preparation for Catheterization
Before placement of lower urinary catheter all the necessary supplies are prepared.
Includes sterile gloves, a catheter, sterile lubricant, antiseptic solution, sterile
drapes, distilled water and collection bag with tubing.
The catheter balloon should be tested by inflating and deflating it with distilled .
water.
The sterile field should be established with sterile drapes, and the external genitalia
should be properly prepared with antibacterial solution.
Urethral catheterization in Male
Patient should be in supine position.
10 to 15 ml of sterile lubricant are slowly injected directly in meatus.
The catheter is gently inserted into the meatus while the penis is pulled straight and taut.
Slow, steady pressure is continued till the catheter is completely positioned.
Then, the balloon is filled with distilled water and the catheter pulled distally to ensure
proper placement.
Urethral catheterization in Women
Patient should be in supine frog legged position.
The thumb, pointer and the middle finger of the non-dominant hand are used to spread the
labia before sterilization of meatus.
The catheter is lubricated with sterile lubricant, then the catheter is inserted gently into the
meatus.
Once urine return is noticed, the balloon port is filled with distilled water.
Urethral catheterization of Children
It follows the same principles as catheterization of the urethra of male and female.
However, there are few important consideration as male children may have physiological
phimosis, so the foreskin can be gently moved ventrally or dorsally to identify the meatus.
Recommended size of Pediatric Catheters According to Age
Types of Urethral Catheters
Urethral catheters can vary by size, shape, number of ports and material.
Catheters are available with either one, two or three ports.
A one-port catheter can be effective in draining of bladder because its lumen is greatest in
diameter.
A two-port catheter is effective for anchoring because a balloon can be filled with sterile
water to prevent the catheter form migrating distally.
A three-port catheter is effective for bladder irrigation and the extra port is usually
connected to a saline bag and fluid is continuously infused.
• Double-Lumen Catheters (Most prevalent and commonly used)
• Single-Lumen Catheters (indicated in those who require intermittent catheterization)
• Hematuria Catheters ( helpful in patients with significant hematuria and clots)
Three-way hematuria catheter
• Drain Catheters
- Malecot catheters are used primarily post surgically for optimal drainage.
- There is no balloon port, but instead the tip has four small arms that can be compressed for
insertion but hold the catheter in place.
- These an be used as nephrostomy tubes or suprapubic (SP) tubes after a simple
prostatectomy.
Condom Catheters
-These are type of external urinary drainage.
- Typically used for male patients who have mobility issues.
Suprapubic Catheterization
Indication
- Urethral disruption from trauma
- Recent urethral or bladder neck reconstruction
- For patient that may be too unhealthy to undergo major urological procedures
(simple prostatectomy, urinary diversion, bladder augmentation, urethroplasty)
Techniques
- Open Cystotomy
- Seldinger Technique
- Seldinger technique with ultrasound guidance
• Once the bladder is palpated, a 21-gauge needle can be inserted and urine can be
aspirated.
• The needle should be place in a vertical plane 1 fingerbreadth cephalad to the
pubic symphysis.
Open Cystotomy
- Usually Performed under general anesthesia or sedation.
- The bladder is distended to capacity.
- A small incision is made in the skin, and rectus fascia are exposed using retractors.
- The fascia is incised and rectus muscle is spreads.
- A small incision is made in the bladder and any catheter can be placed and anchored in
the bladder.
- Catheter is then secured to the skin with permanent suture.
Difficult Catheterization
Prostatic Obstruction
- The prostatic adenoma causes a narrowing of the prostatic uretrha.
- The narrowing combined with angle of the male urethra can lead to the inability
to advance the catheter.
Urethral Stricture
Urethral Trauma
- It can lead to partial or complete urethral injuries.
Abnormal Anatomy
• Posterior Urethral Valves
• Obesity
• Reconstruction of the Lower Urinary Tract
• Bladder Neck Reconstruction or Closure
• Artificial Urinary Sphincter
Complications of Lower Urinary Tract Catheterization
• Infection
• Iatrogenic Trauma
• Stricture
• Erosion
• Malignancy
Reference
Campbell-Walsh-Wein Urology 12th Edition
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