‫السالم عليكم و رحمة هللا و بركاته‬

Catheters in Urology

By
Dr. MOHAMED G. SOLIMAN
Assistant professor of Urology
King Faisel University
 General outlines

• .Classification of catheters
• Indications of Urinary catheters..
• Catheter management.
• Complications of urethral catheter
 Classification

Urethral
catheters Suprapubic Ureteric Nephrostomy
catheter catheter catheter

Kidney
Bladder
 Classification of catheters drain
the bladder

Drain through the Suprapubic

urethera catheter

Internal External

Self retaining:Indwelling Non self retaining:Temporary

 External Catheter: Condom
• Lower incidence of bacteriuria Vs internal

• Useful in ♂ pts without outlet obstruction.

• Disadvantages:
– Skin maceration
– So, frequent changing is
essential.
 Self Retaining Catheters

• Internal
• Indwelling : prolonged use
 Self Retaining Catheters

• Example = Foley Catheter:

double way & triple way
• Triple way for continuous
bladder irrigation:

1- Hematuria with
clot retention
2- Post-operative
oTUR
oProstatectomy
 Non-Self Retaining Catheters

• Temporary: Used for

one time.
Drain / inject
For acute retention.

• Example: Nelaton
 Suprapubic Catheterization
• Indications:
– AUR with failed urethral
catheterization
oUrethral trauma
oUrethra stricture
• Contra-indications:
– Bladder tumor
– Pregnancy
 Catheter Specifications
• Sterilization:
– Factory sterilized & packaged (Gamma Rays)
– Single use – not re-sterilized again
• Size:
– External catheter diameters & endoscopic
instruments are measured by French scale
(units of 0.33 mm = 1 French [F]
– Thus, 3F equals 1 mm in diameter and 30F
equals 10 mm in diameter.
 Catheter Specifications
Catheter Size Age Group

6 Fr Premature

6 – 8 Fr 0–3 yrs

8 – 10 Fr 3 – 10 yrs

10 – 12 Fr 10 – 12 yrs

14 Fr 14 yrs

Standard male patient: 16-18 French

 General outlines

• Classification of catheters
• Indications
1 of Urinary catheters
• Catheter management.
• Complications of urethral catheter
 Indications of urinary catheter

Diagnostic Therapeutic

Relief of obstruction
sampling .Dye inj For acute and chronic .Postop
Retention of urine

Analysis PVR estimation Monitor 24-hr Total Haematuria

UOP Incontinence
 General outlines

• Classifcation of Urinary catheter.

• Indications of Urinary catheters.
• . Catheter management
• Complications of urethral catheter
 Catheter management( before insertion)
• Proper history taking and examination
- Confirm retention .
- Cause of retention.
- Exclude contraindications.
• Assurance
• Using proper sterile technique : prepare and drape the
urethra and surrounding area as for a surgical procedure.
• Selection of catheter: Type of catheter – Size of
catheter (16-18 F).
 Catheter management (insertion)
• In the male, retrograde injection of
10 mL of a water-soluble lubricant-
anesthetic and placement of a
urethral clamp for 5 minutes to
allow the anesthetic to contact the
mucosal surfaces .
(Adequate lubrication)
Catheter management(Technique of insertion)
Key Points
• Understanding of sound anatomy
Catheter management (Technique of insertion)

• In the male patient, the penis is placed on stretch

perpendicular to the body
• Gentle advancement of the catheter

• As one approaches the bulbomembranous urethra

(i.e., level of external sphincter):
- Distract patient attention
- Asking the patient to take slow, deep breaths
- Sustained gentle advancement.
 Difficult catheterization

Physiological Pathological

Ext.sph S-shaped Bl. neck .St.Ureth

.Local Anas sustained BPH

 Catheter management( After insertion)
keep clean patent dependent catheter
• Secure catheter properly.
• No kink
• Dependent

• Keep the drainage system closed.

• Cleansing with soap and water during
bathing suffices to remove accumulated
debris
 General outlines

• Classification of catheters
• Indications of Urinary catheters
• Catheter management.
• Complications of urethral catheter
 Catheter complications

Trauma -1
• Causes:
– Forcible maneuver----False passage
– Inflation of the balloon at the urethra

• Management:
– Control active bleeding → Perineal Compression
– Call for Urologist
– Suprapubic cystostomy
– Endoscopic alignment
 Catheter complications

Catheter Associated UTI -2

• UTI is the most common nosocomial infection
(40%)

• Sources of infection:
– Bacteria enter UT at the time of catheter insertion
– Contamination of the taps of the urine drainage
bag
– Disconnection of the catheter from the drainage
tube.
 Catheter complications

Catheter Associated UTI -2

Pathogenesis: Catheterisation promotes the
development of a biofilm between the catheter
& urethral mucosa.

 Biofilm is an accumulation of
microorganisms and body secretions and
provides a favorable environment for
bacterial proliferation and its protection
against mechanical flushing by urine flow
 Catheter complications

Catheter Associated UTI -2

• Infection is suggested by :
- Systemic : fever greater than 38°C
for more than one day
- Local symptoms: Suprapubic pain
- Unusually cloudy urine.
 Catheter complications

Catheter Associated UTI -2 :

• Chronic suppressive AB / topical antiseptic is not
recommended ( fear of emergence of resistant
strains )

• Treatment of asymptomatic bacteriuria

– As a rule asymp bacteriuria warrants no ttt,
except:
• Immuno-compromised at risk of serious
complications
• Prior to urologic intervention (TURP – ESWL)
 Catheter complications

Catheter Associated UTI -2 :

• Treatment of symptomatic UTI:

– Replace / remove the catheter
(AB cannot penetrate the biofilm).
– Blood & urine culture-- AB
 Catheter complications
Catheter Obstruction -3
• Causes:
– Catheter may be kinked.
– Encrustations
– Blood clots

• Management: prophylactic
– Adequate hydration
– Follow up of daily urine output.
– Change the catheter when an episode of
symptomatic urinary infection occurs.
 Catheter complications
Catheter Obstruction -3

• Management: Active treatment

–Flushing
–Regular irrigation
–Acidic irrigation
–Exchange with silicone catheter
 Catheter complications

Displacement -4
• Accidental pull on catheter with inflated balloon:
– Irritable patient
– During patient transfer

• Management:
– Prevention
• Proper fixation to thigh of the patient
• Patient instruction
– Refer to urologist
• Control active bleeding
• Re-catheterize
• SP-Diversion
 Catheter complications

Non-Deflation -5
• Causes:
– Neglected catheter for a long time
– Malfunction of the valve

• Management
- Avoid: cutting the catheter
– Chemical deflation: ether
– Mechanical deflation:
• SP Spinal needle
• Endoscopic if catheter is cut / retracted
 Follow up

Patient catheter

Infection

Local Systemic Cloudy

urine
leakage
Remove cath
Silicon cath
Acidfying agent Low output
Bl. irrigation Obs
 Recommendations (10) -- 4 pre
1- Indwelling urethral catheters should be avoided
whenever possible (proper indication)
2-Use urinary catheters in operative patients only
as necessary, rather than routinely.
3- Catheters should be removed when they are no
longer needed.
4- Use the narrowest, softest catheter that will serve
the purpose
 Recommendations(10) -4 during and
shortly after
5- Strict asepsis should be observed and insertion should be
done by trained personnel (sterile technique)
6-The catheter and the drainage system should be manipulated
as little as possible.
7-Cleansing with soap and water during bathing suffices
to remove accumulated debris
8- Closed unobstructed dependent catheter drainage system
should be employed in all cases.
 Recommendations(10) - 2 during
follow up period
9- Follow up ( patient, catheter)
Catheter ( leakage, obstructed flow, turbid urine)

10- Silicone might be preferable to other catheter materials

to reduce the risk of encrustation in long-term
catheterized patients who have frequent obstruction.
 Principles of urinary catheter
insertion

Patient Catheter Collecting

bag

Follow up
.Follow up Closed )turbidity(
Proper UOP
selection dependent

Type Aseptic ins Secure No Follow up Remove

size .Routine hyg properly kink obs-leakage(
As early