Definition and Overview
Urinary catheterisation is a procedure that inserts a urinary catheter—a tube made of silicone, latex, or polyurethane—into the bladder through the urethra to drain the urine and/or to introduce liquids into the urethra or bladder for treatment and diagnosis of conditions that affect the urinary tract.
Different types of catheters can be used in this procedure. These include:
- In-dwelling urinary catheter - Also known as a Foley catheter, this is typically made of silicone or natural rubber. It comes with a balloon-like attachment, which is inflated with sterilized water.
- Intermittent catheter - Also known as a Robinson catheter, this type is often prescribed for patients who require a catheter for a shorter period. This does not have a balloon attached to its tip, which means that it cannot be used without drainage. Intermittent catheters can be either coated or non-coated. The former typically has a hydrophilic coating and comes ready to use, allowing patients to perform self-catheterisation. However, it is important to note that the patient should closely follow guidelines for maintaining the cleanliness of the catheter and the surrounding areas, as well as instructions for proper catheter insertion.
- Coudé catheter – This features a curved tip that makes for easier insertion into the prostatic urethra.
- Haematuria catheter – This is a type of Foley catheter prescribed for patients suffering from haematuria or have undergone haemostasis. This can also be used to facilitate endoscopic surgical procedures.
- Condom catheter - Also known as an external catheter, this is often prescribed for male patients suffering from incontinence. This type offers a lower risk of infection than an in-dwelling or Foley catheter.
Who should undergo and expected results
Patients with the following conditions are typically prescribed with a urinary catheter to drain their bladders:
- Urinary incontinence, or when the patient is experiencing urine leakage or an inability to control the passing of urine
- Urinary retention, or the inability to pass urine and empty the bladder
- Medical conditions such as dementia, injury to the spinal cord, or multiple sclerosis
Patients who have recently undergone a surgical procedure to the genitals or the prostate are often fitted with a catheter post-operation to aid them in passing urine and emptying the bladder.
How the procedure works
The method on how the procedure is performed depends on the type of catheter to be used.
An in-dwelling catheter is typically inserted into the urethra. However, there are also instances where a small hole is made in the abdomen before the catheter is inserted directly into the bladder. If this is the case, the procedure must be performed in a hospital or a clinic with a sterile environment to prevent the early onset of infection.
Meanwhile, condom and intermittent catheters can be worn without assistance. However, the catheter must be replaced every day for sanitary purposes.
Possible risks and complications
Because a catheter is placed inside the body and it deals with disposal of bodily waste, infections are not uncommon among patients. The urethra, bladder, and in some rare cases, the kidneys, become infected especially with patients who use catheters for an extended period. These infections are known as urinary tract infections and can be treated with antibiotics prescribed by the doctor.
Other common problems include bladder spasms, which are very similar to stomach cramps, injury to the urethra, bladder stones, haematuria or presence of blood in the urine, and blockage of the urethra.
Patients who are sensitive or allergic to latex might also experience adverse reactions to catheters made of the said material.
More severe complications linked to urinary catheterisation include:
- Kidney damage, usually with patients who are using in-dwelling catheters for extended period
- Infections in the blood, or septicemia
- Bladder stones
Should the patient experience the following symptoms, he or she need to consult with a doctor immediately, who will replace or remove the catheter, or prescribe another form of treatment:
- Recurring bladder spasms that become more painful over time
- Chills or fever
- Bleeding inside or around the catheter
- Large amounts of urine leakage
- The presence of stones or sediments in the urinary catheter or the drainage bag attached to it
- Strong-smelling urine
- Thick or cloudy urine
- Swelling of the urethra around the catheter
- The presence of skin sores (if the patient is using a suprapubic catheter)
Little to no urine draining from the catheter, especially if the patient is properly hydrated
Resnick NM. Incontinence. In: Goldman L, Ausiello D, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 25.