Catheterization, male





Definition

Urinary catheterization is the insertion of a catheter through the urethra into the urinary bladder for withdrawal of urine. Straight catheters are used for intermittent withdrawals, while indwelling (Foley) catheters are inserted and retained in the bladder for continuous drainage of urine into a closed system.


Purpose

Intermittent catheterization is used for the following reasons:

  • Obtaining a sterile urine specimen for diagnostic evaluation.
  • Emptying bladder contents when an individual is unable to void (urinate) due to urinary retention, bladder distention, or obstruction.
  • Measuring residual urine after urinating.
  • Instilling medication for a localized therapeutic effect in the bladder.
  • Instilling contrast material (dye) into the bladder for cystourethralgraphy (x-ray study of the bladder and urethra).
  • Emptying the bladder for increased space in the pelvic cavity to protect the bladder during labor and delivery or during pelvic and abdominal surgery.
  • Monitoring accurately the urinary output and fluid balance of critically ill patients.

Indwelling catheterization is used for the following reasons:

  • Providing palliative care for incontinent persons who are terminally ill or severely impaired, for whom bed and clothing changes are uncomfortable.
  • Managing skin ulceration caused or exacerbated by incontinence.
  • Maintaining a continuous outflow of urine for persons undergoing surgical procedures that cause a delay in bladder sensation, or for individuals with chronic neurological disorders that cause paralysis or loss of sensation in the perineal area.
  • Included in standard preoperative preparation for urologic surgery and procedures for bladder outlet obstruction.
  • Providing relief for persons with an initial episode of acute urinary retention, allowing their bladder to regain its normal muscle tone.

Demographics

As of 2002, experts estimate that approximately 96 million urinary catheters are sold annually throughout the world. Men are less likely than women to use them.


Description

The male urethral orifice (urinary meatus) is a vertical, slit-like opening, 0.15–0.2 in (4–5 mm) long, located at the tip of the penis. The foreskin of the penis may conceal the opening. This must be retracted to view the opening to be able to insert a catheter. With proper positioning, good lighting, and gloved hands, these anatomical landmarks can be identified. Perineal care or cleansing may be required to ensure a clean procedural environment.

The male urethra is longer than the female urethra and has two curves in it as it passes through the penis to the bladder. Catheterization of the male patient is traditionally performed without the use of local anesthetic gel to facilitate catheter insertion. Glands along the urethra provide some natural lubrication. Older men may require lubrication. In such an instance, an anesthetic or antibacterial lubricant should be used.

Once the catheter is inserted, it is secured as appropriate for the catheter type. A straight catheter is typically secured with adhesive tape. An indwelling catheter is secured by inflating a bulb-like device inside of the bladder.

Diagnosis/Preparation

Health-care practitioners performing the catheterization should have a good understanding of the anatomy and physiology of the urinary system, be trained in antiseptic techniques, and have proficiency in catheter insertion and catheter care.

After determining the primary purpose for the catheterization, practitioners should give the male patient and his caregiver a detailed explanation. Men requiring self-catheterization should be instructed and trained in the technique by a qualified health professional.

Sterile disposable catheterization sets are available in clinical settings and for home use. These sets contain most of the items needed for the procedure, such as antiseptic agent, gloves, lubricant, specimen container, label, and tape. Anesthetic or antibacterial lubricant, catheter, and a drainage system may need to be added.


Catheter choices


TYPES. Silastic catheters have been recommended for short-term catheterization after surgery because they are known to decrease incidence of urethritis (inflammation of the urethra). However, due to lower cost and acceptable outcomes, latex is the catheter of choice for long-term catheterization. Silastic catheters should be reserved for individuals who are allergic to latex products.

There are additional types of catheters:

  • PTFE (plastic)-coated latex indwelling (Foley) catheters
  • hydrogel-coated latex indwelling catheters
  • pure silicone indwelling catheters
  • silicone-coated latex indwelling catheters

SIZE. The diameter of a catheter is measured in millimeters. Authorities recommend using the narrowest and softest tube that will serve the purpose. Rarely is a catheter larger than size 18 F(rench) required, and sizes 14 or 16 F are used more often. Catheters greater than size 16 F have been associated with patient discomfort and urine bypassing. A size 12 F catheter has been successfully used in children and in male patients with urinary restriction.

DRAINAGE SYSTEM. The health-care provider should discuss the design, capacity, and emptying mechanism of several urine drainage bags with the patient. For men with normal bladder sensation, a catheter valve for intermittent drainage may be an acceptable option.

PROCEDURE. When inserting a urinary catheter, the health care provider will first wash the hands and put on gloves and clean the tip of the penis. An anesthetic lubricating gel may be used. The catheter is threaded up the urethra and into the bladder until the urine starts to flow. The catheter is taped to the upper thigh and attached to a drainage system.


Aftercare

Men using intermittent catheterization to manage incontinence may require a period of adjustment as they try to establish a catheterization schedule that is adequate for their normal fluid intake.

Antibiotics should not be prescribed as a preventative measure for men at risk for urinary tract infection (UTI). Prophylactic use of antibacterial agents may lead to the development of drug-resistant bacteria. Men who practice intermittent self-catheterization can reduce their risk for UTI by using antiseptic techniques for insertion and catheter care.

The extended portion of the catheter should be washed with a mild soap and warm water to keep it free of accumulated debris.


Risks

Phimosis is constriction of the prepuce (foreskin) so that it cannot be drawn back over the glans penis. This may make it difficult to identify the external urethral meatus. Care should be taken when catheterizing men with phimosis to avoid trauma from forced retraction of the prepuce or by incorrect positioning of the catheter.

Complications that may occur from a catheterization procedure include:

  • Trauma or introduction of bacteria into the urinary system, leading to infection and, rarely, septicemia.
  • Trauma to the urethra or bladder from incorrect insertion or attempting to remove the catheter with the balloon inflated. Repeated trauma may cause scarring or stricture (narrowing) of the urethra.
  • Passage of urine around the catheter. Inserting a different catheter size can minimize this problem.

The presence of residual urine in the bladder due to incomplete voiding provides an ideal environment for bacterial growth.

Urinary catheterization should be avoided whenever possible. Clean intermittent catheterization, when practical, is preferable to long-term catheterization.

Catheters should not be routinely changed. Each man should be monitored for indication of obstruction, infection, or complications before the catheter is changed. Some men require daily or weekly catheter changes, while others may need one change in several weeks. Fewer catheter changes will reduce trauma to the urethra and reduce the incidence of UTI.

Because the urinary tract is normally a sterile system, catheterization presents the risk of causing a UTI. The catheterization procedure must be sterile and the catheter must be free from bacteria.

Frequent intermittent catheterization and long-term use of indwelling catheterization predisposes a man to UTI. Care should be taken to avoid trauma to the urinary meatus or urothelium (urinary lining) with catheters that are too large or inserted with insufficient use of lubricant. Men with an indwelling catheter must be reassessed periodically to determine if alternative treatment will be more effective in treating the problem.



Normal results

A catheterization program that includes correctly inserted catheters and is appropriately maintained will usually control urinary incontinence.

The man and his caregiver should be taught to use aseptic technique for catheter care. Nursing interventions and patient education can make a difference in the incidence of urinary tract infections in hospitals, nursing homes , and home care settings.

The sexuality of a man with an indwelling catheter for continuous urinary drainage is seldom considered. If the patient is sexually active, the man or his partner can be taught to remove the catheter before intercourse and replace it with a new one afterwards.


Morbidity and mortality rates

Injuries resulting from catheterization are infrequent. Deaths are extremely rare. Both complications are usually due to infections that result from improper catheter care.

Alternatives

An alternative to catheterization is to use a pad to absorb voided urine.

See also Catheterization, female .


Resources

BOOKS

Altman, M. Urinary Care/Catheterization. Albany, NY: Delmar, 2003.

Gearhart, John P. Pediatric Urology. Totawa, NJ: Humana Press, 2003.

Hanna, P. M., S. B. Malkowicz, and A. J. Wein. Clinical Manual of Urology, 3rd edition. New York: McGraw Hill, 2001.

Laycock, J. and J. Haslam. Therapeutic Management of Incontinence and Pelvic Pain. New York: Sringer-Verlag, 2001.

Newman, Diane K. Managing and Treating Urinary Incontinence. Baltimore, MD: Health Professions Press, 2002.

PERIODICALS

Johnson, J. R. "Safety of Urinary Catheters." Journal of the American Medical Association 289(3) (2003): 300–301.

Munasinghe, R. L., V. Nagappan V, and M. Siddique. "Urinary Catheters: A One-point Restraint?" Annals of Internal Medicine 138(3) (2003): 238–239.

Wilde, M. H. and B. L. Cameron. "Meanings and Practical Knowledge of People with Long-term Urinary Catheters." Journal of Wound Ostomy Continence Nursing 30(1) (2003): 33–43.

Winder, A. "Intermittent Self-catheterisation." Nursing Times 98(48) (2002): 50.

ORGANIZATIONS

American Board of Urology. 2216 Ivy Road, Suite 210, Chaarlottesviille, VA 22903. (434) 979-0059. http://www.abu.org/ .

American Foundation for Urologic Disease. 1128 North Charles Street, Baltimore, MD 21201. (800) 242-2383. http://www.afud.org/ .

American Urological Association. 1120 North Charles Street, Baltimore, MD 21201. (410) 727-1100. http://www.auanet.org/ .

National Health Service of Great Britain. <http://www.nhsdirect.nhs.uk/nhsdoheso/display.asp?sTopic=Urinary > .

National Kidney and Urologic Diseases Information Clearing-house. 3 Information Way, Bethesda, MD 20892. (800) 891-5390. http://www.niddk.nih.gov/health/kidney/nkudic.htm/ .

OTHER

AdvancePCS. [cited February 28, 2003] <http://www.building betterhealth.com/topic/topic100587629> .

Harvard Pilgrim Health Care. [cited February 28, 2003] <http://www.intelihealth.com/IH/ihtIH/WSHPO000/2579 2/31681.html> .

Mount Clemens General Hospital, Mt. Clemens, MI. [cited February 28, 2003] <http://www.mcgh.org/Health_Information/Articles/URINARYCATHETERI ATION.htm> .

Wayne State University. [cited February 28, 2003] http://www.dmc.org/health_info/topics/urin5266.html .


L. Fleming Fallon, Jr, MD, DrPH

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


Urinary catheterization can be performed by health-care practitioners, by home caregivers, or by men themselves in hospitals, long-term care facilities, or personal homes.

QUESTIONS TO ASK THE DOCTOR


  • Will the catheterization be intermittent or indwelling?
  • If intermittent, who will change the catheter and how long will it remain in place?
  • If indwelling, how often will the catheter be changed and who will change it?
  • Who will teach me or my caregiver how to insert and remove the catheter, monitor it, and perform routine care?


User Contributions:

Mike Donahue
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Apr 16, 2006 @ 8:20 pm
I was told to be careful not to fully empty the bladder when I self catheter as this could cause the bladder to colapse and/or become weak. Another nurse told me only to be careful not to empty my bladder too fast as this could cause shock. Who is right?
Anonymous
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Aug 3, 2007 @ 12:12 pm
note: I am not a medical professional, just a long-time user of catheters.

In response to the previous comment, I typically drain my bladder fully. It doesn't take long for it to fill again. And with a Size 12 catheter, the bladder can't drain very fast. Personally, I can't get a larger one in.

For those of us who have to perform intermittent catheterization, there are some practical issues.
1) cranberry juice: drink at least two cups daily or you will get infections.
2) you can re-use catheters by storing them in a solution of 1 part vinegar to 2 parts water between use. I am not sure how long you can re-use them for. I currently am not having problems by changing them every 3 days. Perhaps someone can provide more information?
3) If you have a foley (balloon) catheter installed, you can minimize infections and other problems by simply drinking extra water. Note that this may limit your mobility as the bag will fill up quickly. However, cranberry juice taken regularly is better.
4) Coffee is a diaeretic. If you don't normally drink coffee, drinking a cup of coffee about two hours before going out will reduce the liquids in your system, lengthening the time before you need to drain your bladder (or empty your bag) again (assuming you drain immediately before going out).
5) drain your bladder when it gets full. If you don't get a full sensation, try to establish a regular schedule. I normally drain 4 to 6 times a day - more in the winter, less in the hot days of summer when I lose most of my liquids through sweat. Try to keep your bladder from getting too full (try not to be holding more than 500 ml).
PRANAV JHA
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Aug 7, 2007 @ 8:08 am
DO SEND ME ALL NEW AND ADVANCE INFO REGARDING MEDICAL FIELD
larry hales
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Aug 8, 2007 @ 5:17 pm
I have experienced first hand having a catheter inserted into my male body improperly. The doctor tells me the bladder that was punctured will heal on its own. What can I do?
jean-paul bellavance
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Nov 15, 2007 @ 2:14 pm
How long should the catheter be kept or change?

Should it be change every 6 to 8 weeks or less or more?

thanks
Anonymous
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May 31, 2008 @ 9:09 am
How long between catheter changes? I currently change mine once a week, storing it in a vinegar and water solution between uses. Cranberry juice on a regualr basis, at least twice a day, seems to be the critical part.

Does anyone have any suggestions for re-using a catheter while on the road? I haven't found anything to store it in that doesn't leak if accidentally tipped over (e.g. reusable water bottles). And most containers are fairly bulky too.
cathy
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Sep 6, 2008 @ 8:08 am
I am wanting to know how long a silastic catheter can be used before its needs to be replaced as a long term use.
Anonymous
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Jul 25, 2009 @ 2:14 pm
I tried replacing catheters every week and that turned out to be too long. I'm currently replacing them every 5 days - storing them.in a vinegar and water solution between use. I suspect the reason they can't be used indefinitely is that a bacterial film builds up on them over time.

There was a recent article in either Scientific American or Discover (forget which, but it was very recent) on bacterial films that mentioned catheters and incidence of films & bladder infections on patients in hospital with permanent catheters. While not directly comparable, the build up of films is fairly fast, leading to infections often within a week.
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Jul 20, 2010 @ 11:11 am
I have a bag at nite and a leg bag in the day. Recently my bed has been wet and not sure were it is coming from, the hole outside my stomach, my Penis or what! What should i do? I wear a diper now because of this. I will be calling my doctor for advice also. bob
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Sep 6, 2010 @ 2:02 am
we do hope that you will contonue publishing this page so that lots of student my search this as it was a big for our project as a good knowledge to be store with
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Jun 4, 2011 @ 11:11 am
i recently had a foley catheter put in me after a surgery i qam hqaving geatdiscomfort and feels like it is putting pressure on me when i release urine is this normal
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Oct 16, 2011 @ 5:17 pm
Intermittent cath several years. Reason, can't release sphincter due to nerve injury?Concerned about tiny pieces of tissue in urine. Not regularly, but happens now & then i.e. a month or so between occurances.

To prevent UTI, Dr. prescribed apple cider vinegar (2 tablespoons in 1/3 glass of V8 juice.
Bruce
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Nov 28, 2011 @ 7:19 pm
HOw painful is the insertion and extraction of catheter?
I'm anticipating this approach or keeping one in at all times, how painful and difficult is this procedure?

Thank you
Noemi
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Mar 13, 2012 @ 8:20 pm
In july of 2011 my 2yr old son was diagnosed with having a urachal remnant, which was a mass of abnormal tissue at the dome of his bladder. The urologist, informed me that if this mass was not removed, that later in life he could have a risk of developing cancer. It was a tough decision for me to make and to have my son go thru the surgery. I know it had to be done, and i put my trust in the doctor and the staff. Yesterday, was when my son had his surgery. It took about an hour and a half, and the doctor said my son did good, and no problems occured. After an hour of recovery from the general anesthesia, he said it would be ok for my son to go home. So of course i was happy everything went smoothly and that my baby boy would be coming home that same day. Once we were at home, my son would grab at his genitals, Complaining and crying and saying"owie owe owe!!". I was confused as to why he was grabbing at his genitals, since his surgery was nowhere near there. I figured maybe it was because he was sensitive and sore from the surgery that the pain may travel. But, later we noticed that he would only have pain and cry only when he urinated, and seemed to have an erection. So today i called his urologist, which is the one who performed the surgery and he said to go ahead and bring in my son. We went and the doctor said that my son is having this pain due to the fact that they had to insert a catheter into his urethra, so that they could fill his bladder to have it expand enough so they can go ahead and only do the one small incision right below his belly button and remove the remnant, instead of making two incisions.
I was not informed before the surgery that this catheter would be inserted so that they could fill his bladder. This catheter was not used for the bladder to be emptied/drained, it was used to fill his bladder. I was upset that i was not told about this, but at the same time relieved that it was nothing major, or an infection.
The doctor said to just make sure my son drinks plenty of water, and that the pain during urination can persist for 2 or 3 days. Has anyone had a child go thru this same thing or known of anyone having the similar surgery?? and if so, was there pain during urination because of the catheter that was used during the surgery? i just wanna know if this is normal. Any advice , opinions , sggestions will be greatly appreciated. Thank you!
James
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Jul 9, 2012 @ 6:06 am
It's been 10 years since urethrotomy, did self-cath for a couple months post original surgery. Though stream has been less than original over the years, but good. Just started spotting last couple of weeks. Noticed some pain when begin to urinate but is gone once flow is going. Stream appears to be about 1/2 to 1/3 of what it was 10 years ago. I was considering doing self-cath on myself again...but I don't know if it would be safe and/or conducive. I have to see my regular doctor before I go see my urologist. So it may be a week or two before I can get the real advice I need. I am worried I could be missing out on opportunity to reduce further progression by taking action now.
Larry
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May 17, 2013 @ 5:17 pm
I was catherized for surgery and developed a bladder infection afterward. After the infection cleared up I noticed what seemed like a knot or bump in urethra. It was very painful to manipulation and it was impossible to have intercourse due to the pain. Do you think this may be due to scarring? Is it possible to leave part of the catheter inside?
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Jul 9, 2013 @ 8:20 pm
I have been struggling with bph that is causing urinary retention. it seems to be getting worse and I do keep my urologist appointments but I do not want to have surgery at this point in my life and would rather never do that. none of the options seem to work for me but I also don't want to allow more damage to occur. currently I am up 2-3 times a night and going to the restroom up to ten times in a workday. I am seriously considering self cath as the best option though I cant imagine how to get past the training part. so two questions I guess 1) Is this even a possibility for bph? the only time I read about it is as a foley type when the stream stops totally I would much rather that not happen. and 2) is training seriously necessary? I really cant imagine going through that either.
julie
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Nov 14, 2013 @ 12:00 am
i look after someone and his catheter leaks at least once a wk.is it poss he makes it happen?

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