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.
Intermittent catheterization is used for the following reasons:
Indwelling catheterization is used for the following reasons:
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.
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.
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.
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:
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.
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.
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:
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.
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.
Injuries resulting from catheterization are infrequent. Deaths are extremely rare. Both complications are usually due to infections that result from improper catheter care.
An alternative to catheterization is to use a pad to absorb voided urine.
See also Catheterization, female .
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.
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.
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=Urinaryc .
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/ .
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/URINARYCATHETERIZATION.htm .
Wayne State University. [cited February 28, 2003] http://www.dmc.org/health_info/topics/urin5266.html .
L. Fleming Fallon, Jr, MD, DrPH
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.