Catheter-associated iatrogenic urethral injuries and methods to prevent them
- Authors: Morozov A.O.1, Khabib D.S.2, Yandiev S.A.1, Gazimiev M.A.1
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Affiliations:
- Institute for urology and reproductive health, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
- N.V. Sklifosovsky Institute of Clinical Medicine, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
- Issue: No 2 (2024)
- Pages: 100-104
- Section: Literature reviews
- URL: https://journals.eco-vector.com/1728-2985/article/view/633597
- DOI: https://doi.org/10.18565/urology.2024.2.100-104
- ID: 633597
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Abstract
Up to a quarter of all hospitalized patients undergo bladder catheterization, regardless of the department profile. Injuries related to this procedure represent up to 32% of all urethral injuries and may compromise or worsen the patient’s treatment. The most frequent causes of iatrogenic injury in this context are unintentional balloon inflation in the urethra or the creation of a false passage. The purpose of our work was to identify the most effective methods to prevent these injuries.
Articles containing the following information were selected: iatrogenic injuries of the urethra, the effectiveness of injury prevention methods, various devices and drugs. The work also included reviews evaluating the effectiveness of various catheterization techniques and data on the significance of the type and material of the catheter.
We reviewed about 20 papers that discussed the frequency of iatrogenic injuries, their early and long-term consequences and ways to prevent them. Urethral strictures are the most common complication of catheterization in the long-term period (78%). The remaining 22% had no consequences. Most researchers agree that the most effective way to prevent injury is the correct catheter insertion technique and the use of additional assets in the form of anesthetic gels-lubricants. In cases of difficult catheterization, modified techniques with different types of catheters can help: catheters with a curved tip or made of more rigid materials. Safety valves that prevent the balloon inflation in the urethra, or visus catheters that help to detect and solve the problem safely, can prevent a traumatic effect.
As a result of our work we have found several approaches to reduce the frequency of injuries. The most accessible and easiest way is to follow the catheterization algorithms, the second and important way is to use proper premedication in the form of gels with anesthetics. In cases of complex catheterization, use a Coude or silicone catheter, and in cases that do not allow catheterization without visual control, use visus catheters.
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About the authors
A. O. Morozov
Institute for urology and reproductive health, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
Author for correspondence.
Email: andrei.o.morozov@gmail.com
ORCID iD: 0000-0001-6694-837X
PhD, Senior researcher
Russian Federation, MoscowD. S. Khabib
N.V. Sklifosovsky Institute of Clinical Medicine, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
Email: diana-khabib@mail.ru
ORCID iD: 0009-0008-4425-2580
student
Russian Federation, MoscowS. A. Yandiev
Institute for urology and reproductive health, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
Email: sylka06@mail.ru
ORCID iD: 0009-0008-1585-1736
PhD student
Russian Federation, MoscowM. A. Gazimiev
Institute for urology and reproductive health, Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)
Email: gazimiev_m_a@staff.sechenov.ru
ORCID iD: 0000-0002-8398-1865
M.D., professor
Russian Federation, MoscowReferences
- Shackley D.C. et al. Variation in the prevalence of urinary catheters: a profile of National Health Service patients in England. BMJ Open. England. 2017;7(6):e013842.
- Manalo M.J., Lapitan M.C.M., Buckley B.S. Medical interns’ knowledge and training regarding urethral catheter insertion and insertion-related urethral injury in male patients. BMC Med. Educ. England. 2011;11:73.
- Patel D.N. et al. Female urethral injuries associated with pelvic fracture: a systematic review of the literature. BJU Int. BJU Int. 2017;120(6):766–773.
- Davis N.F. et al. Incidence, Cost, Complications and Clinical Outcomes of Iatrogenic Urethral Catheterization Injuries: A Prospective Multi-Institutional Study. J. Urol. J Urol. 2016;196(5):1473–1477.
- Davis N.F. et al. Long-term outcomes of urethral catheterisation injuries: a prospective multi-institutional study. World J. Urol. World J Urol. 2020;38(2):473–480.
- Siderias J., Guadio F., Singer A.J. Comparison of topical anesthetics and lubricants prior to urethral catheterization in males: A randomized controlled trial. Acad. Emerg. Med. Hanley and Belfus Inc. 2004;11(6):703–706.
- Kashefi C. et al. Incidence and prevention of iatrogenic urethral injuries. J. Urol. J Urol. 2008;179(6):2254–2258.
- Wagner K.R., Bird E.T., Coffield K.S. Urinary Catheterization: a Paradigm Shift in Difficult Urinary Catheterization. Curr. Urol. Rep. Curr Urol Rep. 2016;17(11).
- Villanueva C., Hemstreet G. AUA Update Series Lesson 5 Volume 30 2011 Difficult Catheterization : Tricks of the Trade Learning. 2011.
- Wein A.J. et al. Campbell-Walsh urology. 10th ed. Philadelphia: Elsevier Saunders, 2012.
- Villanueva C., Hossain S.G.M., Nelson C.A. Silicone catheters may be superior to latex catheters in difficult urethral catheterization after urethral dilation. J. Endourol. J Endourol. 2011;25(5):841–844.
- Gould C.V. et al. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect. Control Hosp. Epidemiol. Infect Control Hosp Epidemiol. 2010;31(4):319–326.
- Croghan S.M. et al. A Prospective Multi-Institutional Evaluation of Iatrogenic Urethral Catheterization Injuries. J. Investig. Surg. Off. J. Acad. Surg. Res. United States. 2022;35(10):1761–1766.
- Thomas A.Z. et al. Avoidable iatrogenic complications of urethral catheterization and inadequate intern training in a tertiary-care teaching hospital. BJU Int. BJU Int. 2009;104(8):1109–1112.
- Sullivan J.F. et al. Avoidable iatrogenic complications of male urethral catheterisation and inadequate intern training: a 4-year follow-up post implementation of an intern training programme. Surgeon. Scotland. 2015;13(1):15–18.
- Zammit P.A., German K. The difficult urethral catheterization: use of a hydrophilic guidewire. BJU Int. BJU Int. 2004;93(6):883–884.
- Kim S.H. et al. Clinical efficacy of retrograde urethrography-assisted urethral catheterization after failed conventional urethral catheterization. BMC Urol. BMC Urol. 2021;21(1).
- Ramakrishnan K., Mold J.W. Urinary Catheters: A Review. Internet J. Fam. Pract. Internet Scientific Publications. 2004;3(2).
- Williams C. Making a choice of catheterisation gel and the role of chlorhexidine. https://doi.org/10.12968/bjcn.2017.22.7.346. MA Healthcare London. 2017;22(7):346–351.
- Jayathillake A. et al. Chlorhexidine in urethral gel: Does it cause pain at flexible cystoscopy? Urology. Elsevier. 2006;67(4):670–673.
- Subramanian V., Soni B.M. Possible Use of a Safety-Valve with a Foley Catheter During Catheterisation of Male Spinal Cord Injury Patients for Prevention of Urethral Trauma Caused by Inflation of the Catheter Balloon in the Urethra. Med. Devices (Auckl). Dove Press. 2023;16:47.
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