Catheter-associated iatrogenic urethral injuries and methods to prevent them

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.