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 .
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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.
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).
Should it be change every 6 to 8 weeks or less or more?
thanks
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.
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.
To prevent UTI, Dr. prescribed apple cider vinegar (2 tablespoons in 1/3 glass of V8 juice.
I'm anticipating this approach or keeping one in at all times, how painful and difficult is this procedure?
Thank you
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!
i noticed that,,when i have sex,i can orgasm but nothing comes out anymore. Can anyone relate to this?
For some reason, the sphincters keep clamping down on the catheter and scrape against the eyelets, which in turn causes bleeding. I have a UTI now, which hurts like crazy. Lubricant doesn't help. I use plastic ones. I had a foley in for a week and even then I passed blood clots. I am now using intermittent ones. Why is this happening and how do I get it to stop?
I am a man with a shorter urethra and have a hard time even inserting it. Catheterization is pretty troublesome for me. I was started on a 14fr, which scraped against my bladder wall/urethral wall and hurt. 8fr, 10fr, and 12 fr cause pain too. I can't empty out my bladder completely and need to cath. so, how do I make it shop hurting?
Im 19 so it feels awkward needing to use these.
Your thoughts. Is this permanent
Drew
resulting in not getting all the cancer ,I was put on a hormone needle Lupron , which kept my psa down , I kind of kept my cancer at bay now for 12 years myself by mega doses
of lipo vitamin C. I got a little lacks a few years ago , and lo behold my psa started to rise at an alarming rate , now at18.5 they call at late stage cancer , it finally got where the lupron did not work anymore 3 bone scans nothing showed , they then took a ct scan and found a trace of cancer on both my hp bones now on Xtandi a new chemo drug
however I have been wearing a catheter now for a few years as I could not control my bladder anymore ,never had much of a problem until the last 4 weeks or so , it feels like my bowel and bladder are fighting for space , I get the slightest bet of gas , and it hurts like hell somewhere in my urinary tract , it is now where my bowel has to be absolutely empty , or it starts again, like every 15 minutes or so if I sit down for a while and get up same thing , and yet my bladder is empty it feels like I have to go real bad ,and then after a minute or so goes away again just wondering anyone else ever experienced the same thing and what they did about it I wear a foley size 18 which is changed every 3 weeks
I'm always stunned when I hear of just ramming the catheter up a much longer urethra with bends in it and a prostate to pass.
It boarders on sadistic.
On top of that, some people have been sexually assaulted via the urethra and it's NOT just a simple procedure for them.
Thank you for letting me share that.
So is shorter form. Get a large variety of them to try. Get different sizes. 12, 14 and 16 french. The only reason to go up (16 is wider then 14) is if you have leakage around the cath. Get samples (LOTS) and Check out the stiffness and go for the ones that are most comfortable. Some are silicone tubing which works for some. Others are stiff as boards (OUCH). Make sure the brands note that the eyelits are polished. Start them at the bottom of your urethera (Not the TOP) if you get stuck near the bladder neck cough and press a little harders. *Note once you get used to them you won't need that and it will eventually stop feeling odd. Remember the goal is to empty the bladder so go slow removing the cath. If you go too fast you may have to reinsert it slightly for one of the eyelits to be up to the bladders bottom edge. If you ever do get stuck where there is no bathroom available and have to use something like the Speedy Compact Set empty the bag asap and DON'T be a jerk and just throw the full bag in the trash.
Oh and one last tip. If you have prostate cancer or a real issue getting a cath to get into the bladder get the Coude type and remember the tip should be bent up. Coloplast has a couple of new ones that they market as Coude but the tip isin't bent up its just VERY easy to get it into the bladder. That might be one to get samples of if you need that or not.