Chapter 187 - Urethral Catheterization (Including Urohydropulsion)

Question 1

Indications for urethral catheterizations?

Answer 1

I. Urinary retention

1. anatomical pathologies
   i. e.) physical obstructions to include urolithiasis, neoplasia, inflammation, and trauma,
2. functional pathologies
   i. e) myogenic neurological or dyssynergic pathologies

II. Contrast diagnostic imaging

III. Monitoring critically ill patients
- urine output, determine fractional excretions (e.g. of free water), or measure intra-abdominal pressure

IV. Keep urinary bladder decompressed or empty
- In surgeries of the urinary tract or associated structures, prolonged procedures or in anesthetized patients with increased urine output, an indwelling catheter may be warranted.
elimination of toxins (e.g. methylxanthines) that are reabsorbed from the bladder

V. patients who are immobilized or who have wounds that would be compromised with normal urination outweigh the risks

Question 2

Risk of urethral catheterization?

Answer 2

1. risk of trauma to the lower urinary tract
2. catheter-associated urinary tract infection (CAUTI).
   (Veterinary studies have reported the incidence of CAUTIs to be up to 55% with indwelling urinary catheters)
   *
   Stylets, stiff catheters (e.g. polypropylene), excessive force, lack of lubrication, and diseased tissue can lead to urethral or bladder trauma

Question 3

How to lower the incidence of catheter-associated urinary tract infection?

Answer 3

Placing a catheter only when it is indicated, using it for only as long as necessary and following aseptic placement and maintenance protocols will limit complications.

Question 4

Explain the French(Fr) Scale for urinary catheters

Answer 4

Urinary catheters’ diameters are expressed in French (Fr) scale. The French scale value divided by 3 is the outside diameter of the catheter in millimeters; so, a 6 Fr catheter would have an outside diameter of 2 mm.

Question 5

Most common materials for u-cath?

Answer 5

Silicone and polyurethane catheters

Other commonly used materials include hydrogel, siliconized and Teflon-coated latex, latex, red rubber, and plastic/ polypropylene. Antimicrobial and antiseptic-coated urethral catheters are available

Question 6

Which do you prefer?

Sterile water vs Saline? to fill the balloon of Foley catheters?

Answer 6

There is some debate between sterile water and saline as the ideal filling solution; sterile water has been proposed to be the preferred solution as it maintains balloon inflation longer and avoids the potential of balloon valve or lumen occlusion due to salt crystals.

Question 7

If the bladder is overdistended prior to retrograde urohydropropulsion, what would you do?

Answer 7

Decompressive cystocentesis to a modest residual volume is recommended in cases of bladder overdistension prior to retrograde urohydropropulsion.
It decreases the pressure against the obstruction, accommodates the volume of flushing solution, provides for a pure urine sample, and relieves the pathologies associated with an overdistended bladder and obstructive uropathy.