A Prospective Multi-Institutional Evaluation of Iatrogenic Urethral Catheterization Injuries

Croghan, Stefanie; Hayes, Leah; O’Connor, Eabhann; Rochester, Mark; Finch, William; Carrie, A.; Considine, S.; D’Arcy, Frank; Ríogh, Aisling Nic An; Mahmalji, Wasim; Elhadi, Mohammed; Thursby, Helen; Pearce, Ian; Modgil, Vaibhav; Noweir, Hosam; MacCraith, Eoin; Madden, A.P.; Manecksha, Rustom P.; Browne, Eva; Giri, Subhasis; Cunnane, Connor V.; Mulvihill, John J.; Walsh, Michael T.; Davis, Niall F.; Flood, Hugh D.

doi:10.1080/08941939.2022.2109226

Cited by 4 publications

(6 citation statements)

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“…Previous studies focusing on traumatic UC also demonstrated poor patient outcomes and significant health care resource utilization. 6,8,10,19 Davis and colleagues analyzed an Irish traumatic UC cohort in which 81% sustained a Clavien-Dindo grade 2 or greater complication, 40% experienced sepsis, 35% required suprapubic catheterization, and injury resulted in an average of $10,000 and 9.4 days excess hospital stay per incident. 8 A later study by the same group analyzed a cohort with more modest utilization, only accruing an average of 2.0 extra hospital days and $4300 in costs per case.…”

Section: Discussionmentioning

confidence: 99%

Characterization and Outcomes of Iatrogenic Urethral Catheterization Injuries

Lawton,

Ortiz,

Henry

et al. 2024

Urology Practice

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Introduction:Iatrogenic injury during urethral catheterization is a common reason for inpatient urologic consultation and is associated with increased morbidity and resource utilization. Literature defining the patient population, interventions, or outcomes associated with traumatic catheterization is scarce.Methods:We performed a retrospective review of consults for adult urethral catheterization at a single tertiary care center (July 2017-December 2019), with focus on patient characteristics and complications. Traumatic urethral catheterization was defined as catheterization by the primary team with at least 1 of these conditions: gross hematuria, meatal blood, or cystoscopic evidence of urethral trauma. Characteristics collected included urologic history, catheterization circumstances, procedural intervention, and subsequent visits.Results:Three hundred urology consults for urethral catheterization were identified, including 98 (33%) traumatic events (5.3 incidents/1000 catheters placed). All traumatic catheterization consults were in men (median age 69 years). Most (71%) patients sustaining injury had significant urologic history (eg, benign prostatic hyperplasia, urethral stricture). Sixty-three (64%) consults were determined to be uncomplicated (not requiring any procedural intervention for catheter placement). Gross hematuria was the most common sequela (50% of patients). The 30-day catheter-associated urinary tract infection rate was 13%, and 2 patients developed sepsis. Complications required a total of 52 additional hospital admission days, 19 of which were intensive-care level, as well 113 outpatient urology visits.Conclusions:Traumatic urethral catheterization is associated with increased need for procedural intervention, risk of catheter-associated urinary tract infection, and additional resource utilization. Further studies on traumatic catheterization are needed to guide systemic efforts for minimizing injury and cost.

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Section: Discussionmentioning

confidence: 99%

Characterization and Outcomes of Iatrogenic Urethral Catheterization Injuries

Lawton,

Ortiz,

Henry

et al. 2024

Urology Practice

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“…The anatomical distinctions between the male and female ureter and urethra are significant and play pivotal roles in both physiological function and susceptibility to urinary complications. 22 In males, the urethra is approximately 18-20 cm in length and is categorized into four sections: prostatic, membranous, bulbous, and penile. Conversely, the female urethra is shorter, measuring around 4 cm, and opens anterior to the vaginal opening.…”

Section: Discussionmentioning

confidence: 99%

“…However, men who underwent Foley catheterization demonstrated an elevated risk of fistulas, diverticula, caruncles, false passages, and prolapsed urethral mucosa compared to women; however, in the absence of Foley catheterization, men exhibited a decreased risk of these conditions relative to women. The anatomical distinctions between the male and female ureter and urethra are significant and play pivotal roles in both physiological function and susceptibility to urinary complications 22 . In males, the urethra is approximately 18–20 cm in length and is categorized into four sections: prostatic, membranous, bulbous, and penile.…”

Section: Discussionmentioning

confidence: 99%

“…21 Another study from the United Kingdom and Ireland reported a higher incidence rate of 6.7 urethral catheterization injuries per 1000 catheterization admissions, all of whom were male patients. 22 Previous research has highlighted a connection between urinary catheterization and potential urinary complications. However, further investigation, involving a large-scale population cohort with extended follow-up, is essential to confirm temporal relationships.…”

Section: Why Does This Paper Matter?mentioning

confidence: 99%

“…A previous study reported an incidence rate of 3.2 urethral catheterization injuries per 1000 male patient admissions in the United States 21 . Another study from the United Kingdom and Ireland reported a higher incidence rate of 6.7 urethral catheterization injuries per 1000 catheterization admissions, all of whom were male patients 22 …”

Section: Introductionmentioning

confidence: 96%

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Urinary catheter placement and adverse urinary outcomes with a focus on elevated risk in men with indwelling Foley catheters

Chang,

Lai,

et al. 2024

J American Geriatrics Society

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BackgroundPrior studies indicated a link between urinary catheter use and urinary complications, highlighting the need for comprehensive, gender‐specific investigations. This study explored the association through a national retrospective cohort, emphasizing gender disparities and long‐term outcomes.MethodsOur study utilized data from the entire population covered by Taiwan's National Health Insurance Research Database from 2000 to 2017. We included 148,304 patients who had undergone Foley catheter placement and their propensity‐scores matched controls in the study. We evaluated urinary complications, which encompassed urinary tract cancer, urolithiasis, urethral stricture, obstructive uropathy, reflux uropathy, fistula, diverticulum, caruncle, false passage, prolapsed urethral mucosa, urinary tract rupture, and urinary tract infection. These were assessed using the Fine and Gray sub‐distribution proportional hazards model to compare between the Foley and non‐Foley groups. Sensitivity analyses were conducted with different matching ratios.ResultsIn the study, the non‐Foley group presented a marginally higher mean age (75.24 ± 10.47 years) than the Foley group (74.09 ± 10.47 years). The mean duration of Foley catheterization was 6.1 ± 4.19 years. Men with Foley catheterization exhibited the highest adjusted sub‐distribution hazard ratios for urinary tract cancer (6.57, 95% CI: 5.85–7.37), followed by women with Foley catheterization (4.48, 95% CI: 3.98–5.05), and men without catheterization (1.58, 95% CI: 1.39–1.8) in comparison with women without the procedure. Furthermore, men with Foley catheterization were found to be at the greatest risk for complications such as urolithiasis, urethral stricture, obstructive and reflux uropathy, fistula, diverticulum, caruncle, false passage, prolapsed urethral mucosa, and urinary tract rupture. Conversely, women with urinary catheterization were most susceptible to urinary tract infections.ConclusionsThe evidence confirms that urinary catheterization significantly increases urinary complications, particularly among men. Our study underscores the crucial need for healthcare providers to carefully evaluate the necessity of catheterization, aim to shorten its duration whenever feasible, and strictly adhere to established protocols to minimize complications.

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Mechanical and morphological characterisation of porcine urethras for the assessment of paediatric urinary catheter safety

Cunnane

Allardyce

et al. 2023

Journal of the Mechanical Behavior of Biomedical Materials

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A Prospective Multi-Institutional Evaluation of Iatrogenic Urethral Catheterization Injuries

Cited by 4 publications

References 18 publications

Characterization and Outcomes of Iatrogenic Urethral Catheterization Injuries

Characterization and Outcomes of Iatrogenic Urethral Catheterization Injuries

Urinary catheter placement and adverse urinary outcomes with a focus on elevated risk in men with indwelling Foley catheters

Mechanical and morphological characterisation of porcine urethras for the assessment of paediatric urinary catheter safety

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