Catheter-induced urethral injury and tubularized urethral plate urethroplasty in such iatrogenic hypospadias

Abstract

Background Catheter-induced urethral erosion can involve meatus, glans and any extent of penile shaft. These injuries cause a lot of psychological, social and sexual trauma to the patient. Though the use of condom drainage system can render this spinal cord injury patient effectively dry, but can lead to penile or urethral complications. Many of these patients are kept on indwelling catheter. Long duration catheterization, poor catheter care in such paraplegic patients and other morbid patients may lead to urethral erosions. We conducted a prospective study of catheter-induced urethral injury from July 2014 to February 2016 in our tertiary care centre. The demographics, past history of illness, catheter material, and duration of catheterization, securing of catheter, local examination findings and associated comorbidities were recorded. Factors leading to urethral erosion were evaluated. And patients, who were fit and were willing for surgery, underwent tubularized urethral plate urethroplasty after 4–6-week supra-pubic diversion. The objective of the study was to evaluate factors of urethral erosion, and the results tubularized urethral plate urethroplasty in iatrogenic hypospadias. Results We had twelve patients of catheter associated urethral injury in the study period. Age of the patients varied from 34 to 95 years with a mean of 61.25 years. Duration of catheterization ranged from 6 to 24 months with a mean duration 10.9 months. Catheters used were silicon coated, not secured to abdomen and had comorbid condition of neurological or cardiac origin in all patients. Long duration of catheter, poor quality of catheter and poor catheter care such moribund with poor body resistance patients were the main causative factor for urethral erosion. Urethral injuries varied from erosion of distal 2 cm to entire ventral urethra till penoscrotal junction with or without penile torque. Six of these patients underwent tubularized urethral plate urethroplasty with good cosmetic and functional postoperative outcome. Conclusion Patients of spinal cord injury, patients with comorbid condition like diabetes mellitus and ischaemic heart disease, poor catheter care and long duration catheterization are likely to have severe urethral injury. Extent of injury may vary from meatal erosion to erosion of entire ventral urethra till penoscrotal junction leading to iatrogenic hypospadias. These patients either may be put on clean intermittent catheterization or supra-pubic catheterization. Results of tubularized urethral plate urethroplasty in such iatrogenic hypospadias are very good.

Urinary Catheter-Related Meatal Pressure Injury Risk Factors in Male Critical Care Patients: A Prospective Repeated-Measures Study

“…The most effective way to prevent MDRPI is to remove the medical device when early indicators of PI appear 1 . Several reports have shown that risk for MDRPI may increase as a result of extended exposure to medical devices 1,6,8,27 . Bhat et al 8 demonstrated that prolonged duration of urinary catheter use is associated with urethral erosion.…”

“…The literature illustrates a significant association between diabetes and PI development attributable to changes in tissue perfusion and nutrition. 1,8,14 Bhat et al 8 showed a direct association between diabetes and erosion of urethra with indwelling catheter. The results of this study offer further evidence of the association between diabetes and UCR-MPI.…”

“…7 A UCR-MPI can lead to physical, psychological, social, and sexual trauma, including penile disfigurement and sexual and urinary disfunction. 6,8 Further, treatment is a clinical challenge. 6 Therefore, UCR-MPI prevention is an important quality concern in particular for male patients with indwelling urinary catheters.…”

“…Patients with penises tend to have a higher risk of UCR-MPI because their urethra is longer than that of patients with female anatomy 7 . A UCR-MPI can lead to physical, psychological, social, and sexual trauma, including penile disfigurement and sexual and urinary disfunction 6,8 . Further, treatment is a clinical challenge 6 .…”

Iatrogenic hypospadias: a penile mucosal pressure injury

“…Research focused on complications associated with the use of urethral catheters has been primarily targeted at catheter-associated urinary tract infection (CAUTI) and increased bladder and urethral pain. Penile mucosal pressure injuries in spinal injury patients with long-term urethral catheters have been reported from time to time [13][14][15] . There has been a very small number of cases reported of elderly men living in residential aged care facilities (RACFs) having mucosal pressure injuries as a result of their long-term urethral catheters 9,13 .…”