Unexpected Urethral Strictures after Short-Term Catheterization in Open-Heart Surgery

Abstract

Urethral stricture was found in 59 of 478 male patients who had undergone open-heart surgery between June 79 and December 81. In 40/59 cases the stricture showed a string-of-pearls configuration or long narrowing of the penile urethra on the urethrogram. Burning pain and dysuria were the main symptoms, and the urinary stream started to weaken immediately after the removal of the siliconized latex catheter which had been routinely inserted at the time of the heart operation and usually kept indwelling for 3 days. The stricture epidemic stopped after change of the latex catheters to silicone-ones. The different catheters were investigated for cell toxicity. Eluates of catheters were added at different concentrations to cultures of various cell lines. The cell proliferation was measured by thymidine incorporation. The results were uniform and showed marked toxicity of the latex catheters against all investigated cell lines.

Toxic Catheters and Diminished Urethral Blood Circulation in the Induction of Urethral Strictures

“…This theory is also supported by the findings of Edwards and Trott [1973] and Engelbart et al [1978], who found that the irritative changes caused by urinary catheters were reduced with a prolonged catheterization time. However, only 12.4% of open-heart surgery patients had urethral strictures [Ruutu et al, 1984]. Individual variation is demonstrated in local blood perfusion during hemorrhagic shock [Roding and Schenk, 1970], This was also seen in the present ani mal experiments.…”

“…Hypotonic periods have also been obvious in these cases [Frazer et al, 1982;Edwards et al, 1983;Ruutu et al, 1984].…”

Elutable Factors from Latex-Containing Materials Activate Complement and Inhibit Cell Proliferation

“…Thus, they would have the opportunity to exert a local effect on the complement system. This is in accordance with the fact that a reduced local blood flow induced a striking infiltration of polymor phonuclear neutrophils in mucosa and sub mucosal space [7], Several authors [2,12,15] have recom mended a toxicity limit for catheters when they cause 50% inhibition of the DNA syn thesis with 30% eluate concentration. In the present study the CEM cell line was much less sensitive than the Jurkat cell line to the cytotoxic substances found in the eluates.…”

“…In duction of urethral strictures caused by a combination of tissue-toxic catheters and re duced local perfusion has, therefore, been suggested [13]. However, individual varia tion was demonstrated in local blood perfu sion during haemorrhagic shock [14], This may explain why only about 12% of openheart surgery patients get urethral strictures when toxic catheters are used [2].…”

Urethral Stricture after Coronary Artery Bypass Grafting

“…Urethral stricture occurred in 12% of 478 men undergoing cardiac surgery over a 2j year period in Finland (Ruutu et al 1984). Usually the urinary stream was reduced immediately after removal of the catheter.…”