Intraurethral Catheters Recommended
BARCELONA—Israeli researchers recommend using an intraurethral catheter (IUC) instead of a conventional indwelling catheter in older men with prostatic obstruction who are at high risk during anesthesia and surgery.
Israel Nissenkorn, MD, Professor Emeritus of Urology and Surgery at the Sackler School of Medicine at Tel Aviv University, and colleagues made their recommendation at the 25th Anniversary European Association of Urology Congress. The researchers had conducted a study showing that IUC insertion cuts the rate of urinary trace infection (UTI) associated with an indwelling catheter and provides a significant boost in quality of life.
The team reported results in 50 men with indwelling catheters that were replaced by 57 IUCs in an ambulatory setting during a recent 18-month period. The IUC used in the study is a self-retaining polyurethane 16F prostatic stent 30 to 60 mm in length that is inserted under local anesthesia in an outpatient setting.
“Catheter-related UTI is the most common nosocomial bacterial infection and the most common bacterial infection in older men,” Dr. Nissenkorn observed. “Overall, 40% of hospital infections are due to urinary tract infection, and 80% of these UTIs are secondary to an indwelling catheter.”
The high frequency of UTI with indwelling catheters is due to the development of catheter-induced ascending bacterial infection between the catheter and the urethral mucosa and along the lumen of the catheter and the urine drainage bag, he said. Ongoing catheter use after onset of a UTI precipitates frequently severe systemic complications that result in death in about 10% of patients within 12 months.
All study subjects were at high risk during anesthesia and surgery, and all had indwelling catheters for one to 36 months because of prostatic obstruction. Patients ranged in age from 54 to 99 years.
Indications for catheter insertion were urinary retention for benign prostatic hyperplasia in 44 men, prostate cancer in four, and, urinary retention lasting more than three months after brachytherapy in two.
Overall, 11 IUCs have remained in the prostatic urethra for three to five months, 40 IUCs for six to 12 months, and six IUCs for more than 12 months. Six catheters had to be reinserted because of initial misplacement or displacement into the bladder. Irritative symptoms were common during the four to eight days after IUC insertion.
The IUC was associated with improved quality of life. For example, all men had reported itching and secretion with an indwelling catheter and most of them had remained generally home-bound because of urinary leakage. After replacement of the indwelling catheter with an IUC, all men could resume their routine activities and were continent with satisfactory voiding.
While all men had developed UTI with the indwelling catheter, UTI occurred in only16% of them during the mean 12.1 month follow-up period after the indwelling catheter had been replaced by an IUC and the patient underwent antibiotic therapy.
Dr. Nissenkorn noted that a major reason for widespread use of indwelling catheters is the ease of catheter insertion. Insertion of an IUC takes longer and requires a urologist's expertise, he said.
He was quick to add, however, that an IUC needs to be replaced only once a year while an indwelling catheter generally requires replacement every three to four weeks.
Finally, he said that while the present analysis included only men in whom IUCs were inserted because of prostatic obstruction, other groups of men might benefit from IUC placement. These include men with overflow incontinence, those who have undergone transurethral microwave therapy, and men who have undergone visual laser ablation of the prostate.