Non-UTI Problems Common with Urethral Catheters

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A group of researchers would like to broaden urologists' conception of common complications from indwelling urethral catheters to include more than urinary tract infections.

In a review of studies on mishaps stemming from these catheters, the team found among an array of non-infectious complications that leakage or incontinence occurs at a rate of 11% and that spinal cord injury patients have high rates of bladder stones and gross hematuria.

The investigators believe this signals the need for much more focus on preventing these events.

“Many such complications may be due to improper insertion,” said lead investigator John Hollingsworth, MD, MS, of the University of Michigan in Ann Arbor after presenting the results at the 33rd Congress of the Societé Internationale d'Urologie. "Because 6% of all inpatient urologic consultations are for complications from catheter placement, most of which were inserted by trainees, education and skill interventions aimed at providers may be important to reduce noninfectious complications.”

Dr. Hollingsworth performed the literature review and meta-analysis after a study was published showing a high rate of genitouriniary trauma associated with indwelling urethral catheter use (J Urol 2012;187:1662-1666). He and his colleagues identified all published studies that included non-infectious complications associated with indwelling urethral catheters. Their meta-analysis focused on 38 studies, including 15 studies of complications associated with catheterization lasting no longer than three weeks and 10 studies of longer-term catheterization. Sixteen of the studies included patients with spinal cord injuries.

The team pooled the complication frequencies for short-term catheterization complications, although in some complication categories the studies were too heterogeneous for Dr. Hollingsworth's group to arrive at an overall rate. Among the complications for which they could determine overall rates, leakage/incontinence, at 11%, topped the list at 11%. Coming in at rates of between 3% and 5% were urethral strictures, gross hematuria and accidental removal. One study examined blockage, showing a rate of 5%. The team also found, among lower-quality studies that included figures on urethral stricture/erosion, that the rate of this complication averaged 17% (compared to 3% in higher-quality studies).

With respect to long-term catheterization, the researchers found a 52% rate of leakage, a 44% rate of blockage among inpatients, a 29% blockage rate in outpatients and, in one study, a 70% rate of accidental removal among inpatients.

The study revealed high rates of bladder stones in catheterized patients with spinal cord injuries, ranging from 4% to 100%, although the studies were too heterogeneous for the team to arrive at an overall rate. Similarly, accidental removal, blockage, leakage/incontinence, and urethral stricture/erosion were common. There was an overall 1% rate of bladder cancer in this population, along with a 3% rate of false passage/trauma and a 13% rate if gross hematuria.

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