Transurethral indwelling catheters | Bladder catheter

Transurethral indwelling catheters

This type of catheter is used to monitor fluid balance, for example in intensive care units, for perioperative urine drainage and after operations to immobilize the bladder and safely drain urine, in cases of constriction of the draining urinary tract or injuries to the urinary tract. These catheters are usually designed as 2-way catheters, often also as 3-way catheters. Via this other tube, a special solution is injected into a bag in the tip of the catheter, which fills it up like a balloon and thus prevents the catheter from slipping out of the bladder again.

This process is called “blocking”. The bladder can be rinsed through the possibly existing third tube, for example after a urinary tract operation, so that the blood does not clot in the bladder. Long-term catheters made of latex should be left in place for less than a week, whereas silicone bladder catheters are suitable for use for up to 6 weeks. Catheter insertion is quite similar to a disposable catheter under sterile conditions, but a local anaesthetic is used in addition to lubricant. This catheterisation should not be carried out if there are existing injuries of the urethra with possible urethral tearing, a severe constriction or existing infections, for example of the prostate.

Complications

The catheter system can lead to catheter-induced infections of the urinary tract, which can lead to inflammation of the renal pelvis and in the worst case to sepsis (blood poisoning). In addition, the urethra can be injured, which can lead to bleeding and in the long term to a scarring of the urethra. In the case of an indwelling catheter, the opening can also become blocked over time, which makes a change necessary.

After ten years of continuous use of a bladder catheter, squamous cell carcinomas have been observed in less than 10 percent. Suprapubic catheter: In view of the problems that a transurethral catheter can cause, a suprapubic catheter is now often used for long-term urine drainage. With the bladder filled, a needle is inserted into the bladder just above the pubic bone under ultrasound control and local anaesthesia.

At this point a silicone catheter is inserted, which is then fixed and sterilely connected. However, such a catheter must not be inserted if there is a severe tendency to bleed, a proven bladder tumour or a shrunken bladder. Strict indication should also be given in case of pregnancy.

A dreaded complication is an injury to the intestine during insertion, but this only occurs in less than 1% of cases. In addition, infections, slipping of the bladder catheter or bleeding can also occur here. However, this type of permanent catheter offers the great advantage that it is better tolerated by most patients, especially since the risk of injury and infection is significantly reduced compared to the transurethral route.