Bladder Catheterization - Indication, Procedure, and Side Effects

Introduction

The urinary system consists of a pair of kidneys, a pair of ureters, a bladder, and the urethra. The urinary system produces, stores, and excretes urine. Normally, in an adult, the kidneys produce approximately 1.5 liters of urine per day. The urine produced in the kidneys passes through the ureters, and the urine is temporarily stored in the bladder. The bladder's capacity to store urine varies between 350 to 500 milliliters. There are three types of muscles that manage the drainage of urine from the bladder into the urethra. The voluntary striated external sphincter muscles encompass the proximal part of the urethra, and the internal sphincter is situated at the bottom of the bladder and is an involuntary smooth muscle. The pelvic floor muscles help provide additional control.

What Is Bladder Catheterization?

Bladder catheterization is a procedure used to drain the urine in the bladder and collect it through a flexible tube called a catheter. The catheters are generally inserted by physicians or a nurse. The catheter remains in the bladder, allowing urine to flow through it into a urine drainage bag. A catheter may be removed after a few minutes, hours, or days, or it may be needed for a long period depending upon the cause for which it is done. Urinary bladder catheterization is performed for diagnostic purposes as well as therapeutic. Based on the duration of time, the urinary catheter can be either short-term or long-term. There are three types of bladder catheterization based on the approach of insertion:

• Urethral Catheters - They are inserted through the urethra, with the tip heading into the base of the bladder.

• External Catheters - They are attached to the external genitalia in men or the pubic area in women to collect urine. These are useful for the management of urinary incontinence.

• Suprapubic Catheters - They are inserted into the bladder surgically through a suprapubic approach.

When Is a Bladder Catheterization Indicated?

The bladder catheterization is indicated in the following conditions-

• Urinary Obstruction - Urinary catheterization is done in case of urinary tract obstruction, such as benign prostatic hyperplasia, strictures, stenosis, tumors, or the presence of stones. If the blockage is present outside the bladder, it is called extrinsic obstruction, which can be caused by an enlarged pelvic organ or abdomen that comprises the bladder neck resulting in obstruction.

• Neurologic Conditions - Multiple sclerosis, spinal cord injury, cerebral vascular accident, Parkinson's disease, brain injury, and dementia can cause urinary retention and requires bladder catheterization.

• Pharmacological Conditions - Drugs with alpha-adrenergic agonists and anticholinergic properties can cause urinary obstruction.

• Inflammatory and Infectious Diseases - Certain diseases like urethritis, prostatitis, vulvovaginitis, and cystitis can result in urinary retention.

• Other Conditions - Psychogenic, dramatic, or any other syndrome can cause urinary retention and may require bladder catheterization.

• Preoperative Conditions - Bladder catheterization is generally done in preoperative procedures for various surgeries, such as gynecological procedures, abdominal pelvic surgeries, and urologic procedures. It is also done in patients who require intraoperative urine output.

• Postoperative Conditions - Bladder catheterization is also helpful in patients to correct postoperative urinary retention due to anesthesia and to attain sufficient postoperative pain control.

Operative Procedure - These include:

• Bladder irrigation.

• Patients that require close urinary output measurement.

• Urinary incontinence.

• Neurogenic bladder dysfunction.

• Drug delivery using chemotherapy.

• Hygiene and social reasons.

Diagnostic Procedures - These include -

• Cystogram (radiographic studies).

• Urodynamics measurement.

• Sample collection for the urine test.

What Is the Procedure for Bladder Catheterization?

• Bladder Catheterization in Men:

Bladder catheterization in men starts with local anesthesia and the placement of lubricant gel. The lubricant gel is milk proximity with the distal occlusion compressed to occlusion. The catheter is inserted in the urethral meats until the 'Y of the catheter is at the urethral meatus. The other end of the catheter is attached to a bag used to collect the urine. The balloon is placed inside the bladder, which inflates and prevents the movement of the bladder.

• Bladder Catheterization in Women:

The catheter tip is attached to the urethral meatus, and the catheter balloon is inflated as per the instructions. If in case the catheter is inserted into the vagina, it should be kept in there until a new sterile catheter is placed in the urethral meatus. Analgesia is of no clinical importancein women. Lubricant gel needs to be applied to the catheter in order to prevent difficulty in its insertion.

What Are the Risk Factors of Bladder Catheterization?

The risk factors of bladder catheterization include:

• Urinary tract infections with symptoms such as headache, chills, fever, cloudy urine, burning sensation in the urethra, blood in the urine, foul-smelling urine, and back pain.

• Pain due to catheter insertion.

• Chronic bladder infection.

• Urethral injury.

• Catheter obstruction due to subclinical bacteriuria.

• Urine leakage from the urethral meatus.

• An allergic reaction to the catheter material, such as latex.

• Blood in the urine (hematuria).

• Kidney damage due to long-term use of catheters.

• Bladder stones.

• Septicemia (infection in the blood).

What Are the Side Effects of Bladder Catheterization?

The side effects of bladder catheterization are:

• The most common side-effect of bladder catheterization is urinary tract infections. Other than this January is potential side effects which include-

• Pain and spasms in the bladder can appear like stomach cramps.

• Blood or other debris in the catheter tube may be seen from the blockage in the catheter's drainage system.

• Catheter leakage can happen due to pushing stools if constipated.

• Urethra or bladder injuries.

• Less commonly, bladder stones may affect long-term catheter use.

Conclusion

Bladder catheterization is an important device to empty the bladder and prevent kidney failure. Catheterization can be for the long term or short term, depending upon the requirement. Catheterization is helpful, but long-term use of it can cause various side effects such as urinary tract infections, urethra, and bladder injuries, pain, spasm, catheter leakage, and blood in the urine. Also, the catheters need to be checked and cleaned in order to avoid various side effects of it. Reusable as well as one-time-use catheters are also available. For reusable catheters, cleanliness must be maintained, and the area where it enters the body should be cleaned with soap and water to reduce the risk of urinary tract infections. Only the body needs to be clean, as the one-time catheter comes with sterile packaging.