1. URINARY CATHETERS DEPARTMENT OF UROLOGY 2006 DIAN L KIRSTEIN

2. CATHETERS Size Shape Material Retaining mechanism Lumens

3. SIZES Different size systems (External catheter diameter) Most common: French (F) (Charriere) 0.33mm = 1F 3F = 1mm, 30F = 10 mm

4. CATHETER TYPES Non self-retaining (Jaques, Robinson, Nelaton) Self-retaining (Pezzer, Malecot) Self-retaining 2/3 way balloon Foley Catheter Postoperative haematuria catheter (rigid)

5. CONDOM CATHETERS Men without outflow obstruction and intact voiding reflex pathways Restricted to selected patients where other measures are unsuccessful

6. TYPES OF MATERIAL Latex Plastic Silicone coated latex Silicone Hydromers (biocath) Silver-inpregnated Antibiotic coated

7. INDICATIONS FOR USE OF URINARY CATHETERS Diagnostic Therapeutic Short-term Long-term

8. SHORT-TERM CATHETERIZATION Acute urinary retention Urine collection (U mcs, residual volume) Urologic surgery Surgery on contiguous structures Urine output (medical, surgical) Urodynamic studies Radiology ( cystogram) Installation of antibiotics, immunotherapy etc

9. LONG-TERM CATHETERIZATION Refractory urine retention – not correctable medically or surgically Neurogenic bladder – some Incontinence – non-responders to specific treatment – terminally ill, severely impaired – intractable skin breakdown

10. TECHNIQUE Inform patient - explain procedure NB aseptic Prepare Indication Size: “ narrowest, softest tube that will serve the purpose”

11. PREPARATION Position patient Expose Open set using sterile technique Wash hands and don sterile gloves Test catheter balloon Attach drainage bag to catheter Lubricate catheter (local anesthetic lubricant) Clean

12. CATHETERIZATION Aseptic Place catheter (urine?) Inflate balloon (5ml) Gently pull back on catheter Tape tubing to thigh Position bag to facilitate drainage by gravity NB: retract foreskin

13. CLOSED DRAINAGE SYSTEM “Open drainage system”: – 95% bacteriuria prevalence in 4 days “Closed”: – 5% per day risk, 40% by day 10 Risk increases: – changing the catheter bags – taking urine samples – bladder washout regimes

14. SUPRAPUBIC CATHETER INDICATIONS Failed urethral catheterization Urethral disruption Long-term bladder drainage

15. SUPRAPUBIC CATHETER CONTRA-INDICATIONS Non-palpable bladder Previous lower abdominal surgery Coagulopathy Known bladder tumour Clot retention

16. SUPRAPUBIC CATHETER TECHNIQUE Informed consent Supine position Confirm full bladder Prepare suprapubic area Anesthetize: skin, sub-cutaneous tissue to the anterior bladder wall Confirm distance to full bladder by aspiration

17. TECHNIQUE Plan angle and depth of puncture Stab wound Cystostomy trocar Fixate catheter

18. Area to be shaved, prepared and draped prior to trochar placement Position of the Stamey trochar in the bladder. The angle, distance from the pubis and position of the catheter in relation to the bladder wall are demonstrated