Urinary catheterisation is a procedure in which a flexible tube, called a catheter, is inserted into the bladder to ensure that the bladder is regularly and adequately emptied.  Catheters can be used long term, or temporarily in patients who need to retrain their bladders or after certain types of surgeries, and help to reduce risk of kidney infection and damage.

Conditions which require a urinary catheter

Surgeries around the genital area, such as on the prostate gland, hip, or hysterectomies, can require an indwelling catheter during the initial days of recovery. A catheter is also a way to monitor fluid output when a patient has to receive intravenous fluids.

Many different conditions may require catheterisation. It’s commonly required in patients who have bladder problems that cause:

- Urinary retention – the inability to empty the bladder fully
- Bladder obstruction, which can be a result of urethra narrowing, or the presence of bladder stones

Most of the time, catheterisation is just a short term option and can be discontinued once the patient regains control over their bladder.

However, patients can also have a long term chronic condition such a spinal injury, which prevents them from emptying their bladder, or a mental condition such as dementia, which can cause urinary incontinence. These conditions can require a long term use and reliance on a catheter to aid urination (2).

Choosing a catheter

The continence professional will discuss with the patient or the patient’s family which catheter and equipment is suitable for them. This all depends on the reasons for a catheter, how long it will be required, and which is most suitable for the patient’s lifestyle.

When choosing a catheter, multiple factors need to be considered (1):

- The external and internal (lumen) circumference of the catheter.

- Material. There are multiple materials available but the material that is selected depends on how long the catheter is expected to be in place.

- Structural features, such as length, shape and design, including the size of the collection bag and means of attachment. These depend on lifestyle factors such as whether the patient can walk, how they intend to wear the collection bag, and how frequently they will be able to empty the bag.

- How to stabilise the catheter. Patients need to feel comfortable and have minimal possible trauma so that there is no bladder or urethra irritation.

- Personal lifestyle needs. Sometimes patients require easily portable and discreet equipment so the catheter does not hinder their lifestyle.

The different types of urinary catheters

Urinary catheters can simply be divided into the two following categories (1):

Indwelling catheter. These are more commonly used, however come with a high risk of infection. The catheter is inserted via the urethra, into the bladder where it is held by a water filled balloon. Indwelling catheters can be used continuously, and drained into a tube via a drainage bag or intermittently and drained into a catheter valve, which can be emptied directly into a toilet and resealed so the bladder can refill. Patients who can walk will usually opt for a small discreet collection bag which can be easily emptied, whereas patients on bed rest can use a larger collection bag which is hung nearby on the bed, stand, or on a wheelchair.

Intermittent catheter. These catheters have a low risk of causing infection and kidney damage and can be inserted by the patient or their caregiver at home. The catheter is inserted through the urethra into the bladder and urine is drained.


Sources:

1. Better Health
2. Health Talk