Long-term Outcomes of Urethral Catheterization Injuries: A Prospective Multi-Institutional Study

In this prospective study involving 2 tertiary referral university teaching hospitals, we aimed to monitor the long-term clinical outcomes and complications of patients with traumatic urethral catheterization related injuries. We defined traumatic urethral catheterization as a physician requesting a urological consultation after difficult/failed catheter placement and at least 1 of the conditions of haematuria, blood at the urethral meatus, perineal/urethral pain, cystoscopic evidence of urethral trauma and retrograde/antegrade urethrogram demonstrating urethral trauma. Study exclusion criteria were patient inflicted trauma and trauma from intermittent self-catheterization.

The study took place between July 2015 and January 2016 and the length of follow-up was 37 ± 3.7 months. In total, 37 iatrogenic urethral injuries from urinary catheterization were recorded and the incidence of urinary catheter-related urethral injuries was 13.4 per 1,000 catheters inserted in male patients. Urethral injuries were caused by inflating the catheter anchoring balloon in the urethra (n=26) or by creating a false passage with the catheter tip (n=11). In total, 29 patients (78%) developed urethral stricture disease requiring urological intervention during the follow-up period. There were 8 patient mortalities among the 37 patients injured. One mortality was due to severe urosepsis resulting from catheter balloon inflation in the urethra.

Our findings demonstrate that urinary catheter-related injuries are associated with significant long-term complications. We conclude by emphasizing that such injuries may be preventable if the safety profile of the urinary catheter is modified because education on proper catheterization techniques does not eradicate iatrogenic catheter-related injuries.

Written by: Niall F. Davis^1,2,6, Nikita Bhatt³, Eoin MacCraith⁴, Hugh D. Flood⁵, Rory Mooney⁵, G. Leonard⁵, Michael T. Walsh⁵
1. Department of Urology, Beaumont and Connolly Hospitals, Dublin, Ireland
2. Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
3. Department of Urology, Tallaght Hospital, Dublin, Ireland
4. Department of Urology, St Vincent’s University Hospital, Dublin, Ireland
5. School of Engineering, Bernal Institute and the Health Research Institute, University of Limerick, Limerick, Ireland
6. Department of Urology, The Austin Hospital, Melbourne, Australia

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