Catheter problems

Summary: Urological referral rarely required

Advice: Most catheter problems can be resolved by washing out or changing the catheter. Any other problems may require referral. Suprapubic catheters, if they fall out, must be replaced as a matter of urgency to prevent the tract from closing up.
Refer To: Any adult urologist

Contents:

Catheter changes

Long-term catheters should be changed every 2-3 months and should be replaced by the smallest catheter for the purpose required. Silicone-coated catheters should be used wherever possible. There is no evidence that silver-coated catheters prevent infection in patients with long-term catheters.

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Catheter blockage

  • Exclude kinks in catheter or drainage tubing
  • Employ regular bladder washouts with Urotainer® solutions
  • If drainage problems persist, arrange plain abdominal X-ray to exclude stones and refer for urological advice
  • Long-term acidification of the urine may be helpful in preventing recurrence of stone formation (Vitamin C, Mandelamine)

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Leakage around the catheter

Usually caused by catheter blockage (see above) or by unstable bladder contractions. Treat the latter with anticholinergic drugs (e.g. Detrusitol®, Detrunorm®, Vesicare®, Regurin®, Oxybutynin or Oxybutynin patches), diazepam, codeine phosphate or by a reduction in the amount of water in the self-retaining balloon.

Erosion of the bladder neck in women may result in leakage around the catheter. This usually requires closure of the bladder neck and insertion of a suprapubic catheter under general anaesthetic. Do not insert a larger catheter since this will increase the erosion further.

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Extrusion of the catheter

Replace an urethral catheter as soon as feasible. With suprapubic catheters, immediate replacement is vital to prevent closure of the tract. In the event of difficulty with re-insertion, contact the on-call staff as an emergency

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Other catheter problems

Major bleeding, erosion of the glans penis (traumatic hypospadias) and peri-urethral abscesses may require urological referral.

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