Assessment and treatment of patients with urethral catheters

Indications for catheterisation⁴

Verbal/implied consent on urethral catheterisation should be recorded in the patient notes.

Urethral catheterisation may be carried out for many reasons, some of which are stated below:

• Drainage – surgical (pre and postoperative), acute and chronic retention.
• Instillation – drugs, washout.
• Investigation – bladder function tests, measure residual volume. (In absence of a bladder scanner).
• To manage incontinence when all other means have been exhausted following discussion with the Continence Team.
• Record accurate residual urine volume and ongoing output.

• Relieve and manage acute and chronic retention of urine, which may be due to physical and neurological obstruction or Detrusor hypoactivity⁵.
• Incomplete bladder emptying to reduce the incidence of urinary tract infection and preserve renal function⁶.
• Estimation of residual urine as a last resort in the absence of a bladder scanner.
• Management of overflow urinary incontinence as instructed by urologist.
• Following specific surgical intervention e.g. Clam cystoplasty or Mitroffanoff.
• Management of urethral stenosis e.g. bulbar urethral or meatal stricture.
• Maintenance of continence e.g. Detrusor sphincter dyssynergia.

• Clarification should always be sought from medical staff prior to carrying out catheterisation. If the patient has had previous surgery or treatment to the genito-urinary tract, caution should be taken with these patients.
• Lack of patient consent (verbal or implied).
• Medical instruction not to undertake intermittent catheterisation.

Cautions should be exercised when undertaking intermittent self catheterisation / intermittent catheterisation (ISC/IC) in patients with the following conditions:

• Active inflammation of the lower urinary tract
• Recent radiotherapy to the lower urinary tract
• Penile/vaginal pain
• Penile/vaginal bleeding or discharge
• Haematuria
• In spinal injured patients in view of risks of autonomic dysreflexia
• Congenital abnormality (hypospadias/epispadias)
• Previous sexual abuse
• Previous traumatic catheterisation.

In order for the treatment to be successful a comprehensive assessment must be carried out and a plan of care devised. The assessment will include:

• Diagnosis of bladder dysfunction as indicated above.
• Physical ability of the patient/carer to carry out the procedure.
• Psychological aspects including motivation and cognitive ability of the patient/carer.

• The bladder must be able to store at least 100mls.
• The urinary sphincter must be competent.
• There should be a sensation of bladder filling, or a strict regime to empty the bladder. Initial assessment of voiding diaries must be carried out to determine the frequency of catheterisation. Residual urine should be no more than 400-500mls¹. This will then determine the frequency of ISC (up to 4/5 daily)
• The patient/carer must be able to understand the benefits, procedure and technique.
• The patient/carer must be highly motivated.
• Regular follow up must be made.