Problems with Intermittent Self-Catheterization

Intermittent Self-Catheterization (ISC) is the method of choice to deal with incomplete or non-emptying of the bladder. However, when performed over long periods of time, ISC can cause problems to the urethra, scrotum, and bladder. The best way to avoid issues from continued ISC is through an optimal understanding of the procedure, selection of a urinary catheter that adapts to the patients particular needs (i.e.: shape, size, and type), and flawless patient self-catheterization technique.

Below there is a description on the most common ISC related problems.

Urethral: More common in men since their urethra is longer. These include:

  • Inflammation of the urethral opening due to excessive friction during insertion.
  • Creation of a false passage as a result of poor catheter lubrication and poor catheterization technique. False passages are more prevalent in men with urethral stricture or enlarged prostates and can lead to significant bleeding.
  • Urethral stricture due to repeated trauma or inflammation to the anterior urethra and/or to the prostatic urethra. Patients who are more skilled at self-catheterization have fewer stricture incidences. Generous lubrication or even better, using hydrophilic catheters, can reduce the rate of strictures.

Scrotum: Common in patients with spinal cord injuries. They may also present themselves in those with urethral strictures. Included here are:

  • Epididymis and testicular tissue inflammation.
  • Prostatitis
  • Other infections involving the prostate as well as other organs and sections of the urinary tract.

Bladder:

  • Temporary Frank blood in the urine. Continued incidences may point to an infection or a urethral stricture setting in.
  • Bladder stones resulting from foreign materials, such as pubic hairs, inadvertently inserted into the bladder during catheterization.
  • Catheters lost in the bladder.

Pain: Common during the first instances of self-catheterization when the urethral lining sensation is still intact. Anxiety and tension can also increase pain during insertion. Reassurance, a lubricated catheter and good technique are effective pain reducers.

Urinary tract infections: Catheter associated urinary tract infection (CAUTI) is the most common complication in patients who have to do repeated catheterizations. Usually the urethral lining is damaged and the bladder mucosa gets infected. This leads to compromised bladder metabolic processes and a deficiency of nutrients and immune agents to the bladder. Risk of infection is increased if aseptic conditions are not observed or the wrong technique is employed.  A CAUTI can complicate further and include the kidneys. Other factors that promote the incidence of CAUTIs include:

  • Long duration of intermittent catheterization
  • Time between bladder emptying
  • Incomplete bladder emptying
  • Too much urine output at night (which may be a sign of heart disease)
  • Relative dehydration status
  • Over hydration status since it will lead to high bladder volume and stretching.

Trauma during catheterization. Open urethral mucosa creates a good entry point for disease causing microorganisms.

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