How To Reduce Unnecessary Urinary Catheter Use

Having a urinary catheter is uncomfortable for men. Placing the catheter, keeping it in, and taking it out is usually very awkward. 

Moreover, using catheters for a long time is associated with urinary tract infections and other adverse events. 

Still, it is necessary in some cases, and a urethral catheter can help with urinary problems in men and women.

Prostate cancer and other types of prostate enlargement often cause urinary retention. The urine stays in the bladder because the prostate presses upon the urethra and obstructs urine flow. 

A urinary catheter can help the problem in the short term by draining the bladder. But is there a way to prevent this problem? Can we reduce the need for urinary catheters in cases of prostate health?

What is a urinary catheter?

A urinary catheter is a hollow silicone or latex tube inserted in the urethra by a healthcare professional. It reaches the bladder and collects urine leading the fluid into a drainage bag.

There are different materials and sizes to adapt for each patient. There are also different types, and one of the most commonly used is known as Foley catheters. This type can be left in the bladder as an indwelling catheter. It is connected to a drainage bag.

There are also condom catheters used in case of urinary incontinence and intermittent catheters that do not connect to a urine collection bag. The latter is inserted to drain the bladder and then taken out. The procedure is repeated several times every day.

Side effects and risks of a urinary catheter

As mentioned above, the main risk for men of having a urinary catheter is a urinary infection. Urinary catheters are in contact with the environment outside of the body. 

The bladder is supposed to be a sterile environment and should not have bacteria. Urinary catheters allow bacteria to enter the urinary bladder and cause urinary tract infections.

The risk of urinary infections is higher in men left with an indwelling catheter. It is exceptionally high in prolonged hospital stays, especially when patients have poor health. A urinary infection triggered by indwelling catheters causes fever, chills, and pelvic or groin pain.

Other side effects of urinary catheters include (1,2):

• Bladder spasms: The bladder feels the inflated balloon of an indwelling catheter as a foreign body. Trying to take out the balloon, the bladder starts to contract, causing symptoms similar to a stomach cramp.

• Catheter leakages: If you notice leakages around the catheter, it can be because the catheter is blocked.

• Urinary bleeding: It is a common problem of indwelling catheters, especially when there’s something wrong with the drainage system. It can also be a sign of infection, urethral damage, or bladder stones.

• Urethral scarring: Prolonged use of an indwelling catheter in men may lead to scar tissue formation in the urethra. In some cases, scar tissue narrows the urethral opening.

• Bladder stones: Patients who keep using indwelling catheters for years may ultimately develop bladder stones.

When a urinary catheter might be necessary

Urinary catheters are required and indicated in these circumstances (3):

• As a perioperative procedure in surgery: Long surgeries and other complex procedures may require a urinary catheter to drain the bladder.

• Urinary volume monitoring: They are sometimes used to monitor urinary volume in patients. Critically ill patients require accurate monitoring of renal function, and indwelling catheters can be helpful in such cases.

• Hospice use and palliative care: In seniors and end-stage patients, indwelling catheters may become necessary to assist patients. It is beneficial in patients with mobility issues.

• Assisted healing of wounds: Perineal and sacral wounds may require a catheter to heal appropriately. In perineal surgery, catheters are left in place to prevent obstructions in the process of healing.

• Urinary obstruction and retention: In prostate cancer patients and prostate enlargement, doctors may advise using a urinary catheter.

Do patients with prostate issues need a catheter?

Not all patients with prostate problems will need a catheter. They are only reserved for complicated cases. 

These are patients with urinary retention or a significant obstruction. The urethra is pressed by the excess tissue found in the prostate gland. Urine flow is compromised and sometimes blocked altogether.

What’s more, male catheterization in the case of enlarged prostate glands is very difficult. Doctors often face catheterization problems, and failed catheterization is common in these patients. 

The catheter should traverse the prostatic urethra, which is blocked. Thus, a larger size and a correct urethral catheterization technique are required to prevent injury.

What methods can prevent unnecessary urinary catheter usage in the first place?

Urinary catheters are often needed to solve a medical problem. However, unnecessary urinary catheter placement is also common in medical practice. 

Studies show that 21-55% of urinary catheters are placed in patients who do not need them. This is a worrying problem considering the side effects associated with this practice. 

Thus, one of the medical strategies to prevent unnecessary catheter placement is reminding providers about the correct use of these devices (3).

When inappropriate catheter use is detected, the device should be removed promptly. For example, when a catheter is placed to obtain urine samples in a patient who can urinate voluntarily.

Reminding the doctor about the catheter’s existence is fundamental, especially when the patient is at home and receiving instructions via telemedicine. 

How to improve your prostate issues so you won’t need a catheter

Besides the medical considerations to prevent unnecessary urinary catheter usage, patients can also prevent prostate complications to avoid needing a catheter in the future. How can you prevent urinary obstructions if you have prostate enlargement issues?

Men with benign prostatic hyperplasia (BPH) usually relieve their symptoms and prevent the progression of the disease by following their treatment. 

But what if you don’t have a severe prostate problem and want to prevent this from happening? 

It is possible to avoid the need for urinary catheters by following these simple recommendations:

• Stop smoking and reduce alcohol and coffee consumption. These substances worsen urinary symptoms and may lead to urinary retention in some cases.

• Even if they have prostate issues, patients who stay active may reduce the severity of urinary problems. Losing weight in case of obesity is also essential to reduce the risk of urinary retention.

• Bladder training exercises may improve some urinary symptoms in BPH

• Avoid taking decongestants and antihistamine treatment. They tighten your urethra and may precipitate an episode of urinary retention.

Conclusion

A male external catheter is inserted through the penis to drain the bladder contents into a collection bag.

However, an indwelling Foley catheter is associated with side effects. They include urinary infections (UTI), urethral trauma, and others. Thus, doctors should always revisit patients with urinary catheters to evaluate if they really need them. Prompt catheter removal is recommended when the indications are not clear.

Patients may also contribute and reduce the need for male catheter use. Following your doctor’s recommendation is key for a good prognosis. 

You should also stop smoking and reduce alcohol and coffee consumption. Stay active and lose weight if you are obese or overweight. Consider bladder training exercises and avoid using decongestant and antihistamine treatment to reduce the stress in your urethra.

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