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Catheterization of the urinary bladder

What is a catheter?

Catheters are an indispensable part of medical care today. The flexible tubular instruments enable both the detection of diseases and the treatment of various disorders and diseases. Thus, there are catheters in many variations.

Different diseases may require the placement of a catheter – thus, catheters form part of medical care in various fields. Catheters are particularly important, for example, in the following areas:

  • UrologyInterior medicine
  • Radiology
  • Pain therapy
  • Neurology

A classic field of application for the catheter is the diagnosis and treatment of urological diseases or their symptoms.

Urinary catheter

A urinary catheter is a plastic tube which is either inserted into the urinary bladder through

  • the urethra (transurethral) or
  • the abdominal wall (suprapubic)

The urinary bladder may thus be

  • examined
  • emptied
  • filled or
  • rinsed

Depending on who is doing the catheterization, a distinction is made between

  • Catheterization assisted by others

    The medical doctor or appropriately trained nurses perform the catheterization for the patient.

  • Self-catheterization

    Patients can learn how to apply single catheterizations with a urinary catheter and carry it out on their own. Thus, for example, patients whose bladder sphincter prevents normal urination due to a health problem, e.g. paraplegia, can empty their bladder at regular intervals.

What types of urinary catheters are there?

A distinction is made depending on the indication and use

  • Transurethral disposable catheter (catheters, which are passed through the urethra)

    Disposable catheters are aids for artificial urinary diversion through the urethra in the case of bladder dysfunctions.
    They are intended for single use:

    • For diagnostic purposes
    • For accurate fluid balance drainage
    • For self-catheterization
  • Transurethral indwelling catheter

    As an alternative to repeated single-use catheterization, in some diseases - for example, when the urethra is narrowed permanently by a tumor or an enlarged prostate - the long-term insert of a urinary catheter is useful. These urinary catheters called permanent or indwelling catheters carry the urine continuously into attached collecting bags. Indwelling catheters through the urethra are suitable to empty the bladder during long operations and for intensive-care patients.

  • Suprapubic urinary catheters (catheters placed through the abdominal wall)

    The suprapubic bladder catheter does not pass through the urethra, but the urologist places the catheter tube through the abdominal wall to the lower abdomen directly into the bladder.
    The suprapubic bladder catheter is useful if an indwelling catheter is needed for a longer period. This variant has a lower risk of urinary diseases for the person concerned.

How is a catheterization performed through the urethra?

During each catheterization through the urethra special care should be paid to germ-free work and the use of sterile gloves and disinfectants. Absolutely clean work is essential to prevent the spread of germs in the urinary tract.
After disinfection of the urethra opening, a lubricant gel is introduced into the urethra.

The use of a lubricant

  • Facilitates the entry and advancement of the catheter
  • Reduces friction
  • Protects the urethral mucosa
  • Unfolds the urethra and allows the gentle and less painful insertion of the catheter

If the catheter remains in the bladder, it is blocked via a balloon by means of a special liquid (usually 10% glycerol or 5% saline). Thus, the catheter cannot slip out of the bladder. A plastic bag is connected at the catheter into which the urine is collected.

Tips for a complication-free as possible catheterization

As part of a catheterization, inter alia the following problems may occur

  • Ascending infections
  • Colonization of the urogenital tract with bacteria
  • Allergies to the catheter material

These risks may, inter alia, be prevented using an antiseptic, sterile lubricant.

Sterile Lubricants allow a particularly gentle insertion of the catheter into the urethra. The urethra is unfolded and the gel reduces the friction between the catheter and the urethra. In this manner, any arising injuries are avoided.

The substances lidocaine, diphenhydramine and chlorhexidine have an anesthetic, numbing effect and thus help to combat unpleasant pressure feelings. They also help prevent infection and inflammation and alleviate existing ones, whereby painful burning sensation passes. The substances act locally, i.e. only where they are needed.

The treating physician or nursing staff introduces the lubricant into the urinary tract and the bladder to make the patient the procedure as pleasant as possible.

Due to the structure and length of the male urethra, and the fact that it contains several bends, the catheterization may be more difficult and dangerous for men than for women. Here it is particularly important to pay attention to the adequate use of lubes.

What kinds of lubricants are available?

A distinction is made among the following types of lubes

  • Gel without anesthetic and chlorhexidine (antiseptic)
  • Gel with chlorhexidine (antiseptic)
  • Gel with anesthetic
  • Gel with anesthetic and chlorhexidine

Which version to be used depends on the patient and the situation.

  • Paraplegic patients do not need a pain reliever
  • Patients with preserved sensitivity are helped by a maximized, anesthetic effect, to relax and the insertion of the catheter works easier