Noninfectious complications common with urethral catheters

Noninfectious complications of urethral catheters are common, and should be a focus of surveillance and prevention efforts, according to new research published in JAMA Internal Medicine.

“While there has been appropriate attention paid to the infectious harms of indwelling urethral — or Foley — catheters over the past several decades, recently we have better appreciated the extent of noninfectious harms that are caused by the indwelling catheter,” Sanjay Saint, MD, MPH, chief of medicine at the Veterans Affairs Ann Arbor Healthcare System and lead author of the study, told Healio Internal Medicine. “Our multicenter study of over 2,000 catheterized patients found that patients reported that noninfectious harms — such as blood in the urine and urine leakage once the catheter was removed — were five times more common than infectious complications.”

Saint and colleagues conducted a prospective cohort study that included 2,227 patients who received a new indwelling urethral catheter at one of four hospitals. The researchers evaluated the patients at baseline and contacted the patients 14 days and 30 days after the catheter insertion to determine complications.

According to the results, 30 days after the urethral catheter was inserted, 57% of patients reported at least one complication. Noninfectious complications, such as pain or discomfort, blood in the urine or urinary urgency, occurred in 55.4% of patients, whereas 10.5% of patients reported infectious complications. Researchers also found that women were more likely to report infectious complications, but men were more likely to report noninfectious complications.

“Furthermore, over 40% of catheterized patients reported that the indwelling catheter restricted their social activities, and almost 5% of patients reported that the catheter led to sexual problems after removal,” Saint said. “Our findings underscore the importance of avoiding the indwelling catheter unless it is absolutely necessary, and removing it as soon as possible.”

The researchers noted some limitations, including that the study was conducted in four sites within two states, and only patients who received an indwelling catheter during acute care hospitalization were included.

“We should launch efforts to reduce the noninfectious complication of urethral catheters in the same way that we have used collaborative efforts to reduce catheter-associated urinary tract infections in some patient populations,” the investigators wrote. “Attention to the technical aspects of proper catheter insertion and maintenance as well as increased focus on reducing unnecessary catheter insertions and unnecessary days of catherization duration seem likely to reduce noninfectious and infectious complications.” – by Jake Scott

Disclosure: Saint reports he is serving on the medical advisory board for Doximity, and on the scientific advisory board of Jvion, a health care technology company. Please see the full study for all authors’ relevant financial disclosures.