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bladder punctures related to foley catheters

• are there any causes of bladder puncture that could occur in male patients with long term use of indwelling foley catheters?

• Answer:

  Hello anita6450, When long term catheterization is needed, an indwelling Foley catheter is usually used. To reduce infection, these catheters are changed usually between the third and sixth week of placement, with 30 days being the average. Bladder perforation is not a common complication, with infection, stones and irritation seen far more often. Occasionally urethral perforation and trauma may occur. When an indwelling Foley is correctly inserted and properly stabilized so as not to irritate or become dislodged, risk of perforation is greatly reduced. http://www.chclibrary.org/micromed/00069700.html Bladder perforation is more commonly seen during other procedures, such as endoscopy, cystoscopy, biopsy, and prostate surgery. ?Success rates have varied from 18 percent to 77 percent, but complications such as bladder perforation? http://www.clevelandclinic.org/urology/news/incontinence/07-04.htm ?Perforation of the bladder during a bladder biopsy, cystolitholapaxy, transurethral resection of the prostate (TURP), or transurethral resection of a bladder tumor (TURBT) is not uncommon. Incidence of bladder perforation is reportedly as high as 36% following bladder biopsy.? http://www.emedicine.com/med/byname/bladder-trauma.htm ?As with any invasive procedure, complications can occur. Complications related to cystoscopy include, but are not limited to, the following: ?infection ?bleeding ?urinary retention ?bladder perforation? http://www.stjohnsmercy.org/healthinfo/test/urology/TP067.asp You can see an illustration of a male with a Foley catheter placement on this page. Look for the second little camera icon, and click ?Indwelling catheter? to the left of the camera icon: http://my.webmd.com/hw/female_incontinence/zp1652.asp Bladder perforation is rather rare, and not even listed as a risk or complication on most sites: ?Trauma to the urethra and/or bladder may result from incorrect insertion of the catheter. Repeated irritation to the urethra during catheter insertion may cause scarring and/or stricture, or narrowing, of the urethra. The catheter may introduce bacteria into the urethra and bladder, resulting in urinary tract infection. UTI can cause fever and inflammation of the bladder and urethra. Patients who practice intermittent catheterization can reduce their risks for UTI by using antiseptic techniques for insertion and catheter care.? http://www.chclibrary.org/micromed/00069700.html Complications of longterm catheterization A.See Urinary Catheter associated Urinary Tract Infection 1.Urosepsis 2.Bacteriuria a.Single intermittent catheterization: 20% of elderly b.Bacteriuria occurs in most patients in 2-3 weeks B.Chronic renal inflammation C.Pyelonephritis D.Nephrolithiasis E.Cystolithiasis http://www.fpnotebook.com/URO98.htm Using a catheter increases the risk for: ?Damage to the urethra. ?Damage to the skin of the penis. ?Urinary tract infection http://my.webmd.com/hw/female_incontinence/zp1652.asp I was able to find few articles on actual bladder perforation from an indwelling catheter. Here is what I did find: From a case report by Drs.Shapiro, Soderdahl, and Stack: ?Complications associated with long-term indwelling catheters include bladder tumors,7 fistula formation,8 bladder perforation,9 and periurethral abscess.10 These complications may also result from long-term retention of a Foley catheter fragment and would likely result in morbidities similar to those previously mentioned.? http://www.turner-white.com/pdf/hp_jun00_foley.pdf ?Spontaneous bladder rupture is a very rare condition. The majority of the cases are due to long-term indwelling catheters, radiation, or acute infravesical obstruction.? http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ProduktNr=224282&Ausgabe=228713&ArtikelNr=66119&filename=66119.pdf ?It is important to note that Foley catheter clamping is not a benign procedure. Potential risks include cystitis, pyelonephritis, urosepsis, and bladder perforation. Thus, Foley catheter clamping is not commonly employed except in those rare occasions where bladder reconstruction is being contemplated. The clamping should be performed under strict supervision by monitoring patient comfort and bladder capacity. Coexisting urinary tract infections must be eradicated prior to proceeding with this endeavor.? http://www.cgmh.org.tw/intr/intr5/c6700/OBGYN/f/web/USI%202/ ?If you are changing the catheter because the old one was plugged, a large amount of urine may be in the person?s bladder. Never drain more than 500 cc of urine at one time. Pinch the catheter for 5 minutes before finishing. Emptying the bladder too fast can cause problems.? http://lifecenter.ric.org/content/510/?topic=1&subtopic=300 Insertion of the catheter can rarely cause problems: ?The urethra or bladder can be damaged. Occasionally, the bladder wall is punctured.? With long term use the following may occur: ? The urethra can be damaged or scarred. ? A long-term inflammation or infection of the kidneys can develop. ? "Stones" made of mineral deposits can form inside the kidneys or bladder, or on the catheter tip or balloon. ? The scrotum, prostate or nearby structures can become infected. http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/31695.html Additional Information: ?Indwelling catheters should only be used when absolutely necessary and removed as soon as feasible. Strict asepsis should be followed during insertion. An iodophor preparation should be used to cleanse the perineal area and the meatus prior to catheter insertion. Cleansing the meatus and surrounding tissues with an iodophor preparation provides effective action against most gram-positive and gram-negative bacteria and fungi (Axnick & Yarbrough, 1984 [2]). The smallest catheter that will ensure adequate drainage should be used. A small catheter will minimize trauma to the urethra thus reducing the risks of infection. The smallest balloon possible should be used so as to minimize trauma to the bladder neck (Edwards, Lock, Powell, & Jones, 1983 [8]). Large balloons may cause tissue damage to the bladder neck. Once inserted, the catheter should be secured to the anterior thigh so as to minimize movement of the catheter and tension on the balloon thus reducing the possibilities of infection and trauma.? This article makes no mention of bladder perforation risk. http://www.stti.iupui.edu/VirginiaHendersonLibrary/articles/030002.pdf Alternative to indwelling catheters for some patients http://tis-group.org/cath.html http://www.findarticles.com/p/articles/mi_m0PHH/is_1996_March_15/ai_64974956/pg_23 I hope this has cleared things up for you. If any part of this answer is unclear, please request an Answer Clarification, before rating. This will enable me to assist you further, if possible. Regards, crabcakes Search Terms bladder perforation + indwelling Foley catheter risks indwelling catheters