2026-03-16
Improper catheterization procedures may lead to some complications. This article describes the causes and clinical manifestations of these complications, and proposes prevention and treatment measures, hoping to be helpful to patients.
I. Urethral mucosa injury
1. Causes of the incident
1.1 The male urethra is long and has curved and narrowed sections, with individual variations, making it difficult to determine the insertion depth.
1.2 The operator is not familiar with the common knowledge and pathology of urinary catheters and male urethral anatomy.
1.3 Due to negative psychological factors such as shyness, anxiety, fear, etc., the patient becomes highly tense during catheter insertion, which may cause urethral sphincter spasm.
1.4 When there are lesions in the lower urinary tract, the urethral anatomy changes. For example, in cases of benign prostatic hyperplasia, due to varying degrees of glandular hyperplasia in the prostate, the prostate part of the urethra becomes narrow, twisted, and deformed. At this time, inserting the urinary catheter may cause urethral injury.
1.5 Patients find it unbearable to tolerate the bladder and urethral irritation caused by the urinary catheter and may pull the catheter by themselves or forcibly remove it.
1.6 The selected urinary catheter is too thick or the rubber catheter used is stiff. During insertion, it is prone to cause damage to the urethral mucosa. Repeated insertions may lead to edema, injury, and bleeding of the urethral mucosa.
1.7 When using an air-filled urinary catheter, if the end of the catheter does not enter the bladder or has just entered the bladder, water is injected into the air sac at this time. At this point, although urine flows out from the catheter, the air sac part is still located in the posterior urethra, and the swollen air sac compresses the posterior urethra.
2. Clinical manifestations
Excessive bleeding from the external urethral orifice, sometimes accompanied by blood clots; pain in the urethra, which worsens during urination and is accompanied by local tenderness; in some cases, there is difficulty in urination or even urinary retention; in severe cases, there may be perineal hematoma, urethral exudation, or even rectal fistula; when there is a severe injury, there may be urethral discharge of pus or surrounding urethral abscesses.
3. Prevention and Treatment
3.1 Before insertion, lubricate the urinary catheter routinely to reduce the friction during insertion. During the operation, handle gently and insert slowly. Do not force the insertion and do not repeatedly pull and insert.
3.2 For patients with incomplete lower urinary tract obstruction, before catheterization, use the right hand to take the prepared lubricating and analgesic gel, squeeze out a little of the gel to lubricate the tip of the catheter and the external urethral orifice, then gently insert the tip of the nozzle into the urethra, and push hard with the thumb to promote the gel in the catheter to enter the urethra and reach the membranous part of the urethra. After withdrawing the tip of the catheter, apply pressure with the thumb, index finger, and middle finger of the left hand for 1-2 minutes to close the external urethral orifice. Alternatively, use a syringe without the needle tip to inject the lubricant into the urethral orifice, or connect a lubricant injection device to the rear end of the catheter and inject the lubricant while inserting, which is more likely to succeed.
3.3 For patients with benign prostatic hyperplasia, when there is resistance during insertion, inhale 5-10 ml of sterilized paraffin oil into the syringe in advance, and inject it rapidly from the end of the catheter. The inserter should lift the penis with the left hand at a 60-degree angle to the abdominal wall, and inject the paraffin oil with a little force with the right hand. At the same time, use its lubricating effect to quickly insert the catheter, so as to pass through the hyperplastic area smoothly.
3.4 Select a catheter of appropriate size and soft texture.
3.5 If using a balloon-type catheter, extend the insertion length during insertion, see urine flow after that, continue to advance 5 cm or more, fill the balloon, then gently pull back to the point of resistance, which is generally 2-3 cm. This can avoid the catheter not entering the bladder, the balloon filling expanding and compressing, and damaging the urethra.
3.6 Patiently explain. If the patient is overly nervous, follow the doctor's advice to inject diazepam or atropine into the muscle before insertion, and wait for the patient to calm down before performing the insertion.
3.7 For mucosal damage caused by catheterization, mild cases do not require treatment or can recover through hemostasis, analgesia, and other symptomatic treatment. Occasionally, severe cases require surgical treatment such as urinary diversion or urethral repair.
The content of this article is sourced from the internet. The author assumes no responsibility for it. Without permission, copying is strictly prohibited.
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