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Sunday, January 3, 2010

Bleeding During Catheterization of Male Urethra

Posted by Prahallad Panda on 7:47 AM 10 comments

Diagram of a foley catheterA Foley's Catheter
I was called at 10.30 PM to attend a case of bleeding from urethra following urethral catheterization in a semiconscious male, admitted to the medicine ward. I went and saw a healthy male in sixties bleeding from urethra. The foley's catheter, a narrow silicon tube used for draining the retained urine was in the hand of a paramedic.

The full history became apparent; the male patient suffering from a brain stroke was semiconscious and there is involuntary passage of urine; a self retaining catheter was put to prevent the soiling of the bed. The catheter did not drain urine, rather blood was seen coming out from the tip of urethra. So, the catheter had been removed from the urethra.
Bleeding occurs when there is injury to the urethra while inserting a catheter. Sometimes a catheter does not pass with ease especially in an elderly; where some prostatic enlargement is expected. In this case it appeared that the catheter has not gone right to the urinary bladder, and folded upon itself in the urethra. This would have evoked pain, if the patient was conscious. The first person putting the catheter has not done his job correctly, and had inflated the balloon, present in the tip of the catheter, in the urethra resulting in rapture of urethra and consequent bleeding.

The ideal way to deal such a case is to insert a catheter surgically to the urinary bladder from the lower abdominal side, as reinsertion from urethral side may result in more damage to the already injured urethra. But this requires operation theatre ready for the purpose. A have handled such cases earlier, and tried reinsertion from the urethral side with success in many
Vertical section of bladder, penis, and urethra.A Cross Section of Urethra
cases and failure in some cases. I used to put two tubes of 2% xylocaine jelly, a local anaesthetic to the urethra and wait for 10 minutes; so that the urethra is completely lubricated and anaesthetized. A very slow non-forceful insertion of catheter with a little manipulation usually passes the injured part and the narrowed part of urethra en route to the urinary bladder. And it was successful in this particular case too. In this way a stressful surgery was avoided on an already stressed patient from brain stroke. But in future, there is 50% chance that, he may develop a narrowing called a stricture at the level of injury in the urethra. But, that can be managed by dilation of urethra at regular intervals.
I always repeat as my teacher does; urethra is like a glass and handle it with care! 


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