Long-term indwelling of the Foley catheter

 

Case: A 48-year-old female with urethral erosion

The patient is a 48-year-old female with a history of traumatic C5 SCI in 10 years ago that left her with near quadriplegia.  She has minimal use of her upper extremities. The patient also has subsequently developed a neurogenic bladder with severe urinary incontinence.  She has had a Foley catheter in place for several years, and she now has developed marked urethral erosion, with near complete destruction of her urethra.  Her incontinence has been so bad that she now leaks around her urethra. When she began leaking urine around the Foley catheter and ever larger Foley catheters were being used.

She was seen in consultation by us, and we noted erosion of the anterior urethra and a tiny bladder with lack of compliance, and we told them that in order to salvage this situation, an ileovesicostomy and closure of the urethra [VIDEO] . would be necessary.

Comments and Lessons: In women urethral damage is almost always associated with loss of continence function. Urethral problems related to chronic catheter use are usually compounded by bladder dysfunction that is also the result of the indwelling catheter. In women the most common complaint is incontinence despite a Foley catheter. This is further complicated by treating by larger and larger catheters and more fluid in the retention balloon. That makes the condition worse. The compression necrosis of the urethral mucosa and sphincter muscle by the pressure from the balloon or the catheter develops and ultimately results in urethral erosions. These can involve the anterior or posterior urethra or they can be circumferential.  Primary chronic suprapubic catheterization avoids injury to the urethra, but is no safer in the long term than a urethral catheter. Both indwelling methods are associated with high rates of bladder carcinoma, urosepsis, stone formation, upper tract disease, renal tissue loss and incontinence. The usual reason for Foley catheter or suprapubic catheter treatment is management of incontinence. Within five years most patients are incontinent around the catheter, and more than half have a urethral erosion.

Please also refer to this.

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