The indications and technique of urinary catheterization in men, complications are possible
The introduction of the catheter into the bladder men through the urinary (urethral) canal is quite frequently used medical procedure. This method is widely used for diagnostic and therapeutic tasks. The catheter of the urinary bladder in males can be installed for a short time, as a rule, it is necessary during long complex surgical procedures or long-term. Prolonged catheterization is often carried out in diseases, in cases where the physiological act of urination is difficult or impossible, such as when carcinoma prostate.
Knowledge of male urethral anatomy is essential for all specialists carrying out this procedure – catheterization of the bladder is one of the most frequently performed healthcare. The male urethra is highly susceptible to a variety of pathological States: from traumatic to infectious to neoplastic. Pathophysiological processes in the urethra can have disastrous consequences, such as kidney failure or infertility. Therefore, catheterization should be performed only by an experienced technician.
Indications and contraindications
Catheter the bladder in men is established in the following diagnostic indications:
- Obtaining a urine sample for subsequent research directly from the cavity of the bladder. It is often necessary to determine the species composition of the microflora contained in it.
- Constant monitoring of the amount of urine passed and its organoleptic characteristics in the process.
- A study of the patency of the urinary tract.
Formulation of the therapeutic catheter includes the following reasons:
- Acute retention of urine excretion, for example in benign prostatic hypertrophy, obstruction at the bladder neck or urethra.
- Chronic obstruction caused by hydronephrosis.
- Irrigation of internal bladder drugs.
- Intermittent decompression for neurogenic bladder. Catheterization is an integral part of the therapy.
- Ensuring the excretion of urine in patients for whom the organization of the physiological act of urination poses its own challenges. Often required in bedridden patients.
In some cases, the catheter of the bladder in men may be not recommended or completely contraindicated. This is true when:
- Fractures of the penis.
- Injuries of the lower urinary tract – the urethra,the cervix or the urinary sphincter.
- Other injuries in the pelvic area in which catheter insertion may be difficult or will provoke additional disorders: extensive hematoma of the perineum, fractures and so on. In this case, the introduction of the catheter is always preceded by conducting retrograde urethrogram.
The methodology of the
Urethral catheterization in men is associated with certain difficulties in the methods of procedure, due to anatomical structure of the urinary tract. The male urethra is longer and the diameter of her for that, among other things, require additional anesthesia.
In addition, because of the tenderness of the mucous membrane of the urethra catheterization should be carried out carefully to avoid unnecessary pain and injury. Internal damage to the urethra can lead to the development of purulent-necrotic inflammation, which can lead not only to problems of urination in the future, but also violations of reproductive functions.
Staging urinary catheter is carried out with the patient lying on the back with a slightly divorced the lower limbs. Pelvic area men is covered with sterile cloth, which is cut a hole for the withdrawal of the penis. The whole procedure is carried out in antiseptic conditions.
Local anesthesia of the urethral channel is 2% lidocaine gel, which is inserted immediately before the catheterization in the outer opening of the urethra men. Many modern sets for catheterization of the urinary bladder include the appropriate syringe with a plastic needle filled with anesthetic. After the introduction of lidocaine opening of the urethra is clamped by the fingers for a few minutes to prevent leakage of medication.
Catheterization is performed using urinary catheters, a common tube of narrow diameter, made of different materials. The most commonly used catheters made of latex or pure silicone coated with silver alloy and antibiotic impregnated. The inner end of the tube is sealed, the sides are few openings. On the outside of the catheter, as a rule, there are two branches: sleeve to connect the urostomy pouch off the withdrawal for the abstraction of urine analysis.
Immediately before the introduction of the penis men slightly retracted, the foreskin moves over a head and compress it with the aim of opening up the hole in the urethral canal. Then the inner end of the catheter slowly porochivshimi movements introduced into the urethra. The outer edges of the urethra during introduction of the catheter is draped sterile cotton rolls impregnateddisinfectant solution.
After visual confirmation of the receipt of urine in the catheter tubing its introduction is stopped. It should be noted that the anesthetic gel can clog the inlet of the catheter at its inner end, in the process of entering. Therefore, in the case of the absence urine is possible her aspiration syringe. If this failed, the catheter is removed and catheterization is repeated under the control of us.
After the successful introduction of the catheter the penis is lowered the outer end of the tube is fixed to the patient's skin with the inner side of the thigh.
In General, catheterization of the bladder in men is not particularly difficult for professionals, but in some cases the following complications caused by a medical error:
- Infectious inflammation in the urinary system: urethritis, cystitis, pyelonephritis, carbuncles, transient infection.
- Paraphimosis due to compression of the foreskin of the penis below its head. Catheterization is performed only when the raised foreskin.
- The creation of false channels – physical damage to the urethral catheter.
- Strictures, perforation of the urethra.
Additional noninfectious complications include loss of a catheter, the blockage and leakage of urine by an artificial channel of the catheter.
The most important thing in establishing the need for catheterization of the bladder to account for the causes, clinical indications and contraindications. If such a medical procedure is still needed, it must be implemented very carefully and to contact an experienced expert to avoid complications. Proceed thoughtfully and carefully, because health is the most valuable thing a man can have.