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Urethral Catheterization in Women

  • Author: Gil Z Shlamovitz, MD, FACEP; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Jan 10, 2016
 

Background

Urethral catheterization is a routine medical procedure that facilitates direct drainage of the urinary bladder.[1] It may be used for diagnostic purposes (to help determine the etiology of various genitourinary conditions) or therapeutically (to relieve urinary retention, instill medication, or provide irrigation). Catheters may be inserted as an in-and-out procedure for immediate drainage, left in with a self-retaining device for short-term drainage (as during surgery), or left indwelling for long-term drainage in patients with chronic urinary retention.

Patients of all ages may require urethral catheterization, but those who are elderly or chronically ill are more likely to require indwelling catheters, which carry their own independent risks.[2] The basic principles underlying urethral catheterization are gender-neutral (see Urethral Catheterization in Men), but certain aspects of the procedure require particular attention in the female urethra.

Relevant Anatomy

The developed female urethra is a 4-cm tubular structure that begins at the bladder neck and terminates at the vaginal vestibule (see the image below). It is a richly vascular spongy cylinder and is designed to provide continence.

Female urinary organs, anterior view. Female urinary organs, anterior view.

The female urethra is suspended by the urethropelvic ligament with its 2 sides (the abdominal side being the endopelvic fascia and the vaginal side being the periurethral fascia). The female urethra pierces the pelvic diaphragm and the perineal membrane just posterior to the pubic symphysis. Distally, it exhibits more genital characteristics, becoming rich in glands and developing a squamous epithelium.

For more information about the relevant anatomy, see Female Urethra Anatomy. See also Female Urinary Organ Anatomy and Bladder Anatomy.

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Indications

Diagnostic indications for urethral catheterization in women include the following:

  • Collection of an uncontaminated urine specimen
  • Monitoring of urine output
  • Imaging of the urinary tract

Therapeutic indications include the following:

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Contraindications

Traumatic injury to the lower urinary tract (eg, urethral tearing) is a contraindication for urethral catheterization in women.

Suspected bladder injury is not a contraindication to placement of a urethral catheter. A urethral catheter allows drainage of urine from an injured urinary bladder and provides a route for contrast administration during cystoscopy. Extraperitoneal urinary bladder injuries are usually treated conservatively with an indwelling catheter, whereas intraperitoneal urinary bladder injuries usually call for operative repair.

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Technical Considerations

A larger than standard catheter should be used when the indication for placement is continuous bladder irrigation for hematuria and clots. A 3-way catheter (with an additional port) is often used in conjunction with a large-volume reservoir to create a “Murphy drip” for continuous irrigation.

Prophylactic antibiotics are recommended for patients with a prosthetic heart valve or an artificial urethral sphincter.

Consider suprapubic catheterization if vaginal hygiene is impaired.

 

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Contributor Information and Disclosures
Author

Gil Z Shlamovitz, MD, FACEP Associate Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Chief Medical Information Officer, Keck Medicine of USC

Gil Z Shlamovitz, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Acknowledgements

Andrew K Chang, MD Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center

Andrew K Chang, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Luis M Lovato, MD Associate Clinical Professor, University of California, Los Angeles, David Geffen School of Medicine; Director of Critical Care, Department of Emergency Medicine, Olive View-UCLA Medical Center

Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of Medscape Reference gratefully acknowledge the assistance of Lars Grimm with the literature review and referencing for this article. They also thank Michel Rivlin, MD, and G Rodney Meeks, MD, for the videos and several of the images in this article.

References
  1. Ortega R, Ng L, Sekhar P, Song M. Videos in clinical medicine. Female urethral catheterization. N Engl J Med. 2008 Apr 3. 358(14):e15. [Medline].

  2. van den Broek PJ, Wille JC, van Benthem BH, Perenboom RJ, van den Akker-van Marle ME, Niël-Weise BS. Urethral catheters: can we reduce use?. BMC Urol. 2011 May 23. 11:10. [Medline]. [Full Text].

  3. Selius BA, Subedi R. Urinary retention in adults: diagnosis and initial management. Am Fam Physician. 2008 Mar 1. 77(5):643-50. [Medline].

  4. Newman DK. The indwelling urinary catheter: principles for best practice. J Wound Ostomy Continence Nurs. 2007 Nov-Dec. 34(6):655-61; quiz 662-3. [Medline].

  5. Lam TB, Omar MI, Fisher E, Gillies K, MacLennan S. Types of indwelling urethral catheters for short-term catheterisation in hospitalised adults. Cochrane Database Syst Rev. 2014 Sep 23. 9:CD004013. [Medline].

  6. Doherty W. Instillagel: an anaesthetic antiseptic gel for use in catheterization. Br J Nurs. 1999 Jan 28-Feb 10. 8(2):109-12. [Medline].

  7. Gerard LL, Cooper CS, Duethman KS, Gordley BM, Kleiber CM. Effectiveness of lidocaine lubricant for discomfort during pediatric urethral catheterization. J Urol. 2003 Aug. 170(2 Pt 1):564-7. [Medline].

  8. Wong ES, Hooton TM. Guideline for Prevention of Catheter-associated Urinary Tract Infections. http://www.cdc.gov/ncidod/dhqp/gl_catheter_assoc.html. Centers for Disease Control and Prevention Web site. Available at http://www.cdc.gov. Accessed: July 10, 2009.

  9. Tanabe P, Steinmann R, Anderson J, Johnson D, Metcalf S, Ring-Hurn E. Factors affecting pain scores during female urethral catheterization. Acad Emerg Med. 2004 Jun. 11(6):699-702. [Medline].

  10. Kunin CM. Urinary-catheter-associated infections in the elderly. Int J Antimicrob Agents. 2006 Aug. 28 Suppl 1:S78-81. [Medline].

  11. Hart S. Urinary catheterisation. Nurs Stand. 2008 Mar 12-18. 22(27):44-8. [Medline].

  12. Suskind AM, Smith PP. Evidence of a functional effect of transient transurethral catheterization on micturition in women. Int Urogynecol J. 2012 Jan 17. [Medline].

  13. Hollingsworth JM, Rogers MA, Krein SL, Hickner A, Kuhn L, Cheng A, et al. Determining the noninfectious complications of indwelling urethral catheters: a systematic review and meta-analysis. Ann Intern Med. 2013 Sep 17. 159(6):401-10. [Medline].

 
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Commercial urinary catheterization kit.
Preparatory solution in commercial urinary catheterization kit.
Urinary catheterization kit. Image courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.
Urinary catheterization supplies. Image courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.
Urinary catheter tip. Image courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.
Urinary catheter urine collection bag. Image courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.
Urinary catheterization. Video courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.
Taping of urinary catheter. Video courtesy of Michel Rivlin, MD, and G Rodney Meeks, MD.
Female urinary organs, anterior view.
 
 
 
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