UPJ INSIGHT Characterization and Outcomes of Iatrogenic Urethral Catheterization Injuries

By: Jack Dougherty Lawton, BS, University of Virginia School of Medicine, Charlottesville; Nicolas Ortiz, MD, University of Virginia, Charlottesville; Alexander Henry, MD, University of Virginia, Charlottesville; Caleigh Smith, BS, University of Virginia School of Medicine, Charlottesville; Ryan Smith, MD, University of Virginia, Charlottesville; David E Rapp, MD, University of Virginia, Charlottesville | Posted on: 18 Mar 2024

Lawton JD, Ortiz N, Henry A, Smith C, Smith R, Rapp DE. Characterization and outcomes of iatrogenic urethral catheterization injuries. Urol Pract. 2024;11(2):385-393.

Study Need and Importance

Iatrogenic traumatic urethral injury is a risk of urethral catheterization (UC) previously associated with increased personal morbidity and health care utilization. Using a prospectively collected UC consult database, we sought to identify the patient population, interventions, and outcomes surrounding iatrogenic UC injury to guide development of strategies for minimizing traumatic UC and its associated costs.

What We Found

We identified 98 adult traumatic UC events over 30 months. Overall incidence was 5.3 events per 1000 catheters placed. There were a mean 1.5 UC attempts by the primary team prior to urology consultation. Patients were generally elderly, with multiple comorbidities, and had some current or previous lower urinary tract diagnosis (Table). However, there was no identifiable factor complicating catheterization in 47 (48%) cases, and evidence of urethral balloon inflation was noted in 20 (20%) cases. Cystoscopy was required for placement in 35 (36%) consults; patients requiring cystoscopy had a mean 2 past or current lower urinary tract urologic diagnoses vs 1.2 in noncystoscopic placements. Forty-nine (50%) cases experienced gross hematuria, and 13 (13%) developed catheter-associated urinary tract infection as an inpatient or within 30 days of catheter placement. Fifty-two additional hospital days were required for treatment of traumatic UC sequelae.

Table. Patient Demographics and Characteristics

Factor	Traumatic (n = 90)	Nontraumatic (n = 184)	P value
Age, mean (SD), y	68.8 (13.9)	66.8 (14.5)	.30
Male sex, No. (%)	90 (100)	156 (85)	< .01
BMI, mean (SD)	28.0 (6.0)	28.9 (7.5)	.29
Race/ethnicity, No. (%)
White	74 (82)	155 (84)	.67
Black	14 (16)	28 (15)	.94
Other	2 (2)	1 (1)	.99
Charlson Comorbidity Index, mean (SD)
Mean (SD)	4.6 (2.3)	4.67 (2.4)	.79
Score ≥5-<21% 10-y survival, No. (%)	45 (50)	94 (51)	.87
Score ≤5->21% 10-y survival, No. (%)	45 (50)	90 (49)	.87
Urologic history, No. (%)
Previous or existing lower urinary tract condition	64 (71)	116 (63)	.18
BPH	43 (48)	52 (28)	< .01
Previous difficult catheterization	17 (19)	30 (16)	.59
Chronic indwelling or intermittent catheterization	13 (14)	26 (14)	.94
Urethral stricture	12 (13)	23 (13)	.85
TURP/Greenlight/Urolift	11 (12)	15 (8)	.28
Prostate cancer s/p intervention	6 (7)	27 (15)	.06
Abbreviations: BPH, benign prostatic hyperplasia; s/p, status-post; TURP, transurethral resection of the prostate. Bolded text indicates statistical significance.

Limitations

Data harvest and analysis were performed retrospectively. Hospital setting, operative case mix, and urology consultation availability may affect the characteristics of traumatic urethral injuries; our data sourced from a single academic tertiary care center may not generalize to other institutions. Long-term follow-up of this group for posttraumatic sequelae is limited.

Interpretation for Patient Care

Our findings highlight the significant personal and systemic costs associated with traumatic UC, while underscoring the need for improvement in placement technique and early identification of patients requiring cystoscopic guidance. To improve outcomes, tailored development of educational initiatives, difficult catheterization teams, and risk stratification algorithms are likely necessary.