High Risk of Complications with Urethral Catheters

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Close to 60% of patients undergoing placement of an indwelling urethral catheter experience complications—mainly noninfectious—within 30 days, reports a study in JAMA Internal Medicine.

The prospective cohort study included 2967 patients undergoing new insertion of an indwelling urethral catheter at four US hospitals (including two VA medical centers) over a 2-year period. All were enrolled within 3 days after catheter placement. Patients underwent a baseline examination, with follow-up contacts at 14 and 30 days after insertion. In addition to catheter-related infectious and noninfectious complications, the study assessed impact on activities of daily living, social activities, and general comfort.

About three-fourths of patients agreed to participate. Of the 2076 patients included in the analysis, 71.4% were male; the mean age was 68 years. Catheters were placed before surgical procedures in 79.6% of patients. In 76.0% of patients, catheters were removed within 3 days.

Overall, 57.0% of patients reported at least one complication during the 30 days after catheter insertion. Noninfectious complications such as pain/discomfort, blood in urine, or a sense of urinary urgency occurred in 55.4% of patients, while the rate of infectious complications was 10.5%.

Women were more likely to report infectious complications, 15.5% versus 8.6%; but men were more likely to report noninfectious complications, 58.6% versus 47.3%. Of 124 patients with a catheter still in place, 39.5% reported restrictions in activities of daily living while 43.9% reported social limitations.

Sexual problems after catheter removal were reported by 4.9% of patients. Both infectious and noninfectious complications were more likely to be reported by patients with moderate and severe American Urological Association symptom scores at baseline and in those with urinary catheter duration of longer than 3 days.

Indwelling urethral (Foley) catheters are widely used in the care of hospitalized patients. Infectious complications related to urethral catheters are well recognized; however, relatively little is known about the noninfectious complications that may occur with these invasive devices.

This prospective cohort study finds a 57% rate of complications in patients undergoing indwelling urethral catheter placement. Noninfectious complications are five times more frequent than noninfectious complications. Patients with catheters in place report high rates of restrictions in activities of daily living and social activities.

The authors note that their active follow-up study identified complications of concern to patients that occur outside the hospital setting. The investigators conclude: “In light of the frequency with which urethral catheters are used, we should consider not only infectious complications but also the noninfectious complications associated with these catheters as key areas of possible harms and thus vital targets for future prevention efforts” [Saint S, et al. A multicenter study of patient-reported infectious and noninfectious complications associated with indwelling urethral catheters. JAMA Intern Med 2018 doi:10.1001/jamainternmed.2018.2417].