584 CHAPTER 16 Urological surgery and equipment

Catheters and drains in urological surgery

Catheters

Catheters are made from Latex or Silastic (for patients with Latex allergy or for long-term use—better tolerated by the urethral mucosa).

Types

•Self-retaining (also known as a Foley, balloon, or two-way catheter) (Fig. 16.1). An inflation channel can be used to inflate and deflate a balloon at the end of the catheter, which prevents the catheter from falling out.

•Three-way catheter (also known as an irrigating catheter). Has a third channel (in addition to the balloon inflation and drainage channels) that allows fluid to be run into the bladder at the same time as it is drained from the bladder (Fig. 16.2).

Size

The size of a catheter is denoted by its circumference in millimeters. This is known as the “French” or “Charriere” (hence Fr) gauge. Thus a 12 Fr catheter has a circumference of 12 mm.

Uses

•Relief of obstruction (e.g., BOO due to BPE causing urinary retention—use the smallest catheter that you can pass; usually a 12 Fr or 14 Fr is sufficient in an adult)

•Irrigation of the bladder for clot retention (use a 20 Fr or 22 Fr threeway catheter)

•Drainage of urine to allow the bladder to heal if it has been opened (trauma or deliberately, as part of a surgical operation)

•Prevention of ureteric reflux, maintenance of a low bladder pressure, where the ureter has been stented (post-pyeloplasty for UPJ obstruction)

•To empty the bladder before an operation on the abdomen or pelvis (deflating the bladder gets it out of harm’s way)

•Monitoring of urine output postoperatively or in the critical patient

•For delivery of bladder instillations (e.g., intravesical chemotherapy or immunotherapy)

•To allow identification of the bladder neck during surgery (e.g., radical prostatectomy, operations on or around the bladder neck)

Drains

Drains are principally indicated for prevention of accumulation of urine, blood, lymph, or other fluids. They are particularly used after the urinary tract has been opened and closed by suture repair.

A suture line takes some days to become completely watertight, and during this time urine leaks from the closure site. A drain prevents accumulation of urine (a urinoma), the very presence of which can cause an ileus, and if it becomes infected, an abscess can develop.

CATHETERS AND DRAINS IN UROLOGICAL SURGERY 585

Figure 16.1 A Foley catheter with the balloon inflated.

Figure 16.2 Twoand three-way catheters.

588 CHAPTER 16 Urological surgery and equipment

Figure 16.6 The eyeholes at the tip of the suction drain.

Box 16.2 Failure to deflate catheter balloon for removal of a urethral catheter

From time to time an inflated catheter balloon will not deflate when the time comes for removal of the catheter.

•Try inflating the balloon with air or water—this can dislodge an obstruction.

•Leave a 10 mL syringe firmly inserted in the balloon channel and come back an hour or so later.

•Try bursting the balloon by overinflation.

•Cut the end of the catheter off, proximal to the inflation valve—the valve may be stuck and the water may drain out of the balloon.

•In the female patient, introduce a needle alongside your finger into the vagina and burst the balloon by advancing the needle through the anterior vaginal and bladder wall.

•In male patients, balloon deflation with a needle can also be done under ultrasound guidance. Fill the bladder with saline using a bladder syringe so that the needle can be introduced percutaneously and directed toward the balloon of the catheter under ultrasound control.

•Pass a ureteroscope alongside the catheter and deflate the balloon with the rigid end of a guide wire or with a laser fiber (the end of which is sharp).

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