Abstract: Urologists to the Rescue: Catheterization Problems of Infants

Timothy P. Bukowski, MD, and Andrew L. Freedman, MD. "Urologists to the Rescue: Catheterization problems of infants." Contemporary Urology (November 1999).

Objectives:
* To increase urologists' awareness of the unique problems and issues associated with the urethral catheterization of infants and small children, in order to help prevent urethral injury and complications.

Conclusions:
* In the medical and surgical treatment of infants, "the placement of a urinary drainage catheter for continuous monitoring of urine production or to obtain urine for analysis or culture has become as routine as using cardiac leads or a temperature probe."
* Complications associated with the catheterization of infants include urinary tract infection, urethritis, bladder spasms, hematuria, meatal stenosis, urethral tear or false passage, and particularly, urethral stricture, which can lead to a lifetime of voiding difficulties requiring multiple complex reconstructive surgeries.
* Boys two years old or younger are most vulnerable to complications associated with infant catheterization.
* The authors summarize three cases of catheter injury in infants to illustrate preventable problems. In one case, a balloon catheter was inflated prematurely, causing bleeding in the urethra of a new born infant who was under observation in the intensive care unit. The second case involved a 2-year-old boy, who experienced balloon catheterization; the balloon was overinflated, revealing that a catheter balloon can obstruct the ureter either mechanically or because of bladder spasm. The third case involved a one-month-old boy who was catheterized for an outpatient VCUG; the catheter folded in on itself, and the attendent medical personnel were unable to withdraw it until the child had undergone a perineal urethrostomy to expose and remove the catheter.
* In order to minimize the risks associated with the urethral catheterization of children, the authors recommend that practitioners follow certain guidelines: 1) make sure a catheter is truly needed; 2) choose the right catheter; 3) take care in placing the catheter; 4) immobilize the catheter; and 5) remember the "tricks of the trade" for catheter removal. Each of these recommendations is discussed in greater detail by the authors.
* "Bladder ultrasonography is non-invasive and provides an accurate estimate of volume. It can be a good alternative to catheterization when urinary obstruction or hydration status is a concern."
* "Although urethral catheterization has become routine, the procedure is fraught with potentially serious complications. Proper catheter selection and gentle manipulation and placement by thoughtful, trained personnel with an appreciation of the delicate nature of the infant urethra will go a long way toward avoiding serious injury."

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