934 EVALUATING THE IMPACT OF MALE IATROGENIC URETHRAL INJURIES DURING URINARY CATHETERIZATION

Abstract

INTRODUCTION AND OBJECTIVES: Male urinary catheterization is commonly performed during hospitalization, yet is not without complications. The incidence of male iatrogenic urethral injuries related to catheterization is unknown and may represent unplanned clinical activity for urologists. Our objective was to evaluate the incidence of male iatrogenic urethral injuries during hospitalization and identify risk factors for injuries in an effort to prevent these adverse events. METHODS: All male patients seen in consultation for iatrogenic catheter related urethral injuries were identified through our prospectively maintained, urology consult database. After institutional review board approval, all cases were reviewed and events surrounding injury, patient comorbidities, and complications were recorded. RESULTS: From July 1, 2009 to June 30, 2011, 118 consultations were made for male urethral injuries related to catheterization. Average patient age was 64.2 years. Forty-seven percent of catheterization was performed to monitoring urinary outputs. Fourteen percent of injuries occurred during catheter change. Median size of catheter causing injury was a 16 Fr straight latex catheter (95.4%). Averages of 2.2 catheterization attempts were made prior to consultation (range 1-6). Inpatient setting was the most frequent location of injury (56.7%), followed by intraoperative (25.4%), and emergency department (17.7%). An 20 Fr coude catheter was the median catheter placed during consultation (61%). Bedside cystoscopy and need for OR was required in 24.6% and 6.8% of cases respectively. Complications included hematuria (85.6%), false passage (18.6%), stricture (4.2%), UTI (7.6%), recurrent bleeding needing ER visits (2.5%), and anemia requiring transfusion (0.8%). CONCLUSIONS: Male iatrogenic urethral injuries are common and can significantly impact a patient’s hospitalization, and may lead to life-long complications. Potential factors identified during this two-year review have lead to a male catheterization algorithm, currently being initiated at our institution in an effort to prevent these avoidable injuries.