Editorial Comment

Abstract

The history of urethral catheterization dates back to 3000 years. 1 Fenley R.C.L. Hopley I.B. Wells P.N.T. Urinary catheters: history, current status, adverse events and research agenda. J Med Eng Technol. 2015; 39: 459-470 Crossref PubMed Scopus (152) Google Scholar During the last century, several advances have been made both in design and the catheter material to mitigate the patient discomfort and reduce potential complications related to catheterization. Despite these advances and the usage of anesthetic lubricants, introduction of the catheter tip through the bulbourethral junction into the prostate and bladder can sometimes be painful and can lead to false passages in the vicinity of the bulbous urethra. This mechanical problem during catheter introduction is generally considered to be due to noncompliant spasticity of the rhabdosphincter component around the membranous urethra; this is especially common in neuropathic male subjects with striated sphincter dyssynergia. Another potential problem in this vicinity is anatomical curvilinear alignment of the bulbar urethra with membranous urethral axis. Because the bulbar urethra is relatively capacious and compliant and may not be in an ideal alignment with the membranous urethra, the catheter tip could be held at the bulbar region causing discomfort and pain if catheter insertion is forced. Another reason for catheter-related discomfort is the inadequacy of local anesthetic effect on prostatic urethra as the anesthetic jelly mostly remains in the anterior urethra without prostatic urethra being adequately exposed to the anesthetic jelly; this phenomenon is often seen with retrograde urethrograms that mostly delineate anterior urethra but not the posterior urethra.