Prolonged use of indwelling urinary catheter following acute urinary retention in a tertiary care centre in sub-Saharan Africa: Causes, costs and concerns

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ObjectivesTo evaluate the causes, estimate out-of-pocket payments and assess concerns associated with prolonged use of urinary catheters following acute urinary retention secondary to benign prostate enlargement (BPE) and urethral stricture disease (USD) in men attending the urology out-patient clinic of a tertiary referral centre in North-central Nigeria. Patients and methodsThis was a cross-sectional survey of men attending urology clinic and who are using indwelling urinary catheter for >3 months following acute urinary retention due to BPE or USD. The study was conducted over a six-month period (1st March 2012 to 31st August 2012) at a tertiary hospital in North-central Nigeria using interviewer administered questionnaires. ResultsOf seventy-six men, 36/76 (47.4%) had BPE and 40/76 (52.6%) had USD. Median age, median duration of catheter use and median out-of-pocket payment per catheter change was 65 years (range 20–90 years), 12 months (range 3–120 months) and US$9.31 (range $3.63–18.75) respectively. There was no significant difference in the duration of catheter use and out-of-pocket payments between men with BPE and USD; however, men with USD were significantly younger than those with BPE.One-fifth and half of the men with BPE and USD, respectively attributed inability to pay for surgery as the reason for prolonged use of catheters. The second common reason was long waiting list for surgery. Men with BPE had their sexual relationships disrupted significantly more than those with USD and unexpectedly, we found that men using catheters for less than 6 months describe themselves as unhappy significantly more than those using the catheters for longer periods (p=0.033). ConclusionsInability to pay for definitive surgery and long waiting lists are the leading causes of prolonged use of indwelling urinary catheters in men with BPE and USD in our sub-Saharan setting. Prolonged catheter use adversely affected quality of life disrupting sexual relationships especially of men with BPE. Recommendations made to reduce out-of-pocket payments and shorten waiting times may help to improve access to urologic surgical care for these men.