Urethral Catheterization in Women
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Urethral catheterization is a routine medical procedure that facilitates direct drainage of the urinary bladder. [1] It may be used for diagnostic purposes (to help determine the etiology of various genitourinary conditions) or therapeutically (to relieve urinary retention, instill medication, or provide irrigation). Catheters may be inserted as an in-and-out procedure for immediate drainage, left in with a self-retaining device for short-term drainage (as during surgery), or left indwelling for long-term drainage in patients with chronic urinary retention.
Patients of all ages may require urethral catheterization, but those who are elderly or chronically ill are more likely to require indwelling catheters, which carry their own independent risks. [2] The basic principles underlying urethral catheterization are gender-neutral (see Urethral Catheterization in Men), but certain aspects of the procedure require particular attention in the female urethra.
The developed female urethra is a 4-cm tubular structure that begins at the bladder neck and terminates at the vaginal vestibule (see the image below). It is a richly vascular spongy cylinder and is designed to provide continence.
The female urethra is suspended by the urethropelvic ligament with its 2 sides (the abdominal side being the endopelvic fascia and the vaginal side being the periurethral fascia). The female urethra pierces the pelvic diaphragm and the perineal membrane just posterior to the pubic symphysis. Distally, it exhibits more genital characteristics, becoming rich in glands and developing a squamous epithelium.
For more information about the relevant anatomy, see Female Urethra Anatomy. See also Female Urinary Organ Anatomy and Bladder Anatomy.
Diagnostic indications for urethral catheterization in women include the following:
Collection of an uncontaminated urine specimen
Monitoring of urine output
Imaging of the urinary tract
Therapeutic indications include the following:
Acute urinary retention [3] (eg, blood clots)
Chronic obstruction that causes hydronephrosis [4]
Initiation of continuous bladder irrigation
Intermittent decompression for neurogenic bladder
Hygienic care of bedridden patients
Traumatic injury to the lower urinary tract (eg, urethral tearing) is a contraindication for urethral catheterization in women.
Suspected bladder injury is not a contraindication to placement of a urethral catheter. A urethral catheter allows drainage of urine from an injured urinary bladder and provides a route for contrast administration during cystoscopy. Extraperitoneal urinary bladder injuries are usually treated conservatively with an indwelling catheter, whereas intraperitoneal urinary bladder injuries usually call for operative repair.
A larger than standard catheter should be used when the indication for placement is continuous bladder irrigation for hematuria and clots. A 3-way catheter (with an additional port) is often used in conjunction with a large-volume reservoir to create a “Murphy drip” for continuous irrigation.
Prophylactic antibiotics are recommended for patients with a prosthetic heart valve or an artificial urethral sphincter.
Consider suprapubic catheterization if vaginal hygiene is impaired.
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Hollingsworth JM, Rogers MA, Krein SL, Hickner A, Kuhn L, Cheng A, et al. Determining the noninfectious complications of indwelling urethral catheters: a systematic review and meta-analysis. Ann Intern Med. 2013 Sep 17. 159(6):401-10. [Medline].
Gil Z Shlamovitz, MD, FACEP Associate Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Chief Medical Information Officer, Keck Medicine of USC
Gil Z Shlamovitz, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association
Disclosure: Nothing to disclose.
Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Sexual Medicine Society of North America, Tennessee Medical Association
Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Endo, Avadel.
Andrew K Chang, MD Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center
Andrew K Chang, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
Luis M Lovato, MD Associate Clinical Professor, University of California, Los Angeles, David Geffen School of Medicine; Director of Critical Care, Department of Emergency Medicine, Olive View-UCLA Medical Center
Luis M Lovato, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.
Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Nothing to disclose.
Acknowledgments
The authors and editors of Medscape Reference gratefully acknowledge the assistance of Lars Grimm with the literature review and referencing for this article. They also thank Michel Rivlin, MD, and G Rodney Meeks, MD, for the videos and several of the images in this article.
Urethral Catheterization in Women
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