Urinary Catheterization - Sex Differences

Sex Differences

In males, the catheter tube is inserted into the urinary tract through the penis. A condom-type catheter, if used, (fits around the tip of the penis, rather than being inserted). A urisheat or Texas catheter can also be used. In females, the catheter is inserted into the urethral meatus, after a cleansing using povidone-iodine. The procedure can be complicated in females due to varying layouts of the genitalia (due to age, obesity, female genital cutting, childbirth, or other factors), but a good clinician would rely on anatomical landmarks and patience when dealing with such a patient. In the UK it is generally accepted that cleaning the area surrounding the urethral meatus with 0.9% sodium chloride solution is sufficient for both male and female patients as there is no reliable evidence to suggest that the use of antiseptic agents reduces the risk of urinary tract infection. Males may have a slightly higher incidence of bladder spasms. If bladder spasms occur, or there is no urine in the drainage bag, the catheter may be blocked by blood, thick sediment, or a kink in the catheter or drainage tubing. Sometimes spasms are caused by the catheter irritating the bladder, prostate, or penis. Such spasms can be controlled with medication such as butylscopolamine, although most patients eventually adjust to the irritation and the spasms go away.

Common indications to catheterize a patient include acute or chronic urinary retention (which can damage the kidneys), orthopedic procedures that may limit a patient's movement, the need for accurate monitoring of input and output (such as in an ICU), benign prostatic hyperplasia, incontinence, and the effects of various surgical interventions involving the bladder and prostate.

For some patients the insertion and removal of a catheter causes excruciating pain, so a topical anesthetic is used. Catheterization would be performed as a sterile medical procedure by trained, qualified personnel, using equipment designed for this purpose, except in the case of intermittent self-catheterization where patients have been trained to perform the procedure themselves. Intermittent self-catheterization is performed by the patient four to six times a day, using a clean technique in most cases. Nurses use a sterile technique to perform intermittent catheterization in hospital settings. Incorrect technique may cause trauma to the urethra or prostate (male), urinary tract infection, or a paraphimosis in the uncircumcised male. For patients with spinal cord lesions and neurogenic bladder dysfunction, intermittent catheterisation (IC) is a standard method for bladder emptying. The technique is safe and effective and results in improved kidney and upper urinary tract status, lessening of vesicoureteral reflux and amelioration of continence (Hedlund et al., 2001). In addition to the clinical benefits, patient quality of life is enhanced by the increased independence and security offered by self-catheterization (Lapides et al., 1972).