When does someone need a long term chronic urinary catheter?

I asked this question after meeting a patient with spinal cord injury who intermittently self-cathed who had repeated bouts of acute prostatitis. Would a long term Foley help him?

A urinary catheter is considered “chronic” when a patient maintains a need for a catheter >4 weeks.

Here are the two situations in which long term urinary catheter placement might be indicated:

  • inability to void urine
  • incontinence that affects daily function

These issues might be more common in people with underlying conditions:

  • spinal cord injury
  • cauda equina syndrome
  • multiple sclerosis
  • stroke
  • prostatic enlargement that cannot be surgically improved
  • pelvic surgery (such as hysterectomy, colectomy, etc)

Note: None of these are ABSOLUTE indications to place a long term catheter. Because long term catheters are associated with higher risk of infection, they should only be used when intermittent catheterization has not been working or the patient is unable to manage intermittent catheterization.

Unfortunately, there might be other reasons for my patient to have recurrent prostatitis, and a long term catheter would not necessarily help.

A related question is, how frequently do chronic indwelling catheters need to be exchanged? Medscape has an article on this; the conclusion is that it may be 2-6 weeks depending on the patient, and reasons to exchange are obstruction, either by encrustation or mucus, symptomatic infection, or leakage around the catheter. Catheters should NOT be exchanged unless there is a reason to do so–otherwise, patients are put at higher risk of infection.

* ** When assessing a patient with a chronic indwelling urinary catheter, ask yourself, what is the indication for this catheter? Would it be possible to remove it? Patients are not necessarily doomed to a catheter forever; they should be subjected to multiple trials of void if possible.

I also ran across a condition I’d never heard of before: Fowler’s Syndrome, an uncommon cause of urinary retention in younger (<30 years) women.

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