Catheter-Associated Meatal Damage in Hospitalized Males
Urethral stress ulcer has a documented prevalence of 5% in patients with an indwelling catheter, in the scarce existing literature. Clinical guidelines suggest that if an indwelling catheter cannot be avoided, it should be fixated to the patient's body using a fixation device in order to prevent catheter traction and pressure on the urethral meatus. The objective of this work was to appraise the prevalence of this complication and assess the risk factors involved in its formation.
In this cross-sectional study, a whole-institutional survey was conducted at two time points. The survey included a physical assessment of all patients with an indwelling catheter during hospitalization, as well as collection of clinical data from patient files and staff interviews. We analyzed the possible risk factors contributing to meatal ulcers using univariate and multivariate analyses, including existence and grade of meatal injury, patient mobility, catheter indication, duration of catheter presence, mode of catheter fixation, and patient comorbidities.
268 patients were found to carry an indwelling catheter, 168 of them were male. The male patients' median age was 70.5 (interquartile range: 57-80.3) years, and the median duration of catheter presence was 5.5 (interquartile range: 2-11) days. 86% of the catheters were introduced during hospitalization. The common indications for catheter insertion were urine output monitoring (58%), post-surgical status (20%) and urinary retention (14%). In a univariate model including postulated risk factors, a longer duration of catheter presence (p=0.001), patient immobility (p=0.025), internal ward hospitalization (p=0.045) and other skin ulcers (p=0.008) were all predictors of meatal and urethral damage, while catheter fixation (p=0.041) and a post-operative indication (p=0.037) were associated with reduced meatal and urethral damage. In a multivariate analysis, duration of catheter presence (p=0.017) and lack of catheter fixation (p=0.006) were significantly associated with meatal damage, with a trend for other skin ulcers (p=0.052).
Meatal damage is a common, preventable complication of indwelling catheters in males. Catheter fixation may have a preventative effect on this phenomenon. Longitudinal studies are needed to establish evidence-based guidelines on this matter.