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Last updated: 02/17/2009
Phimosis is constriction of the prepuce (foreskin) so that it cannot be drawn back over the glans penis. This may make it difficult to identify the external urethral meatus. Care should be taken when catheterizing men with phimosis to avoid trauma...
from forced retraction of the prepuce or by incorrect positioning of the catheter.
Complications that may occur from a catheterization procedure include:
- Trauma or introduction of bacteria into the urinary system, leading to infection and, rarely, septicemia.
- Trauma to the urethra or bladder from incorrect insertion or attempting to remove the catheter with the balloon inflated. Repeated trauma may cause scarring or stricture (narrowing) of the urethra.
- Passage of urine around the catheter. Inserting a different catheter size can minimize this problem.
The presence of residual urine in the bladder due to incomplete voiding provides an ideal environment for bacterial growth.
Urinary catheterization should be avoided whenever possible. Clean intermittent catheterization, when practical, is preferable to long-term catheterization.
Catheters should not be routinely changed. Each man should be monitored for indication of obstruction, infection, or complications before the catheter is changed. Some men require daily or weekly catheter changes, while others may need one change in several weeks. Fewer catheter changes will reduce trauma to the urethra and reduce the incidence of UTI.
Because the urinary tract is normally a sterile system, catheterization presents the risk of causing a UTI. The catheterization procedure must be sterile and the catheter must be free from bacteria.
Frequent intermittent catheterization and long-term use of indwelling catheterization predisposes a man to UTI. Care should be taken to avoid trauma to the urinary meatus or urothelium (urinary lining) with catheters that are too large or inserted with insufficient use of lubricant. Men with an indwelling catheter must be reassessed periodically to determine if alternative treatment will be more effective in treating the problem.
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The male urethral orifice (urinary meatus) is a vertical, slit-like opening, 0.15–0.2 in (4–5 mm) long, located at the tip of the penis. The foreskin of the penis may conceal the opening. This must be retracted to view the opening to be able to insert a catheter. With proper positioning, good lighting, and gloved hands, these anatomical landmarks can be identified. Perineal care or cleansing may be required to ensure a clean procedural environment.
The male urethra is longer than the female urethra and has two curves in it as it passes through the penis to the bladder. Catheterization of the male patient is traditionally performed without the use of local anesthetic gel to facilitate catheter insertion. Glands along the urethra provide some natural lubrication. Older men may require lubrication. In such an instance, an anesthetic or antibacterial lubricant should be used.
Once the catheter is inserted, it is secured as appropriate for the catheter type. A straight catheter is typically secured with adhesive tape. An indwelling catheter is secured by inflating a bulb-like device inside of the bladder.
Other Information
Circumcision is a controversial topic, because there is so much misinformation and emotion included as fact; the facts are fairly straightforward and there are some definite biological advantages to circumcision.
-Gerald McMorrow
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