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INTRODUCTION

The first recorded bladder catheterization was by Oribasius of Pergamon (325–403 AD) in a description of a fistula surgery. Philip Syng Physick tied Chief Justice Marshall to the bed and introduced instruments through a bladder catheter to break up bladder stones. August Mercer developed the coudé catheter in 1863. The bend near the tip, known as an elbow in French, made passage in a stenosed urethra easier. The current Foley catheter was developed in the 1930s by Urologist Frederick Foley. There have been no major changes in the Foley catheter in over 90 years.

Urethral catheterization is the most frequent retrograde manipulation of the urinary tract. It is routinely performed for diagnostic and therapeutic reasons in both urologic and nonurologic diseases.1-11 Catheters may be inserted as an in-and-out procedure for immediate drainage, left in place with a self-retaining device for short-term drainage, or left indwelling for long-term drainage.6,7 Although this is one of the more routinely performed procedures in the Emergency Department, great care must be taken to avoid lower urinary tract injury, reduce the introduction of infection, and minimize patient discomfort. The basic principles underlying urethral catheterization are gender neutral.6,7 It is important to respect the patient’s need for modesty and privacy as much as possible.

ANATOMY AND PATHOPHYSIOLOGY

The genitourinary system is frequently divided into upper and lower urinary tracts. The former refers to the kidneys and ureters, or those structures above the bony pelvis. The lower urinary tract includes the bladder and urethra, or those structures contained within or below the bony pelvis. Although the entire urinary tract may be catheterized, it is the lower tract, namely the urethra, that will be the focus of this chapter.

Averaging 4 cm in length, the female urethra is rarely a focus of difficulty. Most of the confusion related to urethral catheterization in the female results from poor anatomic knowledge of the external genitalia (Figure 173-1). The clitoris is often mistaken for the urethral meatus. This can result in catheter-related trauma, bleeding, patient discomfort, and frustration on the part of the patient and the person inserting the catheter. After lateral retraction of the labia minora and exposure of the vaginal vault, the cephalad-most structure is the clitoris. Traveling in a caudal direction, the orifices encountered are the urethra, the vagina, and then the anus.

FIGURE 173-1.

External anatomy of the female genitourinary tract.

The male urethra is most often the site of catheter-associated difficulty.3 The male urethra may extend upward of 20 cm in length and follows a tortuous course. The male urethra is named based on the anatomic structure with which it traverses or travels. The distal-most portion of the male urethra is the meatus, followed proximally by the penile, ...

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