Iatrogenic Urethral Injuries: A Comprehensive Guide to Prevention and Best Practices in Catheterization

Catheterisation is required for 12–16% of inpatients at any given time. The paramedical support crew, junior medical officers, or trainee intern doctors are typically the ones carrying out this treatment. Urethral catheter insertion is a common procedure done in hospital-admitted patients. Iatrogenic urethral injuries are one of the common preventable complications related to urological procedures. Patients with urethral injury present with frank bleeding from the urethra. The bleeding may sometimes be so severe that it may even occasionally present with urosepsis or hemodynamic instability. We describe a case of iatrogenic urethral injury post-catheterisation, following which the patient returned to the ER in shock with an incorrectly positioned catheter. The patient was resuscitated and managed with suprapubic diversion and a perineal compression tamponade. The patient recovered well and voided normally eventually. An orientation program outlining the techniques for catheterisation and the precautions to be taken before inflating the balloon and during catheter insertion is crucial to minimizing this potentially preventable morbidity since most catheterisations are performed by interns, the paramedical support team, or nursing staff. It is advisable to provide education to patients who require self-catheterisation due to detrusor underactivity or stricture urethra self-calibration. Patients who are paraplegic, and need regular bladder emptying have to exert greater caution, especially if the urethra is insensate. A few learning points are to be borne in mind before insertion of the catheter, which if properly followed, can minimize catheterisation-associated morbidity and ensure patient wellness. In order to reduce iatrogenic urethral injuries caused by catheterization, it is the duty of the urologists and senior surgeons to instruct the junior nursing staff and interns on urethral catheterization practices.