What is the role of catheterization in urinary incontinence treatment?

Updated: Sep 23, 2019
  • Author: Sandip P Vasavada, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Urinary diversion, using various catheters, has been one of the mainstays of anti-incontinence therapy. The use of catheters for bladder drainage has withstood the test of time. Bladder catheterization may be a temporary measure or a permanent solution for overflow incontinence. The use of a urethral catheter is contraindicated in the treatment of urge incontinence.

Catheterization is the only way to treat overflow incontinence. This is true whether the bladder has become decompensated as a result of a neurologic insult (areflexic detrusor) or from a mechanical source (atonic detrusor).

Self-catheterization is the preferred approach if the patient is able to perform it. Indwelling Foley catheters or a suprapubic tube is considered if a patient is not able to perform self-catheterization.

Some patients with overflow incontinence respond well to temporary continuous catheter drainage: their bladder capacity returns to normal, and voluntary detrusor pressure improves. Return of spontaneous voiding is more likely for patients without neurologic injury. This usually takes at least 1 week of catheter drainage, depending on the degree of bladder muscle injury. If overflow incontinence has not resolved after 4 weeks, then the bladder is unlikely to recover with catheter drainage alone.

If the underlying cause of the overflow problem can be treated or eliminated, these patients may be able to return to normal voiding. If this is unsuccessful, intermittent catheterization is usually preferred for long-term therapy if logistically possible. Otherwise, a permanent catheter may need to be considered.

Some patients respond well to temporary continuous Foley catheter drainage. Their bladder capacity returns to normal, and voluntary detrusor pressure improves. Return of spontaneous voiding is more likely for patients without neurologic injury. This usually takes at least 1 week of catheter drainage, depending on the degree of bladder muscle injury. If it has not resolved after 4 weeks, then the bladder is unlikely to recover using catheter drainage alone.

If the underlying cause of the overflow problem is bladder outlet obstruction, these patients may be able to return to normal voiding after relief of obstruction. If this is unsuccessful or not feasible, intermittent catheterization is usually preferred for long-term therapy if logistically possible. Otherwise, a permanent catheter may need to be considered.

Different types of bladder catheterization include indwelling urethral catheters, suprapubic tubes, and intermittent self-catheterization.


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