Presentation Authors: Nina Mikkilineni*, Michael Lipsky, Gen Li, David Weiner, Matthew Rutman, New York, NY
Introduction: Iatrogenic urethral injury due to unsuccessful Foley placement continues to be a serious, but preventable, problem. Urological Foley consultation, in select cases, is warranted but is not always the answer. The aim of our study was to detect differences between simple and difficult Foley consults in men and to identify areas for educational intervention.
Methods: We retrospectively reviewed urological catheter consults in men from 7/2016 to 9/2017. Consultation variables included time of year and consulting service (surgery vs non-surgery). Patient variables included age, known genitourinary (GU) diagnosis and/or surgery. Type of Foley placed and any urological trauma was recorded. Each consult was classified as &[Prime]simple&[Prime] (straightforward regular/coude) or &[Prime]difficult&[Prime] (difficult coude/wire/cystoscopy/suprapubic tube). T-test and Chi-square/Fisher&[prime]s Exact analysis was performed.
Results: We identified 276 men for which Foley consultation was placed. 216 patients (78.3%) were simple and 60 patients (21.7%) were difficult. The average age in both groups was 70 years old (p=0.97). There was no difference in prior GU diagnosis (62.7% vs. 63.3%, p=0.47). When comparing individual diagnoses, there remained no difference between groups. More patients in the difficult group had prior GU surgery (26.7% vs. 16.7%, p=0.12). When comparing individual surgeries, transurethral resection of bladder tumor was higher in the simple group (11.1% vs 0%, p < 0.001) and hypospadias/stricture repair was higher in the difficult group (25% vs 2.8%, p=0.009). There was no seasonal difference in simple vs difficult consults (p=0.88). Non-surgical teams placed more consults for simple catheters than surgical teams (80.6% vs 19.4%, p < 0.001). Urethral trauma was higher in the difficult group (46.7% vs 27.8%, p=0.009).
Conclusions: A majority of Foley catheter consults are &[Prime]simple,&[Prime] however, urologic consultation for catheterization may be warranted in patients with previous hypospadias/stricture repair. Surgical teams more often consulted for truly difficult catheterizations, perhaps due to increased familiarity with Foley placement compared to non-surgical colleagues. More trauma was documented with &[Prime]difficult&[Prime] catheterization likely related to multiple attempts in the face of a true obstruction. Therefore, additional urethral catheterization training for surgical, but especially non-surgical services (nurses and residents), should be targeted to not only prevent unnecessary consultation but to improve patient care while reducing harm.