Uro instruments- foley catheter

1. Dept of Urology
Govt Royapettah Hospital and Kilpauk Medical College
Chennai
1

2. Moderators:
Professors:
 Prof. Dr. G. Sivasankar, M.S., M.Ch.,
 Prof. Dr. A. Senthilvel, M.S., M.Ch.,
Asst Professors:
 Dr. J. Sivabalan, M.S., M.Ch.,
 Dr. R. Bhargavi, M.S., M.Ch.,
 Dr. S. Raju, M.S., M.Ch.,
 Dr. K. Muthurathinam, M.S., M.Ch.,
 Dr. D. Tamilselvan, M.S., M.Ch.,
 Dr. K. Senthilkumar, M.S., M.Ch.
Dept Of Urology, KMC and GRH, Chennai 2

3. HISTORY
 The earliest known record of catheterization is from
1500 BCE.
 Ancient Egyptians recorded the use of transurethral
bronze tubes, reeds, straws, and curled up palm trees
 There are references in the writings of Hippocrates
(400 BCE) to the use of malleable lead tubes used for
catheterization.
 Benjamin Franklin used a silver wire catheter to treat
his brother’s urinary retention from a bladder calculus
Later he himself used for bladder calculi.
Dept Of Urology, KMC and GRH, Chennai 3

4.  One of the most important advances in
catheterization was Jean Francois Reybard’s
invention of the self-retaining catheter in 1855.
 In 1929 Frederic Eugene Basil Foley a American
Urologist developed the modern balloon-based rubber
catheter with an inflatable rubber balloon.
 Silicone catheters were developed in 1968.
Dept Of Urology, KMC and GRH, Chennai 4

5. Jean Francois Reybard
Dept Of Urology, KMC and GRH, Chennai 5

6. Dept Of Urology, KMC and GRH, Chennai 6

7. Introduction
 A urinary catheter is a tube placed in the body to
collect urine from the bladder.
 Urinary catheters are available in variety of
 sizes (8 Fr–26 Fr),
 materials (latex,rubber,silicon coated,silicone,
PVC,PTFE),
 Tip types (Council, straight, coude tip),
 Number of ports/Lumens(single,double,triple,four)
Dept Of Urology, KMC and GRH, Chennai 7

8.  Size is usually measured in French catheter scale or
‘French units’ (Fr) or Charriere (Ch) which measures
the outside diameter of catheters (1 Fr is equivalent to
0.33 mm, or 1/77” of diameter).
 French also indicates the circumference in millimeter,
i.e. 16 Fr catheter has 16 mm circumference
(Circumference = p d = 3.14 × diameter = 3 ×
diameter).
 To vonvert French to mm,the number in french is
divided by 3.
 Sterilized by Gamma radiation
Dept Of Urology, KMC and GRH, Chennai 8

9. USES
DIAGNOSTIC
1. Children or females, may require catheterization of the urinary
bladder for sterile acquisition of urine for culture ,when there
is suspicion for contamination of the urine with clean-catch
specimens .
2. Admitted to the hospital for varying diagnoses such as acute
kidney injury or sepsis, catheterization is indicated for urine
output monitoring.
3. When lower urinary tract trauma is expected, catheterization
may be required for diagnosis of a urethral or bladder injury.
Dept Of Urology, KMC and GRH, Chennai 9

10. 4.For cystogram in to bladder and, into the fossa navicular
in retrograde urethrogram requires insertion of the
catheter.
5.Flexible and rigid cystoscopy are a form of lower urinary
catheterization and are used to diagnose various lower
urinary tract pathologies.
6.Urodynamics studies requires catheterization of the
bladder to measure postvoid residual, to fill the bladder
during measurement, and to insert the sensor catheter to
measure detrusor pressure.
7.To collect cytology when there is a suspicion of urothelial
cancer.
Dept Of Urology, KMC and GRH, Chennai 10

11.  THERAPEUTIC
1.Temporary catheterisation in retention of urine of cause
(BPH,Stricture,Trauma,Clots)
2. Long-term urethral catheterization is used for selected
patients with urinary retention and urinary incontinence
when other definitive treatment options are not possible .
3. setting of hematuria if continuous bladder irrigation is
required
4. Intravesical treatments such as Bacillus Calmette-Guérin
vaccine or mitomycin for bladder cancer or dimethyl
sulfoxide for interstitial cystitis .
Dept Of Urology, KMC and GRH, Chennai 11

12. 5.During major surgery to drain the bladder and monitor
urine output
6.Extraperitoneal bladder injury and selected cases of
intraperitoneal bladder injury are managed with
urethral catheterization.
7.Small vesicovaginal fistulas can also be managed
conservatively with urethral catheterization
8.Percutaneous cystostomy.
Dept Of Urology, KMC and GRH, Chennai 12

13. NON UROLOGICAL USES
1.Cholecystostomy
2.To drain the fistulas
3.Feeding gastro/jejunostomy
Dept Of Urology, KMC and GRH, Chennai 13

14. Contraindications
Absolute contraindication
1.a suspected or confirmed urethral injury .
2. a history of bladder neck closure or repair.
Relative contraindication
1.recent urethral surgery or urethral stricture (Thomsen and
Setnik, 2006).
2.Patient with Artificial Urinary Sphincter(AUS).If at all
catheterisation required deactivate the sphincter
completely before insertion. Try 12 Fr .
Dept Of Urology, KMC and GRH, Chennai 14

15. Classification
 Catheters can be classified as:
 1. Single-use (Nonindwelling).
 2. Indwelling (Foley) catheters.
Dept Of Urology, KMC and GRH, Chennai 15

16. Types of Urethral Catheters
Depending on retention mechanism
1. Simple catheter (Nonindwelling):
 Simple rubber catheter (K90 = 14 Fr, K91 = 10 Fr,
Teiman, female catheter, Nelaton catheter). K90, K91
are now available as R90 and R91.
 Metallic catheters, etc.
Dept Of Urology, KMC and GRH, Chennai 16

17. Non Indwelling Catheters
Red rubber catheter Nelaton Catheter Tieman female
Catheter
Dept Of Urology, KMC and GRH, Chennai 17

18. Nelaton Catheter sizes
Dept Of Urology, KMC and GRH, Chennai 18

19. 2. Self-retaining catheters:
 Balloon tip-Foley catheter
 Strapping catheter externally-Gibbons catheter
 Flower tip-Malecots catheter,De-pezzer catheter
 Pig tail catheter
Dept Of Urology, KMC and GRH, Chennai 19

20. De-Pezzers catheter Gibbons Catheter Malecots Catheter
Foley Catheter
Indwelling Catheters
Dept Of Urology, KMC and GRH, Chennai 20

21. Foley Catheters
 Foley catheter is a self-retaining catheter because of
balloon mechanism at the end, balloon connected to a
nozzle with a valve mechanism to the other end
through a small tube running through the wall of
catheter.
 Balloon capacity is mentioned on the side of nozzle
end.
Dept Of Urology, KMC and GRH, Chennai 21

22. Parts
Tip
Drainage
Eye
Balloon
Shaft
Inflation
Channel
Drainage
Funnel
Size(Fr)and
Balloon Capacity
Dept Of Urology, KMC and GRH, Chennai 22

23. Other contributions of Foley
Apart from the ‘all known’ Foley catheter the other
contributions that Foley is credited with are:
1. Foleys completely rotatable resectoscope.
2. A hydraulic cystolithotomy table.
3. Pressurized fluid delivery system.
4. A Canister which would inflate any balloon catheter.
5. A urethral sphincter device.
Dept Of Urology, KMC and GRH, Chennai 23

24. Catheter Sizing
 The clinician should first determine the
indication for catheterization and
 understand the anatomy of the patient’s urethra
based on age and history
Dept Of Urology, KMC and GRH, Chennai 24

25. Paediatric sizes
Dept Of Urology, KMC and GRH, Chennai 25

26. Colour Coding and Sizes
Balloon
Size cc
Length
cm
3 30
3 30
5-10 40
5-10 40
5-10 40
5-10 40
10–20 40
10–20 40
10–20 40
Dept Of Urology, KMC and GRH, Chennai 26

27. Types Of Foley Catheter
Based on type of material used:
1. Simple latex Foley catheter.
2. Siliconized latex Foley catheters (Silicolatex).
3. Silicone Foley catheters.
4.PTFE or PVC Catheters
5.Impregnated(Silver oxide ,Silver alloy,Hydrogel,silicone
elastomer)
Dept Of Urology, KMC and GRH, Chennai 27

28. Based on Use/Lumen
1. Single lumen Foley catheter(Drainage)
2. Double lumen Foley catheter(Inflation +Drainage)
3. Triple lumen Foley catheter(Inflation
+Drainage+Irrigation)
Also called Haematuria Catheters.
4.Four Lumen Foley catheters(Inflation
+Drainage+Irrigation+Simultaneous irrigation)
Dept Of Urology, KMC and GRH, Chennai 28

29. Single lumen Catheter Double lumen catheter
Triple Lumen Catheter Four lumen Catheter
Dept Of Urology, KMC and GRH, Chennai 29

30. 5.Diagnostic Catheters
a)The Lapides -has five radiopaque rings, each 1 cm
apart for calibration of female urethra length.
b)The Davis and Trattner catheters to diagnose
urethral diverticula in females.
Currently, MRI technology has likely replaced the
diagnostic method using these specialty catheters
c)Urodynamic catheters
Dept Of Urology, KMC and GRH, Chennai 30

31.  Davis Catheter
Lapides Catheter
Dept Of Urology, KMC and GRH, Chennai 31

32. Urodynamic Catheter
Dept Of Urology, KMC and GRH, Chennai 32

33. 6. Drain Catheters
Malecot catheters
Pezzer tube
7. Condom Catheters
Dept Of Urology, KMC and GRH, Chennai 33

34. Different Types of end Holes and Catheter Tips
These are the types of catheter tips:
1. Straight tip: This is the most common type.
2. The Delinotte tip (also called Mercier tip/Coude tip):
It is same as straight tip but with bent end for easy
passage through prostate.
3. The Couvelaire tip (also called the whistle tip): Helps
in easy passage of debris, clots from the bladder.
4. Dufour tip (combination of coude and whistle tip).
5. The Tiemann tip: Rigid slightly bent tip and bulbous
end for easy passage through prostate.
Dept Of Urology, KMC and GRH, Chennai 34

35. Dept Of Urology, KMC and GRH, Chennai 35

36. Latex Foley Catheter
 It may be made of
 Amber latex-Very soft ,flexible ,and durable
 Red Latex- Stiffer and Radio-opaque for observation
under flouroscopy.(Barium sulfate is added to amber
latex)
 Disadvantages
 Allergy
 Urethritis
Dept Of Urology, KMC and GRH, Chennai 36

37. Advantages of Coating
 Combining Silver alloy + Hydrogel
Hydrogel coating to minimize bacterial adherence.
• Preserves the body’s natural defenses by minimizing trauma to
urethral cells
• Reduces adherence of urinary tract infection (UTI) pathogens,
including Gram-positive bacteria, Gram-negative bacteria, and
yeasts
• Reduces the incidence of catheter associated urinary tract
infections (CAUTIs).
• Absorbs mucosal fluid to form a “cushion” between the catheter
surface and delicate urethral tissue, reducing friction and
irritation that can lead to infection
• Provides a surface that resists encrustation
Dept Of Urology, KMC and GRH, Chennai 37

38.  Hydrogel—Hydrophilic coating produces a
cushion of fluid between the catheter and the
mucosal lining of the urethra and the bladder.
• Reduces friction
• Increases biocompatibility
• Resistance to cell adhesion
• Less encrustation
• Less clot formation
Dept Of Urology, KMC and GRH, Chennai 38

39. Silicone Elastomer—
• Hydrophobic material that rejects moisture.
• Protects from irritation
• Smooth surface
• Permanent coating
Dept Of Urology, KMC and GRH, Chennai 39

40. Siliconized Latex Foley Catheters
 Have a silicon coating over latex, latex is supposed to be
irritant to the urothelium of the urinary tract leading to
micro-ulcerations and stricture.
 Some patients have allergy to latex too. To overcome above
drawbacks silicon coating was done over latex as former is
considered to be urothelium friendly.
 With time silicone layer may be damaged exposing
underlying latex, restricting their use for 2–3 weeks only,
needing removal or replacement after that.
Dept Of Urology, KMC and GRH, Chennai 40

41. Silicone Foley catheters
 Completely made of silicone and are costlier compared to
siliconized latex catheter.
 These catheters are often transparent but they also come in
white, blue, green and other colors.
 Main advantage is that they are less irritant, resistant to
wear and tear, less prone to encrustation and are more rigid
than siliconized latex catheters (easy passage in obstructive
prostate gland).
 The balloon when empty forms a slight thickening leading
to slight increase in external diameter by French or two
which may sometimes make passage difficult through
stricture. Because of inert nature they can be placed in
bladder for 6–8 weeks.
Dept Of Urology, KMC and GRH, Chennai 41

42. What trials say !!
 Numerous studies have been performed attempting to
compare patient outcomes based on catheter material or
coating. Three trials compared standard catheters with
silver oxide impregnated catheters. Pooling these trials
together still does not provide enough evidence to
recommend silver oxide catheters over the standard.
Several trials comparing silver alloy catheters to the
standard did show a significant decrease in asymptomatic
bacteriuria defined as greater than 105 colony-forming
units (Schumm and Lam, 2008). However, when using
symptomatic urinary tract infections (UTIs) as the primary
endpoint, no difference was found (Pickard et al., 2012)
Dept Of Urology, KMC and GRH, Chennai 42

43.  One trial showed that silicone catheters had a lower
incidence of reported urethral symptoms compared
with nonsilicone catheters (Kalambaheti, 1965), and
 another showed a decrease in urethritis diagnosed on
urethral swab when comparing silicone with latex
(Nacey et al., 1985).
Dept Of Urology, KMC and GRH, Chennai 43

44. Three-way Hemostatic Catheters
 Also called as three way catheters, they are specialized
Foley catheters, have an extra nozzle at the end connected
to an extra tube in the wall of the catheter that opens
distally to the balloon used for continuous irrigation.
 These catheters are often of a larger diameter (20–24 Fr)
which allows large debris to pass through the catheter.
 Catheter is reinforced with steel or nylon spiral meshed
inside the tube wall or some type of catheter are made up
of more rigid type of material, to prevent collapse when
suction is applied for removal of debris.
 Tip has a wide hole for removal of debris.
Dept Of Urology, KMC and GRH, Chennai 44

45. 3-Way Foley /Hematuria Catheters
 Large eyeholes in the hematuria catheters reduce the
risk of clots blocking the eye and funnel strength is
maximized to resist collapse during aspiration of clots.
Tiemann Catheter
 Tip is bulbous, coude and relatively rigid because of
the gentle curve it is easy to pass through the urethra.
Color code is same as Foleys.
Dept Of Urology, KMC and GRH, Chennai 45

46. Tiemann Catheter
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47. Complications
 Infection
 Encrustation
 Bleeding
 Stone Formation
 Blockage
 Erosion:urethra-iatrogenic hypospadiasis
 Malignancy-bladder cancer in spinal cord injury pt.
 Stricture
 Catheter knotting & Balloon malfunction
Dept Of Urology, KMC and GRH, Chennai 47

48. Failure To Deflate
 Failure of a foley balloon to deflate maybe caused by a
 1.Faulty valve mechanism
 2.Blockage of Inflation Channel
 3. Crystallisation of the fluid within the Balloon
Dept Of Urology, KMC and GRH, Chennai 48

49. What to do?
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50. What to do?
 Cut the balloon port and Pass a stiff end of guide wire through
port to puncture the balloon.
 Usg guided puncture of balloon using Intracath or Lumbar
puncture needle.
In males
 Suprapubic approach
 Per rectal approach
In Females
 Suprapubic approach
 Per rectal approach
 Transvaginal approach
After above cystoscopy should be preferred to be sure all
pieces of the balloon are retrieved.
Dept Of Urology, KMC and GRH, Chennai 50

51. Suprapubic Ultrasound Guided Puncture
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52. Dept Of Urology, KMC and GRH, Chennai 52

53. In females
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54. Dept Of Urology, KMC and GRH, Chennai 54

55.  Cystoscopy alongside the catheter with use of
cystoscopic needle or syringe to puncture the balloon
 Chemical disruption using chemicals (not preferred).
 Mineral oil ,
 chloroform,
 benzene,
 acetone,
 ether
 Hyper-inflate the balloon and break it (not preferred)
Dept Of Urology, KMC and GRH, Chennai 55

56. References
 1.Campbell – Walsh –Wein Urology ;12 Th edition .
 2.Urology Instrumentation A Comprehensive
Guide;Ravindra B Sabnis,Sujata K Patawardhan
,Arvind P Ganpule
Dept Of Urology, KMC and GRH, Chennai 56

57. THANKS
Dept Of Urology, KMC and GRH, Chennai 57