Severe Indwelling Urinary Catheter-Associated Urethral Erosion in Four Elderly Men
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Medical devices often are overlooked as a potential cause of pressure ulcers. Indwelling urinary catheters have been described as a cause of urethral erosion. In men, the resultant partial-thickness or full-thickness wound can involve a small area of the glans penis or cleave the glans or penile shaft, requiring reconstructive surgery or urinary diversion. During a 3-month period, four elderly men, all residing in one unit of a long-term care facility, were referred to the wound specialist for erosive urethral injuries. All were observed to have a history of improper securement of a rigid style silicone catheter. As part of creating a latex-free environment, the facility had recently replaced the (softer) latex-containing catheters with new silicone catheters. In addition to providing meticulous catheter care and comfort measures for the patients, all securement procedures were reviewed and different silicone catheters were evaluated for their potential to cause pressure ulcers. This case series highlights the importance of careful evaluation of catheter materials and securement devices before selecting them for widespread patient use and emphasizes the need for research focused on catheter composition and pressure injury risk.
Key Words: urinary catheters, silicone, complication, urethral erosion, pressure
Index: Ostomy Wound Management 2010;56(12):36–39
Potential Conflicts of Interest: none disclosed
Incontinence rates are high among older patients and incontinence remains the primary reason for admission to long-term care (LTC) facilities.1 Incontinence increases the risk for perineal dermatitis, pressure ulcers, hip fractures, and falls. In an effort to reduce comorbid conditions, an indwelling urinary catheter may be placed.2 Despite the known complications of long-term catheter use (bacteremia, urinary tract infection, sepsis, and death), for many elderly LTC residents this may be the only intervention that will preserve skin health and maintain comfort and dignity.3
Pressure ulcers most often are associated with skin breakdown over bony prominences due to unrelieved pressure; less commonly, they are associated with medical devices.4 In practice, medical devices often are overlooked as a potential cause of pressure and research on pressure ulcers caused by the use of medical devices is scant. In one study, Davis et al5 reported that 33% of 90 medical patients wearing cervical collars for stabilization sustained a pressure ulcer in less than 5 days. Although medical devices are commonly used in both acute care and LTC, pressure ulcer statistics often do not differentiate source of pressure.4
An uncommon complication of urinary catheterization is severe urethral erosion, noted in the literature as a known but rare consequence of indwelling catheter use in spinal cord injured patients of both genders.6-8 LeBlanc and Christensen3 addressed nursing care issues such as catheter care and pain control associated with urethral erosion in elderly men in the LTC setting; otherwise, information about this type of pressure ulcer is scarce in the literature.
Urethral erosion in men ranges from a partial-thickness wound involving a small area of the glans penis to a full-thickness pressure ulcer, or erosion, cleaving the glans or penile shaft (see Figure 1). In extreme cases, gangrene of the penis can result.