Choice of urinary catheters by duration

* Acute indications for urinary catheter placement include acute urinary retention, intraoperative or intensive care unit monitoring, and recent urologic procedures. Chronic indications include neurogenic bladder from spinal cord injury, urinary incontinence refractory to other treatments, and comfort or palliative care for immobilized patients. Refer to the UpToDate topic for a comprehensive list of indications.

¶ After 3 weeks, the need for a catheter should be reassessed. If longer catheterization is needed, alternatives to indwelling urethral catheters are generally preferred. Two exceptions are a distended bladder that requires decompression and need for intravesicular instillation of medications, which can be accomplished with a straight catheter.

Δ External catheters include condom sheath catheters for males and urinary pouches for males and females. Compared with internal catheters, external catheters afford more comfort, mobility, and avoid urethral trauma, but they cannot treat urinary retention. They can also cause penile or perineal irritation or ulceration.

◊ Clean intermittent catheterization is most commonly used for neurogenic bladder from spinal cord injury. It is generally thought to reduce complications compared with indwelling catheters, but data are notconclusive.

§ Compared with chronic urethral catheterization, suprapubic catheters incur fewer complications (eg, urethral stricture) and improve patient comfort, but they do require a procedure. Most patients initially choose urethral catheter; some change to suprapubic catheter over time.