Incidence and prevention of iatrogenic urethral injuries.

PURPOSE: Although improper urethral catheter insertion is a source of preventable injury in male patients, to our knowledge the extent of this problem is not known. We studied the incidence and mechanism of iatrogenic urinary catheter injuries occurring in adult male inpatients at a single institution. We also designed and implemented an intervention to prevent these injuries.

MATERIALS AND

METHODS

This study was performed during a 13-month period. During months 1 through 6 all catheter related injuries in all adult male admissions to a single academic tertiary care center were prospectively tracked. Incidence data were calculated, injury severity was analyzed and the injury mechanism was identified. During month 7 based on injury mechanism data a nursing education program was designed and implemented by urology staff that included basic urological anatomy, urethral catheter insertion techniques and catheter safety. During months 8 through 13 catheter related injuries were again tracked. The incidences before and after intervention were compared.

RESULTS

During the pre-intervention period iatrogenic urethral catheter injuries occurred in 14 of 4,310 consecutive adult male admissions, representing an incidence of 3.2 injuries per 1,000 patients. Penile and/or perineal pain occurred in all 14 affected patients (100%) and penile bleeding occurred in 12 (86%). One patient required cystoscopy for catheter placement and 1 experienced recurrent urethral strictures requiring multiple dilations. During the post-intervention period a total of 3 injuries occurred in 4,523 consecutive patients, representing a statistically significant decrease in risk by a factor of 4.9 and an incidence rate of 0.7/1,000 adult male admissions (Fisher's exact test p = 0.006). Of the 3 post-intervention injuries 2 (67%) occurred in the operating room, an area that was not targeted as part of the intervention.

CONCLUSIONS

Iatrogenic urethral injuries are a substantial source of preventable morbidity in hospitalized male patients. Implementation of a nursing education program may significantly decrease the incidence of iatrogenic urethral injury and, thereby, improve patient safety.