From the Guidelines
Dysuria with a Foley catheter is most commonly caused by urinary tract infections, which can be prevented by removing the catheter as soon as possible, ideally within 48 hours, as recommended by the 2005 guideline on management of adult stroke rehabilitation care 1. The catheter itself can also mechanically irritate the urethral lining, while bladder spasms occur as the bladder muscle contracts against the catheter balloon. Some key points to consider in the management of dysuria with a Foley catheter include:
- Ensuring proper catheter size (typically 14-16 Fr for adults) and adequate lubrication during insertion to minimize urethral irritation
- Maintaining a closed drainage system to reduce the risk of infection
- Considering the use of silver alloy–coated urinary catheters, which may help reduce the risk of urinary tract infection, as suggested by the 2005 guideline 1
- Removing the catheter as soon as possible to avoid increased risk of urinary tract infection, as the risk of urinary tract infection from an indwelling catheter increases by about 5% per day, according to the 2014 geriatric emergency department guidelines 1 For bladder spasms, anticholinergic medications like oxybutynin (5mg twice daily) or tolterodine (2mg twice daily) may provide relief. If infection is suspected, urine culture should be obtained and appropriate antibiotics prescribed based on sensitivity results. Phenazopyridine (200mg three times daily for 2 days) can temporarily relieve urethral discomfort. Adequate hydration helps dilute urine and reduce irritation. These symptoms typically resolve after catheter removal, but persistent dysuria warrants further evaluation to rule out complications like traumatic insertion injury or catheter encrustation.
From the Research
Causes of Dysuria with Foley Catheter
- Dysuria, or painful urination, is a common symptom associated with catheter-associated urinary tract infections (CAUTIs) 2, 3, 4, 5, 6
- The use of a Foley catheter can increase the risk of developing a CAUTI, which can lead to dysuria 2, 3, 4, 5, 6
- The pathophysiology of CAUTIs involves the introduction of bacteria into the urinary tract through the catheter, which can lead to infection and inflammation 4
- Risk factors for CAUTIs, and subsequently dysuria, include repeat catheterization, longer use of antibiotics, and improper catheter care 6
Mechanisms of CAUTIs
- CAUTIs can be caused by a variety of microorganisms, including Gram-positive bacteria, Gram-negative bacteria, and fungi 6
- The differential mechanisms used by uropathogens to cause CAUTIs involve adherence to the catheter surface, biofilm formation, and evasion of the host immune response 4
- Understanding the epidemiology, pathogen prevalence, and differential mechanisms of CAUTIs is crucial for developing effective treatment and prevention strategies 4, 5
Prevention and Treatment of CAUTIs
- Proper urethral catheterization and alternatives to indwelling catheters can help reduce the risk of CAUTIs 2
- Techniques to avoid CAUTIs include using sterile equipment, ensuring proper catheter care, and minimizing the duration of catheter use 2, 3
- Treatment of CAUTIs typically involves antibiotics, and novel diagnostic strategies and treatment decision aids are being developed to improve antibiotic accuracy and stewardship 5