What methods can be used to clear a block in the urine passage in a BPH patient with a Foley catheter?

Management of Blocked Foley Catheter in BPH Patients

For BPH patients with a blocked Foley catheter, the recommended approach is to replace the catheter rather than attempting to clear the blockage, as catheter irrigation has not been shown to effectively reduce catheter-associated bacteriuria or prevent blockage. 1

Initial Management of Blocked Catheter

• Catheter replacement is the most effective method to address blockage in the urinary passage in BPH patients with indwelling catheters 1
• Routine catheter irrigation is not recommended as it is time-consuming and studies show it has no effect on reducing catheter-associated bacteriuria compared to normal saline 1
• Catheter blockage often results from encrustation formed by urease-producing organisms (particularly Proteus mirabilis) in the catheter biofilm 1

Special Considerations for Catheter Management

• Avoid adding antimicrobials or antiseptics to the drainage bag as this practice does not reduce catheter-associated bacteriuria or infection 1
• Maintain the closed drainage system to minimize the importance of the drainage bag as a source of bacteriuria 1
• Keep the drainage bag below the level of the bladder to prevent reflux of urine 1

Alpha Blocker Therapy for BPH Patients with Catheters

• Alpha blockers (tamsulosin, alfuzosin, doxazosin, or terazosin) should be administered prior to attempting catheter removal in patients with urinary retention 1, 2
• Non-titratable alpha blockers (tamsulosin or alfuzosin) are preferred and should be continued for at least 3 days before attempting catheter removal 2
• Alpha blockers significantly improve trial without catheter (TWOC) success rates (alfuzosin: 60% vs 39% for placebo; tamsulosin: 47% vs 29% for placebo) 2

Surgical Options for Recurrent Blockage

• Surgery is recommended for patients with refractory retention who have failed at least one attempt at catheter removal 1
• Transurethral Resection of the Prostate (TURP) is the gold standard surgical treatment for BPH with urinary retention 3
• For high-risk patients who are not surgical candidates, options include intermittent catheterization, indwelling catheter, or prostatic stent placement 1, 3
• Prostatic stents should be considered only in high-risk patients due to significant complications such as encrustation, infection, and chronic pain 1
• Balloon dilation is not recommended as a treatment option for BPH 1

Management of Catheter-Associated Complications

• Weekly monitoring of urine specimens may be necessary in patients with long-term catheterization, as 86% will have urease-positive bacterial species that can lead to catheter obstruction 1
• Suprapubic tubes (SPT) are the preferred chronic indwelling catheter option for long-term catheterization due to reduced likelihood of urethral damage 1
• SPTs may be preferred for individuals seeking to maintain capacity for sexual activity or those experiencing urethral discomfort with urethral catheters 1

Pitfalls and Caveats

• Avoid routine addition of antimicrobials or antiseptics to the drainage bag as this does not reduce catheter-associated bacteriuria or infection 1
• Avoid raising the drainage bag above the level of the bladder as this can facilitate bacterial entry into the bladder 1
• Avoid routine periodic change of indwelling urinary catheters to prevent catheter-associated bacteriuria and obstruction as this practice is not evidence-based 1
• Do not administer prophylactic antimicrobials at the time of catheter placement, removal, or replacement as this practice is not recommended 1