What is the best course of treatment for a patient with a split meatus (urethral meatus) caused by a Foley catheter (indwelling urinary catheter)?

Management of Split Urethral Meatus from Foley Catheter

Immediately remove the Foley catheter, establish alternative urinary drainage (preferably suprapubic tube), and consult urology for definitive repair. 1

Immediate Actions

Remove the traumatic catheter without delay to prevent further injury to the urethral meatus and surrounding tissue. 2, 3 Continued catheterization through a split meatus will worsen the laceration and increase the risk of complete urethral disruption. 1

Establish Alternative Drainage

• Place a suprapubic tube (SPT) as the preferred method for urinary drainage in patients with significant urethral trauma, including meatal splitting. 1
• SPT can be placed percutaneously or via open technique depending on clinical circumstances and available expertise. 1
• Avoid repeated attempts at urethral catheterization, as this increases injury extent and delays appropriate drainage. 1, 4

Assessment of Injury Severity

Perform retrograde urethrography if there is concern for injury beyond the meatus (blood at meatus, inability to pass catheter easily, or suspicion of deeper urethral trauma). 1, 5, 4

• If blood is present at the urethral meatus after catheter removal, retrograde urethrography is mandatory to identify the full extent of urethral injury. 1, 4
• The study is performed by introducing a 12Fr Foley catheter or catheter-tipped syringe into the fossa navicularis, placing the penis on gentle traction, and injecting 20 mL undiluted water-soluble contrast material. 1

Definitive Management

Obtain urgent urology consultation for all patients with meatal splitting from catheter trauma. 5, 2

• Meatal lacerations typically require surgical repair to prevent meatal stenosis and ensure proper healing. 1
• Exploration and limited debridement of non-viable tissue should be performed by a urologist, with primary closure when possible. 1
• Early surgical intervention prevents complications including infection, stricture formation, and chronic meatal stenosis. 1, 3

Common Pitfalls to Avoid

• Never attempt to reinsert a urethral catheter through a split meatus, as this will convert a partial injury into a complete disruption. 1, 2
• Do not perform blind catheter passage when urethral injury is suspected—always obtain imaging first unless exceptional circumstances require emergent drainage. 1
• Catheter-related genitourinary trauma requiring intervention is as common as symptomatic urinary tract infection (0.5% vs 0.3% of catheter days), yet receives far less clinical attention. 3
• Avoid small-caliber percutaneous SPT catheters if hematuria is present or prolonged use is anticipated, as these will require upsizing. 4

Prevention Considerations

• Use the smallest appropriate catheter size (14-16 Fr) to minimize urethral trauma in future catheterizations. 5
• Ensure adequate lubrication and gentle technique during all catheter insertions. 1
• Remove catheters as soon as clinically appropriate to prevent ongoing trauma and complications. 5, 2