Management of Split Urethral Meatus from Foley Catheter
Immediately remove the traumatic catheter and place a suprapubic tube for urinary drainage, followed by urgent urology consultation for surgical repair of the meatal laceration. 1
Immediate Actions
Remove the offending catheter immediately to prevent further injury to the urethral meatus and surrounding tissue. 1 Do not attempt to reinsert another urethral catheter, as repeated catheterization attempts increase the extent of injury and delay appropriate drainage. 1
Establish urinary drainage via suprapubic tube (SPT), which is the preferred method for patients with significant urethral trauma including meatal splitting. 1 This can be placed percutaneously or via open technique depending on clinical circumstances and local expertise. 2
Assessment of Injury Severity
Obtain retrograde urethrography if there is concern for injury beyond the meatus, such as difficulty with initial catheterization, suspicion of deeper urethral trauma, or associated pelvic trauma. 1 The study is performed by introducing a catheter into the fossa navicularis, placing the penis on gentle traction, and injecting contrast material. 1
Look for signs suggesting more extensive urethral injury:
- Blood at the urethral meatus 1, 2
- Inability to pass a catheter easily 1
- Perineal ecchymosis 3
- Associated pelvic fracture 3, 2
Definitive Management
Obtain urgent urology consultation for all patients with meatal splitting from catheter trauma. 1 This is not a minor injury that can be managed conservatively.
Meatal lacerations typically require surgical repair to prevent meatal stenosis and ensure proper healing. 1 The urologist will perform exploration and limited debridement of non-viable tissue with primary closure when possible. 1
Common Pitfalls to Avoid
Never attempt repeated urethral catheterization after recognizing meatal trauma, as this worsens the injury. 1 Catheter-related genitourinary trauma requiring intervention is as common as symptomatic urinary tract infection (0.5% vs 0.3% of catheter days) and deserves equal clinical attention. 4
Do not underestimate the severity of meatal splitting—this represents significant trauma that can lead to meatal stenosis if not properly repaired. 1
Avoid placing small-caliber SPT catheters that will require upsizing later, especially if hematuria is present or prolonged use is anticipated. 2