Urinary catheters: history, current status, adverse events and research agenda

For more than 3500 years, urinary catheters have been used to drain the bladder when it fails to empty. For people with impaired bladder function and for whom the method is feasible, clean intermittent self-catheterization is the optimal procedure. For those who require an indwelling catheter, whether short- or long-term, the self-retaining Foley catheter is invariably used, as it has been since its introduction nearly 80 years ago, despite the fact that this catheter can cause bacterial colonization, recurrent and chronic infections, bladder stones and septicaemia, damage to the kidneys, the bladder and the urethra, and contribute to the development of antibiotic resistance. In terms of medical, social and economic resources, the burden of urinary retention and incontinence, aggravated by the use of the Foley catheter, is huge. In the UK, the harm resulting from the use of the Foley catheter costs the National Health Service between £1.0-2.5 billion and accounts for ∼2100 deaths per year. Therefore, there is an urgent need for the development of an alternative indwelling catheter system. The research agenda is for the new catheter to be easy and safe to insert, either urethrally or suprapubically, to be retained reliably in the bladder and to be withdrawn easily and safely when necessary, to mimic natural physiology by filling at low pressure and emptying completely without damage to the bladder, and to have control mechanisms appropriate for all users.

[A case of vesicourethral foreign body for catheterization by scallion: historical discussion about urethral catheter]

A 62 year old man with a spinal injury was referred to our hospital for removal of an impacted scallion that he had inserted into his urethra as a form of self-catheterization. We first attempted unsuccessfully to remove the scallion using a Kocher clamp. We then performed transurethral removal of the foreign body, that turned out to be a scallion 30 cm in length. In this paper, we present a case report of self-catheterization using scallions, as well as a history of the urethral catheter.

The Foley catheter

In the third of our biographical series tracing the origination of some of today's most commonly used surgical instruments and the people behind them, Professor Ellis explores the history of the catheter, and the breakthrough design by American urologist Frederick Foley.

THE CATHETER AND ITS USE FROM HIPPOCRATES TO GALEN

PURPOSE

We comprehensively reviewed the history and use of the bladder catheter in Western medicine from 500 BC to 200 AD.

MATERIALS AND METHODS

Greek and Latin texts were key word searched to identify descriptions of contemporary instruments and their uses.

RESULTS

The catheter and its use were mentioned by about 10 ancient authors in more than a total of 20 texts dating to the end of the second century AD. The authors include Hippocrates, Celsus, Soranus, Rufus, Aretaeus and Galen. They described the use of the instrument in reference to contemporary anatomy and physiology, and indications and contraindications in regard to certain conditions, such as urinary retention, bladder stones and intravesical blood clots. Technical details and particularities of use were also reviewed, as were pharmacological considerations and underlying physical principles.

CONCLUSIONS

Knowledge of the urinary catheter, and its usefulness and risks in ancient medicine can be dated from the 5th century BC. Our study of European texts documents its broad use. Because catheterization was perceived as a practical measure, it generated little scientific controversy.

The catheter and its use in late antiquity and the early middle ages

PURPOSE

Based on Greek and Latin sources the use of the urinary catheter in Western medicine between 200 and 1000 CE was reviewed.

MATERIALS AND METHODS

Computerized databank searches permitted the identification and analysis of ancient and early medieval texts that include material on the catheter.

RESULTS

Ten medical authors mentioned the catheter and its use. In the Byzantine world they include the encyclopedists Oribasius, Aetius and Paul of Aegina. The best known Latin author is Caelius Aurelianus. These writers often put together summaries of earlier works. Innovation or independent research was not easily found at a time during which neither anatomical autopsy nor experimentation was widely practiced.

CONCLUSIONS

Old texts contain numerous instructions on how to skillfully use the catheter. As a technical achievement, it was independent of philosophical trends. Its primary indications, namely urinary retention, bladder stones and the administration of cures, changed little with time. As one of the oldest and most important instruments at the disposal of physicians, the history of the catheter should be known to every urologist.

[The double-J ureteral catheter: its historical development and current status]

OBJECTIVE

To review the history of the development of the double-J ureteral catheter, a device that is necessary in current urological practice.

METHODS/RESULTS

A review of the literature shows that although there are references on the use of the ureteral catheter before 1967, the history of its development began in that year, when Zimskind and co-workers designed and used the first self-retaining catheter that was inserted cystoscopically. However, it was not until 1978 when the double-J shape was adopted following the design of Finney.

CONCLUSIONS

A review of the history of bioimplants development in the field of Urology shows that catheter design and its biomaterials have developed in parallel, in an attempt to create a device that functions well and one that is also well-tolerated by the body in order to reduce the catheter-related complications.

[A brief history of the application of urethral catheterization in ancient China]

Through analysing the ancient medical literatures, the author described the types and the history of urethral catheterization in ancient China and claims that, since urethral catheterization had been used in the Jin dynasty, Sun Simiao isn't the first doctor who used this technique.

The evolution and development of the urinary catheter

The urinary catheter is one of the most frequently used medical devices and has a long and intriguing history of development. This paper describes the catheter from its simple beginnings through the subtle but important changes it has undergone paralleling the advances in plastics technology witnessed this century. The changes have not been without controversy and the recent association of catheters with tissue toxicity, which has forced the implementation of strict guidelines for their manufacture and use, is described.

History of urethral catheters and their balloons: drainage, anchorage, dilation, and hemostasis

Male urethral catheterization, as practiced in early Greece, was made possible by a sound knowledge of anatomy. It has been preserved by written tradition and advanced by the development of new materials. Balloon dilation, conceived and practiced more than 160 years ago by urologists, has undergone a similar cycle. Some useful ideas, once conceived, have been forgotten and have surfaced again, decades, sometimes centuries, later as new inventions.

Third chapter of surgeons lecture: revolution in urology and its evolution in Singapore

Urology has been an evolving specialty since the time of Hippocrates. The itinerant surgeon was known to go from town to town to remove bladder stones in the early middle ages. In this century, urologists had been at the forefront in pioneering minimally invasive surgery with the introduction of transurethral resection of the prostate more than 50 years ago in the United States. This could be considered the first revolution in urology and this has influenced the evolution of urology in Singapore. Transurethral surgery had proved to be far superior to open surgery for most lesions of the lower urinary tract. This technique was introduced to Singapore in the early 1970s by Dr N E Wong. Because of the need for special instruments, skill and training, there was a need for a Department of Urology. This was not to be until after the second revolution in urology. The second revolution saw the introduction of endoscopic surgery of the upper urinary tract and Extra-corporeal Shockwave Lithotripsy in the early 1980s. This had truly revolutionised the treatment of urinary stones and today almost 95% of patients can be treated with these non to minimally invasive techniques. These new modalities of treatment were rapidly introduced in Singapore in the mid 1980s. The need for the establishment of urology as a specialty was more urgently felt. The Singapore Urological Association was formed in February 1986 and in March 1987, a Division of Urology was formed at the Singapore General Hospital.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cystoscopy and its importance in urology]

From the enumeration of modern endoscopic methods for diagnosis and treatment of urological disease, the characteristics of their value and their importance for modern urology becomes evident that by means of these methods, the basis of which was created 100 years ago with the introduction of the cystoscopy, examination and treatment became possible in all regions of the urinary tracts. Based on cystoscopy a subspeciality in urology developed, which might be called endoscopic surgery in urology. The endoscopic treatment methods are relatively atraumatic and loaded with a more insignificant complication rate than the open operative interventions. However, they demand an exact knowledge of the indications and contraindications. By the great possibilities which nowadays open the modern methods of endoscopic diagnostics and therapy we are indebted to their inventors still 100 years after the detection of the cystoscope, among the inventors German researchers and masters play an important role.