Urinary catheterization and techniques for preventing hematuria: integrative review

Meira, Aline de Sousa; Lima, Gabriella Santos; Figueira, Ana Laura Galhardo; Silveira, Renata Cristina de Campos Pereira; Kusumota, Luciana

doi:10.37689/acta-ape/2024AR00012722

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Review Article • Acta Paul Enferm 37 • 2024 • https://doi.org/10.37689/acta-ape/2024AR00012722 copy

Urinary catheterization and techniques for preventing hematuria: integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

Analyze and synthesize the available scientific evidence on urinary catheterization and techniques used to prevent hematuria in bladder emptying and acute and chronic urinary retention in adults and the elderly.

Methods

This integrative review was carried out in the PubMed, LILACS, Embase, Cochrane, Web of Science, and Scopus databases. Hand searching was used in the reference lists of included studies. An unlimited period was used to review the studies published in Portuguese, English, French, German, and Spanish. The PICOS strategy was applied to develop the research question and the Joanna Briggs Institute (JBI) instrument was used to assess the methodological quality of studies.

Results

Eleven studies were included, with a total of 659 patients. Urinary retention occurred mainly in men and the main cause was benign prostatic hyperplasia. Rapid and gradual decompressions were the techniques used for bladder decompression by urinary catheterization, and hematuria and hypotension were the main complications regardless of the technique. The results showed that there was no significant difference between the two techniques in terms of the outcome of hematuria prevention.

Conclusion

Gradual bladder emptying does not prevent hematuria compared to rapid and complete emptying. Case reports describe clinical conditions that deserve attention when hematuria occurs after urinary catheterization and the respective implications in the treatment of patients. We highlight the importance of nursing in identifying and preventing the diagnosis of Urinary Retention to avoid subsequent interventions and clinical complications, including post-catheterization hematuria.

Urinary retention; Urinary catheterization; Urinary bladder; Hematuria


Pubmed: (“bladder catheterization”[All Fields] OR “bladder catheterizations”[All Fields] OR “urinary catheterization”[All Fields] OR “Urinary Catheterizations”[All Fields] OR “Ureteral Catheterizations”[All Fields] OR “Ureteral Catheterization”[All Fields] OR “Urethral Catheterizations”[All Fields] OR “Urethral Catheterization”[All Fields] OR “Foley Catheterization”[All Fields] OR “bladder catheterisation”[All Fields] OR ((“bladder s”[All Fields] OR “urinary bladder”[MeSH Terms] OR (“urinary”[All Fields] AND “bladder”[All Fields]) OR “urinary bladder”[All Fields] OR “bladder”[All Fields] OR “bladders”[All Fields]) AND (“catheterisation”[All Fields] OR “catheterization”[MeSH Terms] OR “catheterization”[All Fields] OR “catheterisations”[All Fields] OR “catheterising”[All Fields] OR “catheterism”[All Fields] OR “catheterisms”[All Fields] OR “catheterise”[All Fields] OR “catheterised”[All Fields] OR “catheterizations”[All Fields] OR “catheterize”[All Fields] OR “catheterized”[All Fields] OR “catheterizing”[All Fields])) OR ((“decompress”[All Fields] OR “decompressed”[All Fields] OR “decompresses”[All Fields] OR “decompressing”[All Fields] OR “decompression”[MeSH Terms] OR “decompression”[All Fields] OR “decompressions”[All Fields] OR “decompressive”[All Fields]) AND (“urinary tract”[MeSH Terms] OR (“urinary”[All Fields] AND “tract”[All Fields]) OR “urinary tract”[All Fields] OR “urinary”[All Fields])) OR “bladder decompression”[All Fields] OR (“decompress”[All Fields] OR “decompressed”[All Fields] OR “decompresses”[All Fields] OR “decompressing”[All Fields] OR “decompression”[MeSH Terms] OR “decompression”[All Fields] OR “decompressions”[All Fields] OR “decompressive”[All Fields])) AND (“haematuria”[All Fields] OR “hematuria”[MeSH Terms] OR “hematuria”[All Fields] OR “haematurias”[All Fields] OR “hematurias”[All Fields] OR (“haematuria”[All Fields] OR “hematuria”[MeSH Terms] OR “hematuria”[All Fields] OR “haematurias”[All Fields] OR “hematurias”[All Fields])).
Lilacs: (“bladder catheterization” OR “bladder catheterizations” OR “urinary catheterization” OR “Urinary Catheterizations” OR “Ureteral Catheterizations” OR “Ureteral Catheterization” OR “Urethral Catheterizations” OR “Urethral Catheterization” OR “Foley Catheterization” OR “bladder catheterisation” OR “bladder catheterisations” OR “decompression urinary” OR “bladder decompression” OR decompression) AND (hematuria OR haematuria) AND (db:(“LILACS”)). (“Cateterismo Urinário” OR “Vejiga Urinaria” OR Descompresión) AND (hematúria).
Embase: (‘bladder catheterization’:ti,ab,kw OR ‘bladder catheterizations’:ti,ab,kw OR ‘urinary catheterization’:ti,ab,kw OR ‘urinary catheterizations’:ti,ab,kw OR ‘ureteral catheterizations’:ti,ab,kw OR ‘ureteral catheterization’:ti,ab,kw OR ‘urethral catheterizations’:ti,ab,kw OR ‘urethral catheterization’:ti,ab,kw OR ‘foley catheterization’:ti,ab,kw OR ‘bladder catheterisation’:ti,ab,kw OR ‘bladder catheterisations’:ti,ab,kw OR ‘decompression urinary’:ti,ab,kw OR ‘bladder decompression’:ti,ab,kw OR decompression:ti,ab,kw) AND (hematuria:ti,ab,kw OR haematuria:ti,ab,kw).
Cochrane Library: (“bladder catheterization” OR “bladder catheterizations” OR “urinary catheterization” OR “Urinary Catheterizations” OR “Ureteral Catheterizations” OR “Ureteral Catheterization” OR “Urethral Catheterizations” OR “Urethral Catheterization” OR “Foley Catheterization” OR “bladder catheterisation” OR “bladder catheterisations” OR “decompression urinary” OR “bladder decompression” OR decompression) AND (hematuria OR haematuria) in Title Abstract Keyword - (Word variations have been searched).
Web of science: TÓPIC: ((«bladder catheterization» OR «bladder catheterizations» OR «urinary catheterization» OR «Urinary Catheterizations» OR «Ureteral Catheterizations» OR «Ureteral Catheterization» OR «Urethral Catheterizations” OR “Urethral Catheterization” OR “Foley Catheterization” OR “bladder catheterisation” OR “bladder catheterisations” OR “decompression urinary” OR “bladder decompression” OR decompression) AND (hematuria OR haematuria)) Tempo estipulado: Todos os anos. Índices: SCI-EXPANDED, SSCI, A&HCI, CPCI-S, CPCI-SSH, ESCI.
Scopus: TITLE-ABS-KEY ((“bladder catheterization” OR “bladder catheterizations” OR “urinary catheterization” OR “Urinary Catheterizations” OR “Ureteral Catheterizations” OR “Ureteral Catheterization” OR “Urethral Catheterizations” OR “Urethral Catheterization” OR “Foley Catheterization” OR “bladder catheterisation” OR “bladder catheterisations” OR “decompression urinary” OR “bladder decompression” OR decompression ) AND ( hematuria OR haematuria ).

Authors / Years / Countries	Objectives	Methodological designs	Main Results / Conclusions	Levels of evidence
Ahmed et al. 2013.⁽²²⁾ Nigeria	To determine the safety and effectiveness of the rapid and complete bladder decompression technique in chronic urinary retention.	Type: observational and prospective study. Sample: 22 male patients with chronic urinary retention. Mean Age: 53 years old. Techniques Used: Rapid decompression.	Hematuria occurred in 54.4% of cases. Benign Prostatic Hyperplasia was the primary cause of Urinary Retention in 45.5% of patients. Urinary catheterization was performed in 72.7% of patients; the others were not catheterized as they had suprapubic cystostomy. Mean volume drained: 1,500 ml.	VI
Boettcher et al. 2013.⁽²³⁾ Alemanha	Quantify and compare the risks of Rapid (RD) and Gradual (DG) Decompression bladder complications in patients with acute and chronic urinary retention.	Type: Prospective randomized clinical study. Sample: 294 male patients with acute and chronic urinary retention. Mean age: 72.5 years. Techniques used: Rapid and gradual decompression.	In the gradual and rapid decompression groups, hematuria occurred in 16 (11.3%) and 16 (10.5%) patients, respectively, with no statistically significant difference (p=1). In the gradual and rapid decompression groups, a drop in blood pressure (146/84 and 142/82 mmHg, respectively) was also observed after decompression. Mean volumes drained: 1,260.9Ml and 1,089mL (gradual and rapid decompression, respectively).	II
Bristoll et al. 1989.⁽²⁴⁾ USA	To investigate how complete and clamped drainage affects blood pressure, pulse, and blood loss in catheterized patients with urinary retention.	Type: Randomized Clinical Study. Sample: Six patients with urinary retention. Age: not described in the study. Techniques Used: Rapid and gradual decompressions.	Blood traces were found in the urine sample of a patient in the rapid and complete decompression group. However, no result resulted in clinical complications. Drained Volume: 1,050-1,950 mL.	II
Christensen et al. 1987.⁽²⁵⁾ Denmark	Investigate changes in intravesical and arterial pressures during continuous or fractionated bladder drainage.	Type: Non-randomized clinical study. Sample: 10 male patients. Mean age: 74.5 years. Techniques Used: Rapid and gradual decompressions. Mean Drained Volume: 1,125 mL.	Only one patient presented mild and transient hematuria. Intravesical pressure fell by 50% of the initial value after eliminating 100 mL of urine. Blood pressure decreased after bladder decompression (p≤0.05). Mean Drained Volume: 1,125 mL.	III
Etafy et al. 2017.⁽²⁶⁾ USA	Compare rapid versus gradual bladder decompression in patients with acute RU to demonstrate benefits.	Type: Randomized Clinical Study. Sample: 62 patients with acute Urinary Retention diagnosed with Benign Prostatic Hyperplasia. Mean Ages: 64.4 and 63.2 years in the rapid and gradual decompression groups, respectively. Techniques Used: Rapid and gradual decompressions.	Hematuria occurred in the rapid decompression group (two patients) but not in the gradual decompression group; no significant difference (p=0.97). After rapid and gradual decompressions, drops occurred in mean arterial pressure (15 and 10 mmHg, respectively). Mean volumes drained: 1,119 and 1,074 mL in the rapid and gradual decompression groups, respectively.	II
Gabriel; Suchard, 2017.⁽²⁷⁾ USA	Describe the case of a patient with urinary retention and the presence of hematuria after urinary catheterization.	Type of Study: Case report. Sample: A male patient. Age: 52 years old. Techniques Used: Rapid decompression.	The patient developed macroscopic hematuria 3 h after the procedure. The authors concluded that severe hematuria may occur rarely although evidence exists that rapid decompression is safe. Drained Volume: 2,000 mL.	VII
Glahn; Plucnar 1984.⁽²⁸⁾ Denmark	Investigate the occurrence of hematuria.	Type: observational and prospective study. Sample: 260 patients; 215 (82.69%) men and 45 (17.3%) women. Mean age: 62 years old. Technique Used: Rapid decompression.	Hematuria occurred in 49 (16.3%) patients, with cases of mild (37; 75.5%), moderate (10; 20.4%), and severe (2; 4.1%) hematuria. In the second case, hematuria occurred for 24 h in a male patient; 2,000 mL of urine was drained; later, the patient was diagnosed with bladder stones and a clotting disorder. Drained Volume: <500 mL and >2,000 mL.	VI
Klamfoth; Burtson, 2022.⁽²⁹⁾ USA	Present the case and highlight the severity of post-obstructive diuresis and decompressive hematuria in the scenario of chronic urinary retention secondary to Benign Prostatic Hyperplasia.	Type of Study: Case Report Sample: Male patient Age: 73 years old Technique Used: Rapid decompression.	One hour after catheterization, the patient presented significant hematuria, post-obstructive diuresis, and hypotension. He received a blood transfusion, bladder irrigation, instillation of antifibrinolytics, and electrolyte replacement. Drained Volume: 5,900 mL.	VII
Knapp; Apgar; Pennell 2022.⁽³⁰⁾ USA	Explore the potentially fatal complications of urinary retention and bladder decompression.	Type of Study: Case Report. Sample: Male patient. Age: 57 years old. Technique Used: Gradual decompression.	The catheter was clamped with 1,000 mL of drained urine. The catheter was unclamped after urology guidance. The patient presented hematuria, and the hemoglobin level dropped from 10.1 to 5.7 ml/dl. The patient received a red blood cell concentrate and intravenous volume infusion and underwent bladder irrigation and surgical intervention (cystoscopy, bladder biopsy, and clot removal). Drained volume: <7,000 mL.	VII
Naranji; Bolgeri, 2012.⁽³¹⁾ UK	To describe a case of hematuria in the upper urinary tract after urinary catheterization.	Type of Study: Case report. Sample: Male patient. Age: 82 years old Technique Used: Rapid decompression	In the first 48 h after the procedure, the patient presented significant hematuria with a drop in hemoglobin to 7.8 g/dl, requiring bladder irrigation and blood transfusion. Laboratory and imaging tests were carried out showing an enlarged prostate. No stone or malignancy was identified. Drained volume: 2,900 mL.	VII
Nayak et al., 2013.⁽³²⁾ India	Describe the case of a patient who presented hematuria after bladder decompression.	Type of Study: Case report. Sample: Male patient. Age: 67 years old. Technique Used: Rapid decompression.	The imaging examination showed an enlarged prostate and bilateral dilation of the kidney. The patient presented severe hematuria followed by hyponatremia. The hematuria followed for more than a week. The patient underwent a nephrostomy. Clots were found in the right ureter. No tumor was identified. Drained Volume: 4,000 ml.	VII

Types of studies	Studies	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Q9	Q10	Q11	Q12	Q13	Total (yes)
Randomized clinical trials	Etafy et al., 2017.⁽²⁶⁾	Y	N*	Y	N**	N	N*	Y	Y	Y	Y	Y	Y	Y	9/13
	Boettcher et al.,2013.⁽²³⁾	Y	Y	Y	N**	N	N*	N	Y	Y	Y	Y	Y	Y	9/13
	Bristoll et al.,1989.⁽²⁴⁾	N*	N*	Y	N**	N	N*	Y	N	Y	Y	Y	Y	N	6/13
Quasi-experimental	Christensen et al.1987.⁽²⁴⁾	Y	Y	Y	Y	N	Y	N	Y	Y					7/9
Case series	Ahmed et al., 2013.⁽²²⁾	Y	Y	Y	Y	Y	Y	Y	Y	Y	N				9/10
	Glahn; Plucnar.1984.⁽²⁸⁾	Y	Y	N	Y	N	N	Y	Y	N	N*				5/10
	Klamfoth; Burtson, 2022.⁽²⁹⁾	Y	Y	Y	Y	Y	Y	Y							7/7
	Knapp; Apgar; Pennell, 2022.⁽³⁰⁾	Y	Y	Y	Y	Y	Y	Y							7/7
	Naranji; Bolgeri, 2012.⁽³¹⁾	Y	Y	Y	Y	Y	Y	Y							7/7
	Nayak et al, 2013.⁽³²⁾	Y	Y	Y	Y	Y	Y	Y							7/7
	Gabriel; Suchard, 2017.⁽²⁷⁾	Y	N	N	Y	N	N	Y							3/7

Randomized clinical trials – Q1: Was the randomization reliable?; Q2: Was the division of groups carried out blindly?; Q3: Were the groups similar at baseline?; Q4: Were participants “blind” to treatment assignment?; Q5: Were those who underwent treatment blind to the assigned group?; Q6: Were the evaluators blind to the evaluation?; Q7: Were the groups treated identically, except for the intervention of interest?; Q8: If follow-up was not complete, were differences between groups adequately described and analyzed in terms of follow-up?; Q9: Were the participants analyzed in groups?; Q10: Were results measured in the same way across treatment groups?; Q11: Were the results measured reliably?; Q12: Statistical analysis was appropriate; Q13: Was the study design appropriate and were possible deviations from the standard design considered? Quasi-experimental – Q1: Is it clear what the causes and effects are?; Q2: Were the participants included in comparisons similar?; Q3: Did the participants included in the comparison receive similar treatments?; Q4: Was there a control group?; Q5: Were there multiple result measurements before and after the intervention?; Q6: If follow-up was not complete, were differences between groups adequately described and analyzed in terms of follow-up?; Q7: Were the results included in the comparison measured in the same way?; Q8: Were the results measured reliably?; Q9: Was statistical analysis appropriate? Case series – Q1: Were there clear criteria for inclusion?; Q2:Was the condition measured in a standardized and reliable way?; Q3: Were valid methods used to identify the condition in all participants?; Q4: Was there consecutive inclusion of participants?; Q5: Was there complete inclusion of participants?; Q6: Was there clear reporting on participant demographics?; Q7: There was clear reporting of clinical information; Q8: Were case follow-up results clearly reported?; Q9:Was reporting of demographic information consistent?; Q10: Was the statistical analysis appropriate? Case reports – Q1: Were demographic characteristics clearly described?; Q2: Was the patient’s history clearly described and presented as a timeline?; Q3: Has the current clinical condition been clearly described?; Q4: Were the treatment intervention(s) clearly described?; Q5: Was the post-intervention clinical picture clearly described?; Q6: Have adverse events been identified and described?; Q7: Does the case provide take-home lessons?; Y: yes; N: no; n*:not clear; n**: not applicable

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[1] Corresponding author: Aline de Sousa Meira Email: alinesomeira@gmail.com