PubMed · 259016
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J Messier, J Nousieux. 1979. [Bladder catheterization].. https://pubmed.ncbi.nlm.nih.gov/259016/
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In an attempt to elucidate factors predisposing to the occurrence of urethral stricture after transurethral resection of the prostate, we performed a prospective follow-up of 178 patients over 12-20 months. We took account of 11 factors that we considered important. Urethral strictures developed in 14.04% of the patients. The resection operations were carried out by five different surgeons, who had different rates of stricture. The only one of the 11 factors studied that was found to involve a statistically significant risk was the presence of an indwelling catheter for more than 3 days. No other factor influenced the result. This patient group was compared with a group of 73 patients followed up for 12-60 months following transvesical prostatectomy. In this group only one stricture (1.36% incidence rate) was observed retrospectively. It seems that urethral ischaemia might increase the risk of urethral stricture. Urethral injuries are considerably less frequent with open prostatectomy. Therefore, we recommend transvesical prostatectomy for pronounced prostatic hyperplasias.
The principal advantages of suprapubic drainage of the bladder compared with the transurethral indwelling catheter are to be seen in holding back ascending infection of the urinary tract and avoidance of urethral trauma. In addition to relieving the bladder in subvesical obstructions the most important indication in practise is continuous drainage of urine in patients in intensive care. With strict observation of puncture technique and contraindications (contracted bladder, tumors in the lower abdomen, bladder carcinoma, macrohematuria and hemorrhagic diathesis) the entire complication rate is 4.3% (2.3% macrohematuria, 1.5% local infection, 0.5% peritoneal lesion). With the introduction of the disposable puncture systems the suprapubic bladder fistula has become a superior alternative to the indwelling catheter in many cases.