Common urethral complications during clean intermittent catheterization

Clean Intermittent Catheterization (CIC) is an important and effective method for managing voiding dysfunction and protecting kidney function. By enabling patients to empty the bladder independently, CIC greatly reduces the risk of urinary tract infections and upper urinary tract damage.

However, as the urethra is the necessary passage for catheter insertion, some minor challenges may occur during the learning process — such as discomfort or pain during catheterization, occasional mild urethral trauma, slight bleeding, and, in cases of improper long-term technique, potential complications like urethral stricture, creation of a false passage, or recurrent urethritis.

Acquiring proper knowledge, standardized techniques, and scientific preventive measures is essential to avoid these complications.

01 Pain and Discomfort

Patients with intact urethral mucosa and nerves may experience pain or discomfort during catheter insertion or removal. In elderly women, incomplete relaxation of the pelvic floor muscles or mucosal atrophy can also cause discomfort during these procedures.

Preventive Measures:

For patients with bladder dysfunction caused by nerve injury, urethral sensation may be reduced or absent, and urethral pain during catheterization is uncommon. However, some individuals may still experience significant discomfort. Since the degree of urethral pain varies from person to person, the following measures are recommended for those with urethral sensitivity:

1. Choose the catheter size that best fits your body.

2. Use hydrophilic-coated catheters and practice proper catheterization techniques to minimize urethral pain—this is especially helpful for men.In women, estrogen deficiency may lead to discomfort due to dryness of the urethral and perineal tissues.

Over time, pain and discomfort during catheter insertion usually decrease as the patient becomes more accustomed to the procedure.

02 Urethral Injury and Bleeding

Insufficient lubrication or overly forceful insertion of the catheter can cause urethral spasm. If no adjustment is made at this point, urethral injury may occur, potentially leading to both urethral bleeding and the formation of false passages. Urethral bleeding frequently occurs at the beginning of catheterization, manifested by blood at the tip of the catheter after insertion, and occasionally by red-colored urine.

Prevention: Fully lubricate the catheter before insertion. If significant resistance is encountered during insertion, immediately pause for 3–5 seconds. The catheterization should be performed gently. For males, correctly manage the three curves of the urethra; for females, the catheter can be slightly rotated before continuing. Avoid forceful catheterization to prevent urethral spasm.

03 Urethritis

Urethritis is one of the main complications in male catheterization. Historical studies have shown that the incidence of urethritis in treated patients ranges from 1% to 18%. It is mainly caused by overly frequent catheterization and poor hygiene awareness.

Preventive measures:Wash hands with soap before each catheterization and clean the urethral meatus; maintain cleanliness throughout the procedure.Drink water regularly and perform catheterization according to medical instructions; do not change the frequency arbitrarily.

04 False passage formation

Urethral false passage formation is a relatively common urethral complication associated with intermittent catheterization. It is frequently seen in patients with urethral strictures or benign prostatic hyperplasia (BPH). False passages often occur at the level of the external urethral sphincter, which is distal to the prostate. Patients with urethral strictures, detrusor-sphincter dyssynergia, or prostatic enlargement should be particularly vigilant for the formation of urethral false passages.

Preventive measures:Be familiar with urethral anatomy and avoid forceful catheterization.Pay special attention in patients with urethral strictures or prostatic enlargement.

05 Urethral stricture

Urethral stricture has an incidence of approximately 5% and occurs only in males. The risk of stricture formation increases over time, with most strictures developing after 5 years. Gentle catheter insertion and the use of hydrophilic-coated catheters can reduce its incidence. Urethral strictures may result from repeated minor trauma to the urethra, leading to an inflammatory response, and are more common in patients performing self-clean intermittent catheterization.

Preventive measures:The use of hydrophilic catheters may reduce the likelihood of urethral stricture.Therefore, whenever possible, hydrophilic catheters should be chosen for intermittent catheterization.