JCU - January 2022 - 23

1032833
URO
Journal of Clinical UrologyPina et al.
Letter
Letter to the Editor re Gration, 'From
indwelling Foley to fail safe voiding:
Proposed changes in design and
thinking', Journal of Clinical Urology,
4 November 2020
Ines M Pina , Ahmed S Khattak , Ahmad M Omar
and Michael S Floyd Jr
We read with interest the recent article by Gration, 'From
indwelling Foley to fail safe voiding: Proposed changes in
design and thinking'.1
The author comments on the catheter-associated urinary
tract infection rates as highlighted by the NHS safety thermometer
report over 10 years and further comments on the
more serious problem of catheter-associated urethral injury.1
The study proceeds by referencing the work of Davis et al.
which highlighted that inappropriate balloon inflation is a
common cause of catheter related urethral injury.2
The article proceeds to discuss the multiplicity of
potential design solutions available and alludes to product
packaging warnings for female catheters and specific to
male catheters, and the role of the urethrotech device with
its safety guide wire is mentioned.3
The role of training workshops is referenced as this has
shown to be effective in reducing catheter-associated urethral
injury.4
The author is to be commended on this article which
again highlights a topic that has been widely commented
on recently in the Journal of Clinical Urology, particularly
in regard to junior practitioners and competencies related
to catheter insertion.5,6
Over 25% of inpatients are routinely catheterised during
their hospital stay with the incidence of iatrogenic injuries
being 6.7/1000.7
Thomas et al. demonstrated that 76% of new qualified
practitioners feel that their catheter training was inadequate.8
A UK study examining the attitudes of recently qualified
graduates towards urology as a postgraduate speciality also
looked at catheter-related competencies with only 21% of
male respondents stating that they were competent at the
procedure.9
As undergraduate exposure evolves and is increasingly
directed towards simulation for procedural tasks, core skills
such as catheter management will increasingly be performed
by nurse practitioners and less commonly by foundation
year trainees. There is evidence to suggest that simulationbased
training in passing a catheter is not beneficial when
compared to real life as difficulties such as strictures,
enlarged prostates etc. are difficult to replicate.10
Although the variety of catheter-related safety issues is
thoroughly discussed, the author omits to reference the
novel safety device that has also been developed by Davis
et al. which, by way of a safety syringe, aims to prevent the
inadvertent inflation of a catheter balloon in the urethra.11
Undoubtedly, for future practitioners designated catheter
education workshops as proposed by Bhatt et al. and
the introduction of novel catheter safety devices as devised
by Davis et al. will increasingly be relied upon to ensure
safe catheter management.4,11
Conflicting interests
The authors declare that there is no conflict of interest.
Funding
The authors received no financial support for the research,
authorship and/or publication of this article.
Ethical approval
Not applicable.
Department of Reconstructive Urology, St Helens and Knowsley
Hospital NHS Trust, Prescot, UK
Corresponding author:
Ines M Pina, Department of Reconstructive Urology, St. Helens and
Knowsley Hospital NHS Trust, Whiston Hospital, Warrington Road,
Merseyside, Prescot, L35 5DR, UK.
Email: ines.pina@doctors.org.uk
Journal of Clinical Urology
2022, Vol. 15(1) 23 -24
© British Association of
Urological Surgeons 2021
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DOI: 10.1177/20514158211032833
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JCU - January 2022

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