#1084
Urethral catheterisation device (UCD®) for difficult catheter insertion in the Emergency Department

Zoe Williams¹, Song Kang¹, Alexander Combes¹, George McClintock¹, Jeremy Saad¹, Ramesh Shanmugasundaram¹, Varun Bhoopathy¹, Brayden March¹, Femi Ayeni², Isaac Thangasamy¹, Nicola Jeffery¹

¹ Nepean Hospital, Urology, Sydney,
² The University of Sydney, Nepean Clinical School, Sydney

Introduction:
Catheter-associated urethral injury (CAUI) occurs in 13.4 per 1000 catheterised males. A urethral catheterisation device with an integrated guidewire (Urethrotech UCD®) can facilitate safe and successful urethral catheterisation (UC) by non-urologists when first-line techniques are unsuccessful. This study assesses implementation of a protocol for difficult urethral catheterisation (DUC) incorporating the UCD® in an Australian Emergency Department and evaluates the cost-effectiveness of this approach.

Materials and Methods:
A prospective trial was conducted over 12 months in the Emergency Department of a tertiary hospital in Australia. For the first 6 months, referrals to urology for assistance with male DUC or management of CAUIs were audited. For the second 6 months, a protocol for male DUC was implemented and the audit was continued. The protocol involved use of the UCD® after failed male UC with a 16 Fr catheter. The cost of urology involvement for assistance with male DUC and CAUI care was obtained from the hospital Finance Department.

Results:
In the 6-month period without the protocol for male DUC, there were 13 referrals to urology for assistance with male DUC or management of CAUI. Urology attended to perform UC over a guidewire in 9 patients using a blind technique (n=5) or guided by bedside flexible cystoscopy (n=4). CAUIs during this period included urosepsis (n=3), false passages (n=2), urethral strictures (n=1), and periurethral bleeding (n=1). The complications required urology admission (n=7), a period of UC and outpatient trial of void (n=4), or rigid cystoscopy (n=1).

After introduction of the protocol for male DUC, the UCD® was used in 9 patients and was successful in 7 patients (78%). Correspondingly, there were fewer referrals to urology for assistance with male DUC (n=2) and fewer cases of CAUI (n=2). Urology attended to perform UC aided by bedside flexible cystoscopy in 2 patients. CAUIs during this period included a mucosal flap at the bulbar urethra (n=1) and a false passage at the prostatic urethra (n=1).

The mean cost of difficult catheterisation-related care for patients for whom the UCD® was trialled (successfully or unsuccessfully) was $1003 per patient, compared with a mean cost of $2154 for difficult catheterisation-related care when UCD® was not used in the first 6 months of the study.