Urethral catheterization (UC) is a common procedure in hospitals, with around 25% of hospitalized patients requiring it. However, Catheter Associated Urethral Injury (CAUI) occurs in about 13.4 out of every 1000 male catheterizations, leading to increased patient morbidity and significant healthcare costs. This study explores the effectiveness and cost benefits of using an integrated guidewire urethral catheterization device (UCD®, by Urethrotech Ltd) specifically designed to aid in Difficult Urethral Catheterization (DUC) cases within emergency departments (EDs). A prospective, multicenter study was conducted with adult male patients who had previously failed initial UC attempts. This research was based in the EDs of a tertiary referral hospital and a regional hospital located an hour away from on-site urology services. A DUC protocol was established, and both ED nurses and doctors were trained to use the UCD® device, which is TGA-approved and allows frontline healthcare workers to utilize the Seldinger technique, typically reserved for urologists.
The UCD® was used in 20 DUC patients, with successful catheterization in 13 cases (65%). Of the remaining seven patients, two required a flexible cystoscopy, revealing urethral strictures, and one needed an emergency suprapubic catheter insertion before subsequent UC by a urologist. The immediate costs associated with emergency UC by urology, including inter-hospital transfer (costing $800-$1300) and urology call-back ($540), averaged $2500 per patient. The UCD® helped prevent urology call-back in four patients and avoided inter-hospital transfers in another four, highlighting its cost-saving potential. Overall, the UCD® proves to be an effective method for DUC management, especially in regional hospitals without on-site urology, as it reduces CAUI-related complications, costs, and delays in patient care by minimizing the need for patient transfer and specialist intervention.
