Urinary tract infections

The urinary catheter is a fact of medical life. It is a valuable instrument when used for proper indications and when aseptic management is enforced. When improperly used, it is the major source of serious gram-negative infection in hospitalized patients. Male patients who require long-term drainage should be first tried on condom catheter drainage if there is no obstruction to flow or significant residual urine. Condom drainage, however, may lead to severe maceration of the penis if daily changing and cleansing is not done. Indwelling urethral catheters must be attached to a good system of closed drainage whether or not infection is present. Continuous bladder irrigation with neomycin-polymyxin solutions is a useful adjunct once closed drainage is established and working well. Suprapubic catheters are of special value for long-term use because they do not obstruct or irritate the urethra. The development of percutaneous methods of suprapubic drainage should improve and increase the use of this method.