Urinary catheters: history, current status, adverse events and research agenda

Figures & data

Figure 1. Tubular silver catheters devised by Ambroise Paré (1510–1590), with long gentle curves (they are known as coudé catheters) to permit easier insertion [8].

Figure 2. Urinary catheterization in the middle ages [17].

Table 1. Some important events in the history of the development of the urinary catheter.

Date	Devices and comments	Reference
1500 BC	Earliest record in an ancient Egyptian papyrus (the Ebers papyrus) of treatment of urinary retention by means of transurethral bronze tubes, reeds, straws and curled-up palm leaves.	Hanafy et al. [1]
400 BC	References in Hippocratic writings to the use of malleable lead tubes.	Milne [2]
79 AD	An S-shaped silver tube was found during the excavation of Pompei, evidently for the treatment of urinary retention.	Nacey and Delahunt [3]
900s	Malleable silver tube with numerous side holes which, according to Albucasis (Abu al-Qasim Khalaf ibn al-Abbas Al-Zahrawi) (936–1013), apparently resulted in easier insertion.	Hanafy et al. [4]
1100s	Chinese records of the treatment of urinary retention by transurethral insertion of hollow leaves of onion (Allium fistulosum). These were often hard to pass and rigid wood or metal tubes were alternatively used.	Herman [5], Hume [6]
1500s	First record by Fabricius of Acquapendente (1537–1619) of indwelling wax-impregnated cloth catheter moulded on silver sound, to reduce incidence of damage due to repeated catheterization.	Murphy [7]
1564	Ambroise Paré (1510–1590) devised a silver tube with a long gentle curve for easier insertion.	Paré [8]
1600s	Jan-Baptiste van Helmont (1578–1644) described a chamois skin catheter impregnated with white lead and linseed oil, inserted over a whalebone stylet. Later, wound silver wire was used to prevent collapse, with external grooves filled with wax, tallow or bound with fine gut. Putrefaction of the chamois skin was a major problem.	Murphy [7]
1684	Cornelius van Solingen (1641–1687) devised a silver wire helical tube covered with parchment held in place by silk thread and coated with wax.	Mattelaer and Billiet [9]
1700s	Jean Louis Petit (1674–1750) devised a silver tube with double curve. This device was less satisfactory than its immediate predecessors.	Petit [10]
1731	Jacques de Garengeot (1688–1759) devised a silver tube with pronounced curve and fine stylet with small terminal rounded tip to occlude the lumen during insertion.	de Garengeot [11]
1750s	Theden of Berlin and Bernard of Paris independently used a natural rubber gum coating of silk closely wound over a brass sound, finished with varnish to overcome stickiness. However, the varnish soon cracked, there was no method for reliable retention and they soon became blocked by encrustation.	Murphy [7], Thomas [12]
1752	Benjamin Franklin (1706–1790) devised a silver wire helical tube rubbed with tallow to fill the external grooves, for use as a catheter by his brother John when suffering from urinary retention due to “the stone”. Later, Benjamin Franklin used it personally when suffering from the same condition.	Nacey and Delahunt [3]
1836	Louis Auguste Mercier (1811–1882) invented the coudé (elbow) catheter	Mattelaer and Billiet [9]
1841	Mercier developed the bi-coudé (double elbow) catheter, with which insertion was much easier.	Mattelaer and Billiet [9]
1850s	Auguste Nétalon (1807–1873) developed a vulcanized rubber (latex) catheter, including the solid-tip and a single-eye. It was retained by adhesive tape or by a stitch (although neither method was satisfactory).	Mattelaer and Billiet [9]
1855	Jean François Reybard (1795–1863) invented a self-retaining catheter, consisting of a device with two channels, one for draining the urine and the other to inflate a balloon close to the tip to retain the catheter in the bladder	Reybard [13]
1929	Development of the “modern” balloon-based self-retaining catheter. In the device constructed by the C R Bard Company to the design of Dr Frederic Foley, a rubber balloon was attached with fine silk and waterproof cement close to the tip of a rubber catheter with a longitudinal groove which accommodated a fine tube to inflate the balloon with water. Bard placed Foley’s device on the market in 1933. Foley’s original application of his now-eponymous catheter was for post-prostatectomy haemostasis, but its wider application in the management of urinary incontinence and retention soon became commonplace, although the latex frequently caused urethritis and urethral strictures, and encrustration and infection were almost inevitable with longer-term catheterization.	Foley [14]
1968	Introduction of catheters constructed from silicone elastomer, reducing the incidence of urethritis and the rates of encrustration and infection.	Mangelson et al. [15]
2001	Introduction of chemical impregnation and “antimicrobial” coating, particularly silver, aimed at inhibiting the formation of surface biofilms and encrustation. These can reduce the risk of catheter-induced urinary tract infection, but only by 2–3 weeks.	Maki and Tambyah [16]

Figure 3. The urinary tract.

Figure 4. A typical Foley catheter. This catheter is size 16 Fr. Its overall length is ∼400 mm and the volume of the fully-inflated balloon is ∼10 ml. The catheter has two channels. When the catheter has been inserted, the retaining balloon is inflated with sterile water from a syringe via the inflation connector and one of the channels. The inflation connector incorporates a valve to prevent the sterile water from escaping when the syringe is detached. The other channel allows the free flow of urine from the drainage eye to the drainage funnel. To remove the catheter, the retaining balloon is first deflated by withdrawing the water from it with a syringe, which opens the valve in the inflation connector when it is attached.

Figure 5. The Foley catheter, introduced (a) Urethrally and (b) Suprapubically. In both cases, the bladder is shown to be draining continuously into a urine collection bag attached to the leg: this bag can be emptied when necessary by opening a valve. Alternatively, the bladder can be drained intermittently if a catheter valve is inserted into the drainage funnel of the catheter.

Figure 6. A section through a Foley catheter that has become blocked during use by the formation of struvite. The smaller patent lumen is the channel for the inflation and deflation of the retaining balloon. The length of the scale bar is 1 mm.

Figure 7. A catheter incorporating some of the concepts in the research agenda. The catheter is retained by wings which spring open after insertion through the suprapubic tract to the bladder: this traps less urine than the balloon of a Foley catheter and the catheter can be withdrawn transurethrally after cutting through it at the external suprapubic port. Multiple drainage eyes in the section of the catheter within the bladder minimize the risk of the formation of pseudopolyps, and this risk is further reduced by a collapsible section (shown stippled) of the catheter situated close to the external meatus of the urethra. The elastic reservoir at the suprapubic end of the catheter and strapped to the abdominal wall expands to accommodate urine from the bladder during spasmodic bladder contraction and returns it to the bladder when it relaxes after the spasm, thus minimizing the possibility of kidney damage. Periodic drainage of the bladder into a leg bag is actuated by a pinch valve beyond the collapsible section of the catheter, under manual or timed automatic control.

Paré, A., 1564, Dix livres de la chirurgie (Paris: Jean le Royer). First English translation by Johnson, T., 1634, The Collected Works of Ambroise Paré. (London: Th. Cotes and R. Young)

 Google Scholar

Greenspan, R.E., 2007, Medicine: Perspectives in history and art (Alexandria: Ponteverde Press)

 Google Scholar

Hanafy, H.M., Saad, S.M., and Al-Ghorab, M.M., 1974, Ancient Egyptian Medicine. Contribution to urology. Urology, 4, 114–120

 PubMedGoogle Scholar

Milne, J.S., 1907, Surgical instruments in Greek and Roman times (Oxford: Clarendon Press)

 Google Scholar

Nacey, J., and Delahunt, B., 1993, The evolution and development of the urinary catheter. Australian and New Zealand Journal of Surgery, 63, 815–819

 PubMedGoogle Scholar

Hanafy, H.M., Saad, S.M., El-Rafaie, M., and Al-Ghorab, M.M., 1976, Early Arabian medicine. Contribution to urology. Urology, 8, 63–67

 PubMedGoogle Scholar

Herman, J.R., 1973, Urology: A view through the retrospectoscope (Maryland: Harper and Rowe)

 Google Scholar

Hume, E.H., 1930, Medicine in China, old and new. Annals of Medical History, 2, 272–280

 Google Scholar

Murphy, L.J.T., 1972, The history of urology (Springfield: C.C. Thomas)

 Google Scholar

Mattelaer, J.J., and Billiet, L., 1995, Catheters and sounds: The history of bladder catheterisation. Paraplegia, 33, 429–433

 PubMedGoogle Scholar

Petit, J.J., 1790, Traité des maladies chirurgicales (Paris: M. Lesne)

 Google Scholar

de Garengeot, J.C., 1731, Traité des operations de chirurgie (Paris: G. Cavalier)

 Google Scholar

Thomas, G.J., 1933, History of Urology (Baltimore, MD: Williams and Wilkins)

 Google Scholar

Reybard, J.F., 1855, Traité pratique des rétrécissements du canal de l’utère (Paris, Labè)

 Google Scholar

Foley, F.E.B., 1937, A hemostatic bag catheter. Journal of Urology, 38, 137–139

 Google Scholar

Mangelson, N.L., Kado, R.T., and Cockett, A.T.K., 1968, Silicone rubber uses in the lower urinary tract. Journal of Urology, 100, 573–577

 PubMed Web of Science ®Google Scholar

Maki, D.G., and Tambyah, P.A., 2001, Engineering out the risk for infection with urinary catheters. Emerging Infectious Diseases, 7, 342–347

 PubMed Web of Science ®Google Scholar