BJU Int 2021; 128: 667–677 doi:10.1111/bju.15406
Review
British Association of Urological Surgeons (BAUS) and
Nurses (BAUN) consensus document: management of
the complications of long-term indwelling catheters
Sheilagh Reid1, Jane Brocksom2, Rizwan Hamid3, Ased Ali4, Nikesh Thiruchelvam5, Arun Sahai6, Chris Harding7,
Suzanne Biers5, Mo Belal8, Rachel Barrett9, Julia Taylor10 and Richard Parkinson11
1
Princess Royal Spinal Injuries Unit, Northern General Hospital, Sheffield, 2Leeds Teaching Hospital, Leeds, 3University
College London Hospitals and London Spinal Injuries Unit, Stanmore, 4Pinderfields Hospital, Wakefield, 5Addenbrooke’s
Hospital, Cambridge, 6Guy’s and St. Thomas’ NHS Foundation Trust, London, 7Newcastle upon Tyne Hospitals – NHS
Foundation Trust, Newcastle, 8Queen Elizabeth Hospital, Birmingham, 9University College London Hospitals, London,
10
Clinical Governance Lead, Salford Royal Hospital, Manchester, and 11Nottingham University Hospitals NHS Trust,
Nottingham, UK
Objective
To look at best evidence and expert opinion to provide advice in the form of a consensus statement lead by Female,
Neurological and Urodynamic Urology (FNUU) section of the British Association of Urological Surgeons (BAUS) in
conjunction with the British Association of Urological Nurses (BAUN).
Methods
Initially a literature search was performed with incorporation of aspects of the existing guidance and further informed by
UK best practice by core members of the group. The document then underwent reviews by the FNUU Executive
Committee members, the BAUN executive committee, a separate experienced urologist and presented at the BAUS annual
meeting 2020 to ensure wider feedback was incorporated in the document.
Results
Complications of long-term indwelling catheters include catheter-associated urinary tract infections (CAUTI), purple urine
bag syndrome, catheter blockages, bladder spasms (causing pain and urinary leakage), loss of bladder capacity, urethral
erosion (“catheter hypospadias”)/dilatation of bladder outlet and chronic inflammation (metaplasia and cancer risk).
Conclusions
We have provided a list of recommendations and a troubleshooting table to help with the management of the
complications of long term catheters.
Keywords
catheter, suprapubic catheter, catheter associated urinary tract infection, bypassing, catheter spasm, #Urology, #UroUTI
and a catheter troubleshooting table to help guide
Introduction management when these complications occur.
The management of the complications of long-term
A long-term catheter is one that can stay in place for more
indwelling catheters falls within the remit of every urologist
than 28 days, although for many patients, it is intended to be
and urology nurse specialist. The primary purpose of the
permanent. It is commonly used for patients who are unable
present document was to share best practice in order to
to empty their bladder or store urine effectively and safely. It
minimize the frequency, severity and impact of these
can also be used to manage incontinence and for those with
problems. We have also produced a set of recommendations
© 2021 The Authors
BJU International
published by John Wiley & Sons Ltd on behalf of BJU International. www.bjui.org wileyonlinelibrary.com
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and
distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
, 1464410x, 2021, 6, Downloaded from https://bjui-journals.onlinelibrary.wiley.com/doi/10.1111/bju.15406, Wiley Online Library on [12/07/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Review
poor mobility. Of people aged over 65 years in care homes in Following FNUU Executive Committee discussion, a literature
the UK, 3.8% use long-term catheters [1] and there are search was performed to identify contemporary data in the
approximately 90 000 long-term catheter users in the UK [2]. published peer-reviewed literature using the MEDLINE
Side effects or complications are not uncommon, but there is database, relevant to the current best standard of
a lack of meaningful data on these. The complications that management for the management of long-term catheter
are addressed in this document include: complications. The terms and phrases used included ‘urinary
catheter’, ‘catheter blockage’, ‘catheter combined with
• Catheter-associated UTIs (CAUTIs)
overactive bladder’, ‘catheter associated urinary tract
• Purple urine bag syndrome (PUBS)
infection’, ‘purple urinary bags syndrome’ and ’suprapubic
• Catheter blockages
catheter’. References from relevant sections of contemporary
• Bladder spasms (causing pain and urinary leakage)
national and international guidelines produced by the
• Loss of bladder capacity
National Institute of Health and Care Excellence (NICE),
• Urethral erosion (‘catheter hypospadias’) and dilatation of
European Association of Urology (EAU) and European
bladder outlet
Association of Urological Nurses (EAUN) were also screened.
• Chronic inflammation, metaplasia and cancer risk Where clinical evidence was lacking, consensus expert
opinion was achieved from core members of the group.
Methods
The document then underwent three rounds of review by
This consensus statement has been devised by the BAUS
FNUU Section Executive Committee members as well as
Female, Neurological and Urodynamic Urology section
representatives from the BAUN Executive Committee. The
(FNUU) Executive Committee (who are an elected group of
document was then reviewed by the whole BAUN Trustee
urologists with an interest in the field of female urology,
group as expert reviewers and a separate experienced
neurourology, urodynamics and reconstruction of the urinary
urologist, and comments were fed back to a further review
tract) in conjunction with British Association of Urological
with the FNUU committee. It was then distributed to all
Nurses (BAUN) Trustees, a collective of nurses appointed by
BAUS FNUU membership for widespread scrutiny and for
BAUN members, who represent experience and expertise in
further comments to help refine the guidance into a
the field of urological nursing.
consensus statement. This revised document was rediscussed
Fig. 1 Consensus document methodology. BAUN, British Association of Urological Nurses; FNUU, Female, Neurological and Urodynamic Urology section.
Consensus Document Methodology
FNUU committee Break out groups
Document formation Further 3 rounds of review
identified important areas Literature Search following mulitiple rounds by FNUU Committee and
of practice, limited
Guideline review of review by break out representatives of BAUN
evidence or requiring
standardisation groups executive committee
key papers review
Document then Expert review: urologist,
Further revisions made whole BAUN Trustee
Presented at Virtual BAUS and re-discussed at FNUU distributed to FNUU
membership and invited group independent of
Meeting Nov 2020 Meeting 22/10/20
further comments FNUU Committee and
further revisions
Further comments
reviewed and final Publication of documents
document sent to BAUN &
BAUS Council for approval
© 2021 The Authors
668 BJU International published by John Wiley & Sons Ltd on behalf of BJU International
Review
British Association of Urological Surgeons (BAUS) and
Nurses (BAUN) consensus document: management of
the complications of long-term indwelling catheters
Sheilagh Reid1, Jane Brocksom2, Rizwan Hamid3, Ased Ali4, Nikesh Thiruchelvam5, Arun Sahai6, Chris Harding7,
Suzanne Biers5, Mo Belal8, Rachel Barrett9, Julia Taylor10 and Richard Parkinson11
1
Princess Royal Spinal Injuries Unit, Northern General Hospital, Sheffield, 2Leeds Teaching Hospital, Leeds, 3University
College London Hospitals and London Spinal Injuries Unit, Stanmore, 4Pinderfields Hospital, Wakefield, 5Addenbrooke’s
Hospital, Cambridge, 6Guy’s and St. Thomas’ NHS Foundation Trust, London, 7Newcastle upon Tyne Hospitals – NHS
Foundation Trust, Newcastle, 8Queen Elizabeth Hospital, Birmingham, 9University College London Hospitals, London,
10
Clinical Governance Lead, Salford Royal Hospital, Manchester, and 11Nottingham University Hospitals NHS Trust,
Nottingham, UK
Objective
To look at best evidence and expert opinion to provide advice in the form of a consensus statement lead by Female,
Neurological and Urodynamic Urology (FNUU) section of the British Association of Urological Surgeons (BAUS) in
conjunction with the British Association of Urological Nurses (BAUN).
Methods
Initially a literature search was performed with incorporation of aspects of the existing guidance and further informed by
UK best practice by core members of the group. The document then underwent reviews by the FNUU Executive
Committee members, the BAUN executive committee, a separate experienced urologist and presented at the BAUS annual
meeting 2020 to ensure wider feedback was incorporated in the document.
Results
Complications of long-term indwelling catheters include catheter-associated urinary tract infections (CAUTI), purple urine
bag syndrome, catheter blockages, bladder spasms (causing pain and urinary leakage), loss of bladder capacity, urethral
erosion (“catheter hypospadias”)/dilatation of bladder outlet and chronic inflammation (metaplasia and cancer risk).
Conclusions
We have provided a list of recommendations and a troubleshooting table to help with the management of the
complications of long term catheters.
Keywords
catheter, suprapubic catheter, catheter associated urinary tract infection, bypassing, catheter spasm, #Urology, #UroUTI
and a catheter troubleshooting table to help guide
Introduction management when these complications occur.
The management of the complications of long-term
A long-term catheter is one that can stay in place for more
indwelling catheters falls within the remit of every urologist
than 28 days, although for many patients, it is intended to be
and urology nurse specialist. The primary purpose of the
permanent. It is commonly used for patients who are unable
present document was to share best practice in order to
to empty their bladder or store urine effectively and safely. It
minimize the frequency, severity and impact of these
can also be used to manage incontinence and for those with
problems. We have also produced a set of recommendations
© 2021 The Authors
BJU International
published by John Wiley & Sons Ltd on behalf of BJU International. www.bjui.org wileyonlinelibrary.com
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and
distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
, 1464410x, 2021, 6, Downloaded from https://bjui-journals.onlinelibrary.wiley.com/doi/10.1111/bju.15406, Wiley Online Library on [12/07/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Review
poor mobility. Of people aged over 65 years in care homes in Following FNUU Executive Committee discussion, a literature
the UK, 3.8% use long-term catheters [1] and there are search was performed to identify contemporary data in the
approximately 90 000 long-term catheter users in the UK [2]. published peer-reviewed literature using the MEDLINE
Side effects or complications are not uncommon, but there is database, relevant to the current best standard of
a lack of meaningful data on these. The complications that management for the management of long-term catheter
are addressed in this document include: complications. The terms and phrases used included ‘urinary
catheter’, ‘catheter blockage’, ‘catheter combined with
• Catheter-associated UTIs (CAUTIs)
overactive bladder’, ‘catheter associated urinary tract
• Purple urine bag syndrome (PUBS)
infection’, ‘purple urinary bags syndrome’ and ’suprapubic
• Catheter blockages
catheter’. References from relevant sections of contemporary
• Bladder spasms (causing pain and urinary leakage)
national and international guidelines produced by the
• Loss of bladder capacity
National Institute of Health and Care Excellence (NICE),
• Urethral erosion (‘catheter hypospadias’) and dilatation of
European Association of Urology (EAU) and European
bladder outlet
Association of Urological Nurses (EAUN) were also screened.
• Chronic inflammation, metaplasia and cancer risk Where clinical evidence was lacking, consensus expert
opinion was achieved from core members of the group.
Methods
The document then underwent three rounds of review by
This consensus statement has been devised by the BAUS
FNUU Section Executive Committee members as well as
Female, Neurological and Urodynamic Urology section
representatives from the BAUN Executive Committee. The
(FNUU) Executive Committee (who are an elected group of
document was then reviewed by the whole BAUN Trustee
urologists with an interest in the field of female urology,
group as expert reviewers and a separate experienced
neurourology, urodynamics and reconstruction of the urinary
urologist, and comments were fed back to a further review
tract) in conjunction with British Association of Urological
with the FNUU committee. It was then distributed to all
Nurses (BAUN) Trustees, a collective of nurses appointed by
BAUS FNUU membership for widespread scrutiny and for
BAUN members, who represent experience and expertise in
further comments to help refine the guidance into a
the field of urological nursing.
consensus statement. This revised document was rediscussed
Fig. 1 Consensus document methodology. BAUN, British Association of Urological Nurses; FNUU, Female, Neurological and Urodynamic Urology section.
Consensus Document Methodology
FNUU committee Break out groups
Document formation Further 3 rounds of review
identified important areas Literature Search following mulitiple rounds by FNUU Committee and
of practice, limited
Guideline review of review by break out representatives of BAUN
evidence or requiring
standardisation groups executive committee
key papers review
Document then Expert review: urologist,
Further revisions made whole BAUN Trustee
Presented at Virtual BAUS and re-discussed at FNUU distributed to FNUU
membership and invited group independent of
Meeting Nov 2020 Meeting 22/10/20
further comments FNUU Committee and
further revisions
Further comments
reviewed and final Publication of documents
document sent to BAUN &
BAUS Council for approval
© 2021 The Authors
668 BJU International published by John Wiley & Sons Ltd on behalf of BJU International
