Katheter-assoziierte Komplikationen: Prävention und Management im geriatrischen Setting

Catheter indication requires strict verification

Long-term catheterization serves as a bridge for unresolved decompensated lower urinary tract dysfunction. Indication requires careful verification, as 30–50% of long-term catheter indications are reportedly questionable. Acceptance by patients, relatives, and care teams remains essential.

Complication prevention requires individualized maintenance

Complication management focuses on infection, dysfunction, bladder stones, dependency, and discomfort. Prevention relies on an individualized maintenance plan with regular reassessment, adapted drainage systems, catheter changes every 4–8 weeks, bag changes about weekly, and targeted flushing or decontamination when needed.

No single drainage system is universally superior

Transurethral, suprapubic, intermittent, and condom-based systems each show specific advantages and limitations. Suprapubic drainage tends to be somewhat favorable for longer-term infection outcomes and comfort, but no uniform best option exists; system selection remains patient-specific.

In the continuing education session “Catheter-associated complications: prevention and management in the geriatric setting,” organized by Klinik Barmelweid, Priv.-Doz. Dr. med. Martin Umbehr presents a structured overview of long-term urinary catheterization in older adults. He emphasizes that bladder dysfunction, especially incontinence and voiding disorders, is highly prevalent in geriatric and nursing home populations, and that long-term catheterization represents a major clinical and health-economic burden. Using a case of an 84-year-old patient, he illustrates that a urinary catheter is not a definitive therapy but a bridging measure for an unresolved underlying problem, and he stresses that the indication must be critically reviewed because it is often questionable. Dr. Umbehr describes the main drainage options—transurethral catheter, suprapubic catheter, intermittent self- or third-party catheterization, and condom urinal—and explains that the choice depends on the individual clinical context, functional capacity, and patient preferences. He reviews relevant complications, including urinary tract infections, catheter dysfunction, paracatheter leakage, obstruction, bladder stones, discomfort, and psychosocial dependence, and notes that suprapubic catheterization may offer some advantages in selected domains but no universally superior solution exists. A central message is the need for an individualized “maintenance package,” including regular reassessment, hygienic measures, scheduled bag and catheter changes, mechanical flushing, and, when indicated, decontamination strategies. He concludes that successful management requires correct indication, acceptance by the patient and environment, and tailored follow-up aimed at minimizing complications and improving quality of life.