Toxic Catheters and Diminished Urethral Blood Circulation in the Induction of Urethral Strictures

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Abstract
Local effects of indwelling urinary catheters are poorly characterized. Latex catheter brands of various degrees of tissue toxicity were implanted into the urethra of 27 male piglets. The systemic hemodynamic states varied from normal to hypovolemia, where the circulation changes simulated the extracorporeal perfusion used in open-heart surgery. The urethral epithelial changes caused by the catheters were studied by light ad scanning electron microscopy (SEM). The blood circulation in paraurethral tissue reacted strongly to systemic hemodynamic changes. A reduced local blood flow induced an accumulation of polymorphonuclear leucocytes in the urethral epithelium and subepithelial space in connection with implanted latex urinary catheter strips. This was not seen in normovolemic piglets. Non-toxic wholly silicone control catheter implants did not induce changes. Epithelial cell damage correlated with the tissue toxicity values of implanted catheter strips. In SEM analysis destruction of microvilli and cell membranes was also discovered in connection with a latex catheter brand regarded as non-toxic. The wholly silicone catheters did not cause any detectable changes. The observed cell damage is induced by toxic chemicals dissolving from latex catheters. Local ischemia exacerbates these toxic effects and activates complement cascade. This induces polymorphonuclear granulocyte accumulation in the damaged urethral epithelium leading to demolition and urethral fibrotization. The present findings explain the etiology of the long urethral stricture epidemics seen in open-heart surgery in the early 1980s by showing the interference between indwelling latex catheters and reduced local blood flow.