Catheter-associated meatal pressure injury in hospitalized males

Aims: To assess the prevalence of catheter-associated meatal pressure injury in acute hospitalized males, to determine risk factors for its formation and to propose a grading system for meatal pressure injury severity. Methods: In this cross-sectional study, we screened all adult males concurrently hospitalized at a tertiary medical center for indwelling urethral catheters and for meatal pressure injury. We proposed a system to grade meatal pressure injury severity and used logistic-regression modeling to calculate odds ratios (ORs) of possible risk factors. Results: A number of 168/751 (22.4%) hospitalized males with indwelling urethral catheters were included. Median age was 70.5 (inter-quartile range [IQR]: 57.0-80.3) years, median time from catheterization 5.5 (IQR: 2-11) days. A total of 61 (36%) had meatal pressure injury, as early as the first day after catheterization. Grade III injuries (<2 cm ulcer) developed in 22 (13%) patients, earliest noted on the second catheter day, and grade IV injuries (≥2 cm) in 7 (4%) patients, as early as 5 days post catheterization. In a multivariable analysis, catheter fixation (OR: 0.26 [95% CI: 0.10-0.70]; P =.008) was associated with reduced risk of meatal pressure injury, while catheter presence over 14 days (OR: 1.46 [95% CI: 1.01-1.08]; P =.005) and other skin ulcers (OR: 2.45 [95% CI: 1.05-5.71]; P =.038) were associated with a higher risk of meatal pressure injury. Conclusions: Meatal pressure injury is a common complication of indwelling catheters in hospitalized males, beginning days after catheterization. Meatal pressure injury was associated with prolonged catheter presence, other pressure injuries, and lack of catheter fixation. Prospective studies are needed to establish evidence-based guidelines.