Indwelling urethral catheter is by far the safest way of managing the urinary tract during the first 48hrs after injury and occasionally longer. Documentation of hourly urine output is essential. Urine output is expected to be initially reduced in the first 24-48 hours. Subsequently it may exceed intake for a few days or weeks in certain instances, during the acute phase of injury.
The team should ascertain that the catheter is introduced in to the bladder and not resting either in the prostatic urethra or in the bulbous urethra – in the absence of sensation the patient is unable to inform the observer of discomfort.
Timely early introduction of intermittent catheterisation, can prevent a number of lower urinary tract complications.
Reflex erection can cause urethral damage if the indwelling urethral catheter is not appropriately strapped with a suitable catheter holding device.
During every turn, make sure the drainage system is not kinked.
Discussions concerning sexual dysfunction and storage of semen should be delayed until informed expert advice becomes available in a Spinal Injuries Unit.