ACS 2018: The Difficult Foley: Factors Predicting Appropriate Urological Consultation

Boston, Massachusetts ( Nina Mikkilineni, MD, New York Presbyterian-Columbia University Medical Center, New York, NY, presented research regarding the identification of predictors between simple and difficult Foley consults and identify areas for educational intervention.

They retrospectively reviewed catheter consults in men from 7/2016-9/2017. Consultation variables included time of year and consulting service. Patient variables included age, known genitourinary (GU) diagnosis and/or surgery. Type of Foley placed and urological trauma was recorded. Each consult was classified as “simple” or “difficult.”

They identified 276 men with Foley consultation. 216 (78.3%) were simple and 60 (21.7%) were difficult. The average age in both groups was 70 years (p=0.97). There was no difference in prior GU diagnosis (62.7% vs. 63.3%, p=0.47). More patients in the difficult group had prior GU surgery (26.7% vs. 16.7%, p=0.12). Specifically, hypospadias/stricture repair was higher in the difficult group (25% vs 2.8%, p=0.009). There was no seasonal difference in consults (p=0.88). Non-surgical teams placed more consults for simple catheters than surgical teams (80.6% vs 19.4%, p <0.001). Urethral trauma was higher in the difficult group (46.7% vs 27.8%, p=0.009).

In conclusion, a majority of Foley catheter consults are “simple,” however, urologic consultation may be warranted in patients with the previous hypospadias/stricture repair. Surgical teams more often consulted for truly difficult catheterizations and more trauma was documented with “difficult” catheterization. Therefore, Foley training for surgical, but especially non-surgical services, should be targeted to prevent unnecessary consultation, improve patient care, and reduce harm.

Presented by: Nina Mikkilineni, MD, New York Presbyterian-Columbia University Medical Center, New York, NY

Written by: Stephen B. Williams, MD., Associate Professor, Division of Urology, The University of Texas Medical Branch, Galveston, TX. and Ashish M. Kamat, MD. Professor, Department of Urology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX at the 2018 American College of Surgeons Clinical Congress, October 21-25, 2018 in Boston, Massachusetts