The Foley catheter is a urinary catheter with a balloon at its distal tip, which is inflated post-insertion to ensure that the catheter remains in the bladder. Originally inflation of the balloon required the instillation of fluid or air via a separate port, next to the external end of the catheter, but modern catheters have a built-in reservoir which can be used to inflate the balloon.
Insertion of a Foley catheter is a common procedure, but still caries risks of complications, either during insertion or after 4, including:
- traumatic insertion
- creation of false passage
- bladder perforation
- urethral placement
- ureteric placement (rare)
- increased risk in neurogenic bladder, long-term catheterization, intra-operative placement, undistended bladder or non-routine catherisation (e.g. during guide-wire assisted insertion (Blitz Technique) or micro-tip catheter insertion during cystometry) 5
- false passage placement
- vaginal placement
- urinary tract infection
- catheter fragment retention
It should be noted that small locules of gas in an anti-dependent position are commonly observed (mostly on CT) in the bladder of recently catheterized patients, and alone are not a sign of complication 6.
History and etymology
The American urologist Frederic EB Foley (1891-1966) 3 first provided details of his now eponymous "hemostatic bag catheter" in an article in 1929, although in a later paper stated he had developed it in 1927 1,2. It was originally introduced as a way of controlling perioperative and postoperative hemorrhage during and after a cystoscopic prostatectomy. He continued to refine it and in an article in 1937 described his improved "self-retaining bag catheter" 2.
- 1. Foley FEB. Cystoscopic Prostatectomy A New Procedure and Instrument; Preliminary Report. J Urol. 1929;21:289-306.
- 2. Foley FEB. A self-retaining bag catheter. J Urol. 1937;38:140–3. https://doi.org/10.1016/S0022-5347(17)71936-2
- 3. Creange C, Enriquez R, Swan K. Frederic E.B. Foley: beyond the catheter. (2013) The journal of trauma and acute care surgery. 75 (3): 520-4. doi:10.1097/TA.0b013e31829bb866 - Pubmed
- 4. Saint S, Trautner BW, Fowler KE, et al. A multicenter study of patient-reported infectious and noninfectious complications associated with indwelling urethral catheters. JAMA internal medicine. 2018 Aug 1;178(8):1078-85.
- 5. Papacharalabous E, Ford M, Butler-Manuel S, Tailor A. Inadvertent insertion of a Foley’s catheter through the orifice of a duplex ureter during catheterisation for laparotomy. Gynecological Surgery. 2011 Feb 1;8(1):99-101.
- 6. Marcela De La Hoz Polo, Amandeep Sandhu, Elika Kashef, et al. Medical and surgical devices in the emergency and trauma patient: what the radiologist should know, and how they can add value. (2020) The British Journal of Radiology. doi:10.1259/bjr.20200530