For someone suffering from acute urinary retention, nothing spells relief quite like a catheter. Today's catheters are safe, indispensable diagnostic and treatment tools in many specialties, employed as much to inject fluid as to drain it. In cardiology, for instance, they're the conduit for radiopaque dye to magnify coronary arteries and miniature stents to unblock them. But the history of the catheter belongs to urology and the process of draining a painfully distended bladder dates to antiquity. The catheter is one of civilization's first therapeutic interventions.
Ancient Chinese wrote of using onion stalks, and the Hindus, Egyptians, Romans and Greeks described tubes of wood and precious metals. In America, Founding Father Benjamin Franklin designed a silver coil catheter for his brother in 1752 and likely used it later himself, remarking once that "only three incurable diseases have fallen to my share the gout, the stone, and old age."
By the mid-1800s, catheters had a urological niche, with innovators producing the first variations. Woven, soaked and dried, Louis Mercier's coud, or elbow, catheter (1836), for instance, eased some catheterizations with its curves and bulges.
But only after Charles Goodyear earned an 1851 patent for vulcanized, or moldable, hard rubber could catheters be custom-shaped. While today's materials may be superior, Goodyear's innovation opened the door for mass production of bent models for many tasks.
But no other invention had the staying power of Minneapolis urologist Frederick E.B. Foley's rubber balloon catheter. With its introduction in June 1935, doctors finally had an in-dwelling hemostatic device that could be held in place by its own configuration not bandages or tape.
Before Foley, Frenchmen Malecot and de Pezzar laid the groundwork with their "four-winged" and "mushroom" models. Before them (1853), Jean Reybard inflated a bladder bag to create the "grandfather" of retained devices.
But nothing matched Foley's single, continuous design in ensuring drainage post-op or short-term. His contribution was so significant that decades after losing the patent battle with industry, a balloon catheter is still referred to simply as a "Foley."
Catheterization was deemed safe and acceptable, largely because of the antiseptic principles advocated in 1867 by Glasgow's Joseph Lister. While skeptics scoffed at swabbing surfaces previous to procedures, urologists insisted on absolute disinfection to prevent microorganisms from infecting the urinary tract.
Well into the early 1900s, chronic sufferers from bladder outlet obstruction self-catheterized like Franklin's brother with concealed catheters they carried in hatbands, canes or umbrellas.
But would Listerian procedures be crucial in treating patients with permanent abnormal bladder function? Post-World War II urologists faced that question on a grand scale as ex-soldiers with unprecedented ballistic spinal cord injuries returned home as a new catheter population. These paralyzed patients needed more than occasional remission from calculi, prostatic obstructions or urethral inflammation. They required ongoing catheter drainage of their dysfunctioning bladders.
For decades, urologists advocated sterile intermittent techniques because of potential bacteria. But only when University of Michigan urologist Jack Lapides introduced clean intermittent self-catheterization in 1971 did the idea that germs weren't the only cause of urinary tract infections (UTIs), first postulated by others, gain attraction. Persistent stagnant urinary residuals and high bladder pressures were also culprits.
Lapides proved, first with a multiple sclerosis sufferer, that neurogenic bladder patients didn't require cumbersome sterilization techniques. Instead, they could routinely self-catheterize with a simple, clean approach based on mapping their own urethral landmarks and suffer no bacterial consequences. By learning his technique in a day, they'd have personal control for life.
Few measures would be as helpful as clean intermittent self-catheterization. Three decades after the initial rancorous debate over the technique, millions of neurogenic patients can testify to its merits. But, there's more to its legacy than patient independence. Like the Foley, it's a powerful example of how ingenuity can turn an ancient remedy into a modern mainstay.
