IN VIVO COEFFICIENT OF KINETIC FRICTION:

STUDY OF URINARY CATHETER BIOCOMPATIBILITY *

J. CURTIS NICKEL, M.D.

MERLE E. OLSON, D.V.M.
J. W. COSTERTON, PH.D.

From the Department of Urology, Queen’s University at Kingston, and

the Department of Biology, University of Calgary, Alberta, Canada

ABSTRACT-An animal model was developed to measure objectively the in vivo intrinsic coeffi-
cient of kinetic friction (COF$ of various catheter materials. Uncoated red rubber catheters had the
highest COF, of the three materials tested. The Biocath catheter exhibited less COF, when com-
pared with the standard silicone catheter. Although the etiology of urethral strictures is multifacto-
rial, better biocompatibility as measured by in vivo COF, may be an important factor in the inevi-
table urethral trauma and irritation associated with indwelling catheterization and possibly with
postcatheterination urethral stricture formation.

The etiology of catheterization-induced Material and Methods

urethral stri&es is definitely multifactorial,
In this study Biocath catheters, hydrophilic
however, mechanical irritation between the
coated catheters introduced in the U.S.A. in
catheter surface and the urethral mucosa has
July, 1984, were compared with silicone cathe-
been implicated in the pathogenesis of these
ters. t Straight catheters (8-F) without balloons
urethral strictures.1-3 Newer, more inert mate-
or eyes were manufactured. A total of ten
rials have been developed, such as silicone,
Biocath and ten silicone catheters each
which appears to cause less tissue reaction.4-6
weighing 1.1 g were used. Four standard
Recently, the measurement of the relative sur-
straight red rubber catheters (1atex)t were
face friction of various catheter materials as a
tested for comparison. Prior to insertion, cathe-
demonstration of mechanical biocompatibility
ters were immersed in phosphate buffered sa-
and tissue irritation has been promoted in ad-
line solution for two minutes.
vertisements in urologic journals. However,
After being anesthetized with Halothane,
these tests were comparisons of relative in vitro
male New Zealand white rabbits were catheter-
coefficients of friction. The urethra, with its
ized with one of the catheters, without the aid
specialized mucosa and secretory capabilities, is
of lubricating jelly. The exposed end of the
impossible to replicate in in vitro situations;
catheter was connected to an F50 Microdis-
therefore these comparisons may not be valid in
placement Myograph Transducer/Physiograph
the real clinical setting. Because the concept of
Desk Model DMP-4B$ with a 4-O silk suture.
better biocompatibility resulting in less tissue
The transducer was mounted on a motorized
reaction has merit, we undertook a study to
pulling device which was set at 10.2 cmlmin.
measure the intrinsic coefficient of kinetic fric-
Both the transducers and the physiograph were
tion of catheter material in vivo in an animal
model.
ICatheters for this study were provided by the manufacturer,
*Project funded by grants from Queen’s University M.R.C. and C.R. Bard, Inc., Murray Hill, New Jersey.
Faculty Trust Fund. $Narco Biosystems, Houston, Texas.

UROLOGY / MAY 1987 I VOLUME XXIX, NUMBER 5 501

 Catheter
.
(I)
q
FIGURE 1. Schematic diagram and drawing
kinetic friction of various catheter materials.
calibrated at 5g-G scale. The sensitivity of the
recorder was set at 50 mV/cm (Fig. 1). Five
minutes after catheterization both the pulling
device and physiograph were activated and
kinetic force was recorded. The procedure was
repeated on the same rabbits for a total of two
Biocath and two silicone catheters selected ran-
domly. Two rabbits were also tested with two
additional red rubber catheters. A total of 5
rabbits were used in this experiment. The ani-
mals were sacrificed at the end of the procedure
without reversal of the anesthetic and urethral
lengths determined by dissection.
Calculation of coeffcient of kinetic friction
The coefficient of kinetic friction by defini-
tion is k = F,/W, where F, is the minimum
force required to sustain the constant move-
ment of a catheter, and W is the total force ex-
erted on the catheter surface by the rabbit
urethra. W, is defined as P,A where P, is the
pressure exerted on the catheter surface by the
urethra and A is the contact surface area be-
tween urethra and catheter. P, is a variable and
correlated to urethral size, muscle tone, and
other physiologic factors. Although P, will be a
variable among rabbits, it is appropriate to as-
502
F Rheostat
(61
J
of apparatus used to determine in vivo coefficient of
sume P is constant for each individual rabbit. A
was calculated from the outside diameter (D) of
a catheter. That is, A = rLD, where L is the
average urethral length of a 3 Kg male rabbit.
Results
The experiment used 5 male rabbits with an
average weight of 3 Kg. The average urethral
length was 8.9 cm. As described, two Biocath
and two silicone catheters were tested in each
rabbit. In addition 2 of the rabbits were tested
further with two red rubber catheters.
Table I shows the coefficients of kinetic fric-
tion (COFd of both Biocath and silicone cathe-
ters as well as uncoated red rubber catheters.
The COF, for each particular catheter was re-
producible within the same rabbit. It is invalid
to compare COF, between rabbits because
muscle tone (PJ of rabbits varies.
Table II illustrates the relative COFk of the
three types of catheters, using the silicone
catheter as the standard. The COFk of the un-
coated red rubber catheter is considerably
higher than both the Biocath and silicone cathe-
ter (192 % to 295 % of that of the silicone cathe-
ters), The COFk of the Biocath is approximately
64 to 84 per cent of that of the silicone catheter,
UROLOGY / MAY1987 / VOLUMEXXIX,hWMBERS
TABLE I. COFk of catheters constructed of various The inevitable movement of the catheter
materials within the urethra during indwelling catheter-
Uncoated ization probably does play an important role in
Rabbit Rubber urethral irritation and possible future stricture
No. Silicone Biocath (latex) formation. Developments in biotechnology
I 3.71p1* 3.21Pl . . have allowed development of a number of ma-
4.7lPl 3.llPl . . terials that would appear to be more biocom-
patible. Materials, such as those incorporated in
II 3.2lP2 2.1/P2 6.7lP2
3.4lP2 2.1lP2 6.OlP2
the new Biocath catheter, have undergone in vi-
tro testing; however, the only valid comparison
III 6.1/P3 5.1/P3 . .
would be objective in vivo studies. Our study
6.4lP3 4.91P3 . .
has indicated that the uncoated red rubber
IV 3.2lP4 2.1lP4 9.61P4
catheter has the highest coefficient of kinetic
3.OlP4 1.9/P4 9.91P4
friction of the three materials tested. The new
V 6.3lP5 5.5lP5 . . Biocath exhibits less COFk when compared
6.51P5 5.2lP5 . .
with the silicone catheter; and although the
‘COFI, has no unit. P is a variable and related to individual numbers are too small for rigorous statistical
rabbit’s urethral characteristics, however, it is appropriate to as-
sume P is constant for each individual rabbit, analysis, this may have an effect of decreasing
urethral mucosal irritation and possibly
TABLE II. Relative COF, of silicone,
urethral stricture formation.
Biocath, and uncoated red rubber catheters This method of testing catheter materials for
coefficient of friction is an objective test that
Rabbit could be used in the evaluation of new biomate-
No. Silicone* Biocatht Red Rubber f
rials that are currently being developed for
I 100 80 manufacture of urethral catheters.
II 100 64 i9i
III 100 79 Department of Urology
IV 100 64 295 Queen’s University
V 100 84 . . Kingston, Ontario, Canada K7L 2V7
100 73 243 (DR. NICKEL)
Average
*COFk of silicone catheter was used as standard for compari- ACKNOWLEDGMENT.To Stacy Grant and Kan Lam for
son.
their technical assistance and to Dimitra Baxter for edito-
fPer cent of silicone.
rial suport .

or as an average, a Biocath exhibits approxi- References

mately 74 per cent of the COF, of a silicone
catheter.
Comment
The formation of urethral strictures asso-
ciated with catheterization is multifactorial. It
is likely related to the degree of trauma with
insertion,7 associated urinary tract infection,1,2
the lubricating jelly,8 chemical irritation9 and
urethral ischemia.e All, or at least some of these
factors, are probably involved in the unex-
pectedly high incidence of urethral stricture in
men who have undergone cardiac bypass sur-
gery. 3,6~8~10Many investigatorsl-e~g have sug-
gested that the catheter material itself may play
a role in the development of urethral strictures.
Silicone catheters were demonstrated to cause
less urethral reaction and irritation,4 and latex
catheters appear to be associated with more
stricture formation than polymeric silicone
catheters.8
1. Painter MR, Borski AA, Trevino GS, and Clarke WE:
Urethral reaction to foreign objects, J Urol 106: 227 (1971).
2. Engelbert RH, Bartone FF, Gardner P, and Hutson J:
Urethral reaction to catheter materials in dogs, Invest Urol 16: 55
(1978).
3. Wesley-James 0: Catheters and postoperative urethral stric-
ture. Letter to the Editor, Lancet 1: 622 (1982).
4. Engel RME, Wise HA, and Whitaker RH: Otis internal
urethrotomy with long-term urethral intubation: a comparison of
latex and Silastic catheters, South Med J 65: 55 (1972).
5. Edwards LE, Lock R, Powell C, and Jones P: Post-catheter-
ization urethral strictures: a clinical and experimental study, Br J
Urol 55: 53 (1983).
6. Abdel-Hakin A, Hassouna M, Teijeira J, and Elhilali M:
Role of urethral ischemia in the development of urethral strictures
after cardiovascular surgery: a preliminary report, J Urol 131:
1077 (1984).
7. Blandy JP: Urethral stricture, Postgrad Med J 56: 383
(1980).
8. Smith JM, and Neligan M: Urethral strictures after open-
heart surgery, Lancet 1: 392 (1982).
9. Wilksh J, Vernon-Roberts B, Garrett R, and Smith K: The
role of catheter surface morphology and extractable cytotoxic ma-
terial in tissue reactions to urethral catheters, Br J Urol 55: 48
(1983).
10. Ferrie BG, et al: Urethral stricture following cardiac sur-
gery: a prospective study, ibid 56: 710 (1984).

UROLOGY / MAY 1987 / VOLUME XXIX, NUMBER 5 503