Difficult male urethral catheterization: a review of different approaches

Abstract

PURPOSE: To review and compare the different methods for difficult male urethral catheterization described in selected literature. MATERIALS AND METHODS: A PubMed search was done with the terms "difficult", "failed", or "complications" and "urethral catheterization", "transurethral catheterization", "Foley catheter", "urethral catheter" or "filiforms and followers". All articles addressing the issue of difficult adult male urethral catheterization were included. RESULTS: Six main approaches were identified on the 14 articles included for review: 1) Passage of either a Glidewire, guide wire or filiform under direct vision; 2) Blind passage of a filiform, guide wire, Glidewire or hydrophilic catheter; 3) "The Peel-away® sheath placed on a cystoscope/resectoscope technique"; 4) "The rigid ureteroscope placed inside the 22F Foley technique"; 5) Suprapubic catheterization; and 6) "The instillation of 60 cc of saline through the catheter as it is advanced technique". CONCLUSION: There is a paucity of prospective data comparing the benefits, risks, success rates and complications of the different approaches for difficult Foley catheter placement. Our suggested approach starts with the initial attempt at urethral catheterization with an 18F coude and a 12F silicone catheter. If these fail, using a flexible cystoscope or the blind Glidewire technique are reasonable alternatives. If dilatation of a stricture is necessary, ureteric dilatators or a urethral balloon dilatator are recommended

A prospective analysis of consultation for difficult urinary catheter insertion at tertiary care centres in Northern Alberta

“…1 Despite the prevalence of consultation, literature regarding DUC is extremely limited and focuses predominantly on techniques of successful catheter placement, rather than understanding the clinical situations associated with difficult catheterization consults. Although the incidence of DUC is unknown, many causes have been identified, including anxiety, poor technique, urethral stricture, phimosis, ansarca, bladder neck contracture, false passages, benign prostatic hyperplasia, unfavourable body habitus and patient positioning.…”

“…Complications of DUC can include urethral abscess, necrotizing infection, rectal injury, urethral stricture, urinary tract infection, urosepsis, hematuria requiring transfusion, as well as extreme physical and emotional distress to the patient. 1,3 Our study prospectively examines the causes and management of DUC consultation at our institution and secondarily identify areas where focused catheter education could reduce the incidence of DUC and related adverse events.…”

Glidewire-assisted Foley catheter placement: a simple and safe technique for difficult male catheterization

“…5 However, in our experience and in other studies 6 the blind use of the glidewire can be safely attempted as a second-line treatment, and this is very effective in most of the difficult cases of catheterization, including urethral stricture and prostatic problems. The technique we described can be easily and safely used by any trained nurse or a family physician in peripheral hospitals.…”

Tips and Tricks for Difficult Urethral Catheterization

“…In uncircumcised patients, reduce foreskin to the anatomic position after the procedure is complete. This maneuver prevents paraphimosis appearing, which can lead to ischemia of the glans penis (2,6). When a patient suffering urinary retention with high urinary volume, we should empty the urine progressively, not more than 400 cc at each time.…”

“…Male catheterization, in particular, can be difficult, especially in patients with enlarged prostate glands or other potentially obstructive conditions in the lower urinary tract (1,2,3,4). Solutions to problematic urinary catheterization are not well known and, when it occurs, the risk of failed catheterization and concomitant complications increase.…”