The approach to the difficult urethral catheterization among urology residents in the United States

Abstract

Purpose: To determine the prevalence of different approaches to the difficult urethral catheterization (DUC) among urology residents (UR) in the United States (US). Materials and Methods: An email invitation to participate in an online survey regarding DUC was sent to 267 UR and to 22 urology program coordinators for them to forward to their residents. 142 UR completed the survey. Results: After the initial unsuccessful attempt by a nurse, 92% of UR attempted a catheter prior to resorting to other modalities. The most common choice of the first catheter was a Coude (76%) size 18F (51%). For situations where multiple sizes and types of catheters (12 -20F) were used without success, 3 scenarios were proposed: 1) Catheter passed the bulbomembranous urethra (BMU) and patient had previous history of transurethral resection of the prostate or radical retropubic prostatectomy, 2) Catheter passed the BMU and no urologic history, 3) Catheter did not pass the BMU and no urologic history. Flexible cystoscopy was used in 74%, 62% and 63%; blind passage of a glidewire was second with 15%, 23% and 20%; and blind use of filiforms and followers was chosen in 7%, 9% and 9% of the scenarios respectively. Conclusions: The most common approach to the DUC among UR in the US involves using an 18F Coude catheter first. After trying one or more urethral catheters, UR most commonly resort to flexible cystoscopy as opposed to the blind placement of glide wires or filiforms/followers.

Tips and Tricks for Difficult Urethral Catheterization

“…This situation induces pain for the patient and uses to lesion the urethra creating false passages which may do impossible blind urethral catheterization and will obligate to place a suprapubic catheter or to perform an optically helped passage with a rigid or flexible cystoscope. Moreover, posterior healing of this lesions may create a urethral stricture or other definitive problems requiring surgical reconstruction (3,6,8). If unsuccessful, repeated attempts with the same catheter are usually done, Catheterization with a different size or consistency probe (typically larger or harder) may be attempted or another more experienced healthcare worker may help in the process.…”

“…Only nurses or emergency physicians properly trained, and with a clear strategy to face the situation, may repeat blind catheterization. If nobody fulfills this characteristic, a urologist has to be requested to decide about any new attempt of blind catheterization or to perform endoscopic maneuvers (3,4,6,7). Little is taught about difficult catheterization during nurse training which is more focused to prevent urinary infection by cleaning properly external genitalia or to create a close urinary circuit.…”

“…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.…”

“…Improved techniques for catheter placement are essential for all healthcare personnel involved in the management of the patient with AUR, including attending nurses who often are the first to catheterize such patients (3,4,7,8). The aim of this article is to show some tips and tricks that may be helpful for the blind placement of urethral catheters.…”

Preventing Traumatic Urinary Catheter Insertion Through a Computerized Ordering System: Quasiexperimental Study From a Tertiary Academic Center

“…8 Urologists typically take a proactive approach in managing these patients by using the Coudé-tip or other catheters during insertion attempts. 9 However, such maneuvers are not routinely performed by the non-urological personnel who place the vast majority of catheters.…”