Clinical efficacy of retrograde urethrography-assisted urethral catheterization after failed conventional urethral catheterization

Abstract

Background Several approaches for urethral catheterization after the failure of initial urethral catheterization have been introduced. However, standard procedures regarding what should be done after failed conventional urethral catheterization have been not established. Therefore, we investigated the clinical efficacy of retrograde urethrography (RGU)-assisted urethral catheterization after failed conventional urethral catheterization. Methods Between July 2015 and July 2018, 136 patients who underwent RGU-assisted urethral catheterization after failed conventional urethral catheterization were included in this retrospective study. Patients’ clinical data, such as age, catheterization site, and previous history of urologic operations, were collected and assessed via chart review. Univariate and multivariate logistic regression analyses were performed to identify predictive factors for the failure of this procedure. Results Of the 136 patients, 94 (69.1%) experienced successful RGU-assisted urethral catheterization. Having a previous history of urologic operations, such as urethrotomy and transurethral prostatectomy, was identified as an independent predictive factor for the failure of RGU-assisted urethral catheterization (odds ratio = 9.453, 95% confidence interval = 2.703–33.063, p < 0.001). Conclusions RGU-assisted urethral catheterization can be one of the modalities for providing successful catheterization after failed conventional urethral catheterization. We believe that RGU-assisted urethral catheterization can be an effective procedure if patients have no previous history of urologic operations, such as urethrotomy and transurethral prostatectomy. Trial registration Soonchunhyang university institutional review board approval (No. 2018-08-021).

Safety and efficacy of fluoroscopy-guided urethral catheterization in case of failed blind or cystoscopy-assisted urethral catheterization

“…These results highlight the safety and efficacy of fluoroscopy-guided urethral catheterization in patients who experience difficulties with urethral catheter insertion or those with failed urethral catheterization attempts. In a similar study conducted by Kim et al 11 , the success rate of urethral catheterization was 69.1%, which was significantly lower than that in the present study ( P < 0.001). This may be because, in their study, only a hydrophilic guidewire was used to pass through the bladder after RGU, which can be technically challenging owing to inadequate support when passing through a stricture or injured segment.…”

“…Compared to other studies, our study had a higher urethral injury rate (40.8%). Kim et al 11 reported definite urethral injury under RGU in 33 patients (24.3%). However, if we excluded the hematuria group and focused only on the 62 patients (34.4%) who showed definite urethral injury on RGU, there was no statistically significant difference compared with Kim et al’s study, as seen in the chi-square test ( P > 0.05).…”

“…However, this technique may sometimes fail, leading to potential complications, particularly in patients with urethral stricture disease, difficult anatomy, or a history of failed catheterization attempts. In such cases, fluoroscopy-guided urethral catheterization using the Seldinger technique 22 , which involves using a guidewire to obtain safe access to blood vessels, is suggested as a safer and more efficient alternative 11 , 13 – 19 .…”

“…However, in various clinical settings, there can be instances where cystoscopy-assisted urethral catheterization fails or is difficult to attempt. In such situations, alternative methods, such as radiologic urethral catheterization, may be considered safer and more effective 10 , 11 . Radiologic urethral catheterization uses imaging techniques, such as fluoroscopy or ultrasonography, to guide catheter insertion into the bladder.…”

“…Radiologic urethral catheterization uses imaging techniques, such as fluoroscopy or ultrasonography, to guide catheter insertion into the bladder. This technique has shown potential advantages over blind catheterization, particularly in patients with challenging anatomies or in those who have previously failed blind urethral catheterization attempts 11 – 19 .…”