Difficult Foley Catheterization
In general, dilation with balloon dilators or metal sounds should be left to the Urologists, but there is one technique that can be tried before giving up. An 0.035” guide wire is frequently able to slip through the narrowed distal passage. If so, then this can be followed with a “12 French Nottingham” or similar ureteral dilator available from most operating rooms and Urology emergency carts - American Urological Association
HWN Suggests
Distal Urethral Strictures and Meatal Stenosis in Men
You’ve found the urethral opening but you cannot get the catheter into the meatus or it only goes 1-2 cm and then stops. Most likely you are dealing with a stricture of the meatus (meatal stenosis) or the very distal urethra (fossa navicularis). The first thing to try is a 12 French Silicone Foley catheter. Silicone catheters are relatively stiff and have narrow walls providing a reasonably good drainage lumen even from such a small catheter. Once passed, the catheter can be changed to a larger size every 24-48 hours which will gently dilate the stricture painlessly. If not successful, then some type of dilation procedure will be needed. In general, dilation with balloon dilators or metal sounds…Featured
Glidewire-assisted Foley catheter placement: a simple and safe technique for difficult male catheterization
When encountering difficulty in Foley catheter placement in a male patient, we recommend a simple and safe technique of a glidewire-assisted Foley catheter placement. This technique minimizes the risk of a false passage that is created by forcing catheters or using Coudé tip catheters in case of urethral stricture.
Articles of Interest
Difficult male urethral catheterization: a review of different approaches
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.
Approach to difficult urethral catheterizations in male patients during the Covid-19 pandemic
A total of 23 male patients who visited the urology outpatient clinic or were referred due to urinary retention or inability to place a Foley catheter in the last 8 months were included in this case series. The patient charts were evaluated retrospectively. After the hydrophilic guidewire, blindly advanced from the urethral meatus under sterile conditions, reached the bladder, a Foley catheter was placed over the guidewire. In cases of urethral stricture, dilatation was performed over the guidewire with the help of hydrophilic S-Curve dilators, and a Foley catheter of suitable diameter was placed.
Difficult Foley Catheterization
Guide wires are useful in assuring access to the bladder. Such wires are optimally used with the aid of cystoscopic visualization to confirm passage into the bladder, though the blind passage of soft guide wires into the bladder can also be done. Passing a guide wire blindly is actually quite safe as, generally, the guide wire will either pass into the bladder or hit an obstruction and reverse direction, eventually protruding from the urethral meatus. If this occurs, a repeat attempt at blind passage can be done. While cystoscopic passage is optimal, the blind passage technique can be done safely even by non-urologists with minimal equipment without waiting for a cystoscope and light source or even a urologist to be available at the bedside
Emergency catheter insertion with a tight urethral stricture and empty bladder
Attempts at urethral catheterisation using Foley's catheter invariably fails in patients with tight urethral strictures. However, a lubricated fine bore infant feeding tube can usually be negotiated through the stricture. Once urine is noticed, up to 1l of normal saline can be infused through the tube. The bladder distension can be confirmed by percussion or using a standard bladder scanner. A suprapubic catheter can then be inserted in the usual way. This procedure can be very useful in critically ill patients, particularly when specialist urological advice is not available, where a urinary diversion is required along with urine output measurements.
Troubleshooting Foley Caths and Suprapubic Caths
Minimizing the number of attempts at urinary catheterization is crucial for success in the procedure and minimizing subsequent complications. With each failed attempt at tube passage, the performing clinician risks superficial damage to the thin urothelium of the urethra resulting in bleeding and edema that will make subsequent attempts both more difficult and dangerous. As such, knowing the patient’s risk factors for DUC allows the provider to select materials and techniques that will maximize the success of the procedure and minimize risk of iatrogenic injury.
Urethral Strictures
Stricture aetiology differs significantly throughout different regions in the world, due to differences in healthcare quality and environmental and practice patterns [26]. Regardless of geography, urethral stricture disease adversely impacts physical health and quality of life.
Resources
StatPearls
Urinary catheterization is a common clinical intervention to ensure adequate urinary drainage when patients cannot void effectively. When a urinary catheter cannot easily be placed, a thorough understanding of anatomic considerations that may impact catheter placement and fundamental working knowledge of various Foley catheterization techniques can aid physicians and other healthcare professionals in successfully enabling urinary bladder decompression.
