Male Urinary Catheter

Urethral catheterization may be performed as either a therapeutic or diagnostic procedure. Therapeutically, catheters may be placed to decompress the bladder in patients with acute or chronic urinary retention. In addition, catheters may be placed to facilitate bladder irrigation in patients also. Diagnostically, urinary catheters may be placed to obtain an uncontaminated urine sample for microbiologic testing to measure urinary output in critically ill patients or during surgical procedures or to measure post void residuals.

Contraindications

The only absolute contraindication to urethral catheterization is known or suspected urethral injury usually in the setting of a pelvic fracture. Trauma patients presenting blood at the urethral meatus or with gross hematuria, Perineal Hematoma or a "High Riding" prostate gland should be evaluated with retrograde urethrography before catheterization.

Relative contraindications catheterization include urethral stricture, recent urethral or bladder surgery and a combative or uncooperative patient.

Equipment

Most of the equipment required for urinary catheterization can often be found in a pre-packaged catheterization tray. The contents of a typical tray include sterile drapes and gloves, antiseptic solution and cotton balls and forceps for the application of the antiseptic. Kits also include a foley catheter, sterile lubricant, syringe with water for balloon inflation and a drainage bag. Additional equipment usually not included in the standard tray, may include viscous lidocaine and tape or other securing device to secure the catheter to the patient.

There are many different types and sizes of urinary catheters. The Foley Catheter is most frequently used. A 16" - 18" is the most appropriate size for most adult patients. Larger catheters, 22" - 24" should be used for patients with gross hematuria in order to prevent clots from obstructing the lumen.

The Coude" Catheter has a semi rigid curved tip that facilitates catheterization for men with prostatic enlargement. Triple Lumen catheters which have an additional port for bladder irrigation, are often used in patients with gross hematuria or clots.

Anatomy

The average male urethra is approximately 20 centimeters long and takes an "S" shaped course through the penis to the prostate gland. Downward traction on the penis will exaggerate the curvature making catheterization difficult. When the penis is held taught and perpendicular to the body the urethra straightens which will facilitate the procedure.

Preparation

Carefully inspect and prepare all equipment before beginning the catheterization. Sterile gloves should be worn when equipment is handled and while the procedure is carried out. Arrange the contents of the catheterization tray on a bedside table. Check the integrity of the retention balloon and securely attach the catheter to the collection tube on the drainage bag. Pour the antiseptic solution on the cotton balls and lubricate the tip of the catheter.

Catheterization

Place the patient in a supine position on the stretcher or bed. Retract the foreskin if needed. Next, inject of viscous lidocaine into the urethra. This will anesthetize the urethra but also distends the urethra. Firmly pinch the end of the penis for several minutes to retain the lidocaine within the urethra. Place the sterile drape over the patients thighs and pubic region. Grasp the shaft of the penis with your non dominant hand. This hand will now be considered to be non-sterile and should not let go of the penis for the remainder of the procedure. Cleanse the head of the penis with antiseptic soaked cotton. During insertion, the penis is held upright, perpendicular to the body. Place the tip of the catheter into the meatus and advance it slowly and gently through the urethra. Never force the catheter since this may create a false passage or other urethral trauma. Continue to hold the penis upright to straighten the penile urethra. Some resistance may be encountered as the catheter reaches the level of the external sphincter. Instruct the patient to breathe deeply to relax the sphincter. Apply slow continuous pressure to the catheter and advance the catheter to the level of the side channel. Before inflating the balloon, confirm proper placement by observing the flow of urine into the collection tube. If no urine is returned, the catheter is probably obstructed by lubricating jelly and should be flushed with saline. Once proper placement is confirmed, inflate the retention balloon with 10 milliliters of water. Saline should not be used. It is important to inflate the balloon while the catheter is fully inserted to avoid inflation while the ballon is still in the urethra. Next, gently pull the catheter back to seat the retention balloon against the bladder wall. If the patient is uncircumcised, pull the foreskin back over the glands. Finally, secure the collection tube to the thigh.

Troubleshooting

Catheterization may be difficult to perform in patients with prostatic enlargement. This is usually sensed as resistance to the advancement of the catheter at approximately 16-20 centimeters. Use of a Coude' catheter may alleviate this problem since it's firm curved tip may traverse the exaggerated curve of the urethra. If a Coude' catheter is not available, use of a French Foley catheter may be used. If a catheter cannot be advanced, urological consultation must be obtained if you are unable to enter or advance through the urethra due to Phimosis, Meatal Stenosis or Urethral Stricture. Never forcefully advance the catheter.

Complications

Urinary tract infections are common after urethral catheterization. Although many cases are limited to asymptomatic bacteria, significant illness or death may result. The single best way to avoid catheter related infections is to avoid catheterization whenever possible. Additional complications of urethral catheterization include Paraphimosis, Trauma to urethra and bladder and Non-deflation of the retention balloon.

Additional reading "How To Insert A Male Catheter."