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Clinical Procedures > Genitourinary Procedures
Urethral Catheterization, Men
Article Last Updated: Aug 10, 2008
AUTHOR AND EDITOR INFORMATION
Section 1 of 14  
Author: Gil Z Shlamovitz, MD, Assistant Professor of Emergency Medicine, University of Connecticut School of Medicine; Attending Physician, Emergency Department, Windham Community Memorial Hospital, Willimantic, CT; Attending Physician, Emergency Department, Hartford Hospital, Hartford, CT
Gil Z Shlamovitz is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Editors: Andrew K Chang, MD, Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center; Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine; Luis M Lovato, MD, Assistant Clinical Professor, David Geffen School of Medicine at UCLA; Director of Critical Care, Department of Emergency Medicine, Olive View/UCLA Medical Center; Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital; Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Author and Editor Disclosure
Synonyms and related keywords:
foley, urethral catheter, urinary catheter, urethral catheterization, catheter placement, catheter insertion, Coudé catheter, Coudé, foley catheter, urine specimen, urine output, urinary tract, urethral tear
Urethral catheterization is a routine medical procedure that facilitates direct drainage of the urinary bladder.1 It may be used for diagnostic purposes (to help determine the etiology of various genitourinary conditions) or therapeutically (to relieve urinary retention, instill medication, or provide irrigation). Catheters may be inserted as an in-and-out procedure for immediate drainage, left in with a self-retaining device for short-term drainage (eg, during surgery), or left indwelling for long-term drainage for patients with chronic urinary retention. Patients of all ages may require urethral catheterization, but patients who are elderly or chronically ill are more likely to require indwelling catheters, which carry their own independent risks.
The basic principles underlying urethral catheterization are gender-neutral, but the specific aspects important in the technique of male catheterization are described in this article. For a procedural description for female patients, see Urethral Catheterization, Women.
For more information on urinary retention, see the Medscape CME activity Management of Urinary Retention Reviewed.
- Diagnostic
- Collection of uncontaminated urine specimen
- Monitoring of urine output
- Imaging of the urinary tract
- Therapeutic2
Urethral catheterization is contraindicated in the presence of traumatic injury to the lower urinary tract (eg, urethral tear). This condition may be suspected in male patients with a pelvic or straddle-type injury. Signs that increase suspicion for injury are a high-riding or boggy prostate, perineal hematoma, or blood at the meatus. When any of these findings are present in the setting of concerning trauma, a retrograde urethrogram should be performed to rule out a ureteral tear prior to placing a catheter into the bladder.2
Topical anesthesia is administered with lidocaine gel 2%.5, 6 Many facilities have a preloaded syringe with an opening appropriate for insertion into the meatus available either separately or in the catheter kit. To instill, hold the penis firmly and extended, place the tip of the syringe in the meatus, and apply gentle but continuous pressure on the plunger. See Technique for details. For more information, see Anesthesia, Topical.
- Commercial single-use urethral catheterization tray
Commercial urinary catheterization kit. - Povidone iodine
- Sterile cotton balls
- Water-soluble lubrication gel
- Sterile drapes
- Sterile gloves
- Urethral catheter7 (see Catheter Types and Sizes below)
- Prefilled 10-mL saline syringe
- Urinometer connected to a collection bag
- Sterile anesthetic lubricant (eg, lidocaine gel 2%) with a blunt tip urethral applicator or a plastic syringe (5-10 mL)
- Place the patient supine, in the frogleg position, with knees flexed.
- Explain the procedure, benefits, risks, complications, and alternatives to the patient or the patient's representative.
- Position the patient supine, in bed, and uncover the genitalia.
- Open the catheter tray and place it on the gurney in between the patient's legs; use the sterile package as an extended sterile field. Open the iodine/chlorhexidine preparatory solution and pour it onto the sterile cotton balls. Open a sterile lidocaine 2% lubricant with applicator or a 10-mL syringe and sterile 2% lidocaine gel and place them on the sterile field.
Preparatory solution in a commercial urinary catheterization kit.
- Wear sterile gloves and use the nondominant hand to hold the penis and retract the foreskin (if present). This hand is the nonsterile hand and holds the penis throughout the procedure.
Retraction of foreskin.
- Use the sterile hand and sterile forceps to prep the urethra and glans in circular motions with at least 3 different cotton balls. Use the sterile drapes that are provided with the catheter tray to create a sterile field around the penis.
Urethral preparation.
- Using a syringe with no needle, instill 5-10 mL of lidocaine gel 2% into the urethra. Place a finger on the meatus to help prevent spillage of the anesthetic lubricant. Allow 2-3 minutes before proceeding with the urethral catheterization.
Urethral analgesia.
- Hold the catheter with the sterile hand or leave it in the sterile field to remove the cover. Apply a generous amount of the nonanesthetic lubricant that is provided with the catheter tray to the catheter.
Foley lubrication.
- While holding the penis at approximately 90º to the gurney and stretching it upward to straighten out the penile urethra, slowly and gently introduce the catheter into the urethra. Continue to advance the catheter until the proximal Y-shaped ports are at the meatus.8
Urethral catheterization.
- Wait for urine to drain from the larger port to ensure that the distal end of the catheter is in the urethra. The lubricant jelly–filled distal catheter openings may delay urine return. If no spontaneous return of urine occurs, try attaching a 60-mL syringe to aspirate urine. If urine return is still not visible, withdraw the catheter and reattempt the procedure (preferably after using ultrasonography to verify the presence of urine in the bladder).
Urine return.
- After visualization of urine return (and while the proximal ports are at the level of the meatus), inflate the distal balloon by injecting 5-10 mL of 0.9% NaCl (normal saline) through the cuff inflation port. Inflation of the balloon inside the urethra results in severe pain, gross hematuria, and, possibly, urethral tear.
Cuff inflation.
- Gently withdraw the catheter from the urethra until resistance is met. Secure the catheter to the patient's thigh with a wide tape. Creating a gutter to elevate the catheter from the thigh may increase the patient's comfort. If the patient is uncircumcised, make sure to reduce the foreskin, as failure to do so can cause paraphimosis.
Securing the catheter.
- Insertion of a Coudé catheter9: The Coudé catheter, which has a stiffer and pointed tip, was designed to overcome urethral obstruction that a more flexible catheter cannot negotiate (eg, patients with benign prostatic hypertrophy). To place a Coudé catheter, follow the procedure described above. The elbow on the tip of the catheter should face anteriorly to allow the small rounded ball on the tip of the catheter to negotiate the urogenital diaphragm.
- Perineal pressure assistance: The distal tip of the catheter might become caught in the posterior fold between the urethra and the urogenital diaphragm. An assistant can apply upward pressure to the perineum while the catheter is advanced to direct the catheter tip upward through the urogenital diaphragm.
- Prophylactic antibiotics are recommended for patients with prosthetic heart valves, artificial urethral sphincters, or penile implants.
- Adults: Foley (16-18 F)
- Adults with obstruction at the prostate: Coudé (18 F)
- Children: Foley (5-12 F)
- Infants younger than 6 months: Feeding tube (5 F) with tape
The author would like to thank Steven Rogers, RN, for his help in videography.
The authors and editors of eMedicine gratefully acknowledge the assistance of Lars Grimm with the literature review and referencing for this article.
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Preparatory solution in a commercial urinary catheterization kit. |
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Urethral Catheterization, Men excerpt Article Last Updated: Aug 10, 2008
Topic originally published: Mar 6, 2006
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