Procedural videos

Male urethral catheterisation animated demonstration

Equipment needed

  • Latex or silicone Foley catheter (14 French gauge for general use; with prostatic hypertrophy a larger 16 French gauge may be easier to pass due to its greater rigidity; sizes from 12 French to 24 French may be needed depending on the situation)

  • Sterile drape

  • Sterile paper towel (preferably fenestrated)

  • Sterile gloves

  • Plastic apron

  • Sterile pot

  • Kidney dish

  • 10 mL syringe filled with 10 mL sterile water (NOT saline)

  • Lubricating anaesthetic gel (e.g., lignocaine gel) in a pre-filled 10 mL syringe

  • Swabs and saline solution (not chlorhexidine or other cleaning solutions, as these can be irritating to the skin).

Contraindications

Do not perform urethral catheterisation after pelvic trauma, especially if there is suspicion of urethral injury that may accompany a pelvic fracture, for example. In patients with a urethral injury, there is a risk that the catheter may pass straight through the urethra and into the surrounding tissues. In these patients, arrange for further imaging of the urethra before attempting catheterisation.

If you fail to insert a urethral catheter on two or more occasions, seek a more experienced clinician for assistance. It may be necessary to use a curved coude tip catheter, a smaller or larger catheter, or a three-way irrigation catheter.

If the patient has capacity and refuses urethral catheterisation after sufficient communication and understanding, do not perform the procedure against their wishes.

Phimosis, hypospadias, and penile deformity may make urethral catheterisation more difficult but they are not contraindications.

Indications

  • Acute retention of urine

  • Perioperative urinary collection

  • Accurate measurement of urine output in the acutely or critically unwell

  • Re-insertion of a long-term urinary catheter

  • Prostatic enlargement with chronic bladder obstruction

  • Bladder irrigation or instillation.

Patients with urinary incontinence and immobility may need catheterisation but these are not clear indications. Clinicians must balance the risk of infection against the convenience of the catheter.

Complications

  • Failure to catheterise: seek help from a more experienced clinician

  • Urinary tract infection: remove the catheter and give antibiotics as directed by local policy

  • Bleeding: minor bleeding is common and generally stops spontaneously; for more significant urethral haemorrhage seek expert advice from a more experienced clinician

  • Creating a false passage: forceful catheterisation can lead to formation of blind ending passages making it increasingly difficult to catheterise the true urethra and creating traumatic bleeding; avoid using force during catheterisation at all times

  • Blocked catheter: may result from clots or other debris. Aspirating or flushing the catheter with sterile water may clear the lumen; however, repositioning may be required. The patient may need irrigation with a three-way catheter if haematuria and retention of clots recur.

Aftercare

Documentation:

Clearly document that the patient’s consent was obtained. Also document the volume of sterile water instilled into the balloon and the residual volume of urine. It may also be sensible to document the colour and quality of the urine produced, and whether there were any complications to the procedure.

Catheter bag:

After successful positioning of the catheter ensure it is draining adequately and that the correct type of urine collection bag is attached.

  • A urometer may be required to measure hourly urine volumes accurately

  • Leg-bag attachments are available for the ambulant patient.

Removal:

Once the patient no longer requires the catheter, remove it as soon as possible to prevent infection. Deflate the balloon before removing the catheter.