Urethral Catheterization

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Urethral Catheterization

• Jerome Green MD
• Jim Watterson MD, FRCS
• January 14, 2003

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Outline

• catheterization
• contra/indications, complications, catheters,
  procedures
• difficult catheterization
• reasons, options
• suprapubic cystotomy
• I C/I, complications

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Indications for Catheterization

• Drain bladder
• OR
• Intubated pt
• Retention
• Neurogenic bladder
• Monitor output
• Trauma
• Medical (CHF, RF, sepsis)
• C S specimen

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Indications

• Hematuria
• Diagnostic studies
• Residual
• Radiographic contrast studies
• Renal function (24 h)
• Urodynamics

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Contraindications

• Blood _at_ meatus in trauma setting
• not post-iatrogenic traumatic insertion
• Trauma
• Blood _at_ meatus- RGU Cystogram CT
• Gross hematuria post catheter- Cystogram CT

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Retrograde Urethrogram
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Duration

• Intermittent / In Out
• CIC- usually colonized
• Indwelling
• 4 colonization / day

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Complications of Catheterization

• Short Term
• Trauma
• False passage
• Hematuria
• UTI

• Long Term
• colonization
• urethral sloughing
• malignancy
• stones
• hematuria
• obstruction
• stricture

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Catheters

• Size
• French (FR) 1 Fr 0.33 mm
• Material
• Latex
• Silicone (scilastic)
• Type

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Type of Catheter

• Way
• 1 vs 2 vs 3 way
• Design
• Foley
• Coude (Tieman)
• Malecot
• Counsel
• Holes
• hematuria
• 6 eyed

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Equipment

• Foley trays
• Gloves, drapes, bottle, gauze, lubricant
• General Campus prep, syringe w/ water
• Collection bag
• 2 xylocaine (Urojet)
• Catheter
• extra set of hands

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Procedure

• Sterile technique
• Lubricant in male and on catheter
• Penis to the sky

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Procedure

• Penis to the sky
• No force needed
• not an orthopedic procedure
• DO NOT INFLATE UNTIL URINE SEEN
• Can irrigate in out
• Inflate with hub at meatus in males

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Procedure
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N.B.

• Antibiotics
• Infected short course
• SBE prophylaxis
• traumatic
• Lubricants your friend
• Latex allergy
• water (not saline)
• Reduce foreskin (paraphimosis)

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DEMONSTRATION
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Difficult catheterization
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Difficult catheterization

• History attempts, PMHx, surgery, LUTS
• P/E- abdomen, genitals
• Instrumentation
• Why?
• Where?
• Options?

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Difficult catheterization

• Youre in (urine)
• Bladder empty
• Irrigate with fluid

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WHY Difficult catheterization??

• Females
• exposure
• lots of hands
• Female hypospadius
• Tieman run along finger
• Urethral stenosis
• Introital mass

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WHY Difficult catheterization??

• Males
• exposure
• phimosis
• hypospadius
• meatal stenosis

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WHERE Difficult catheterization

• Males
• meatus
• urethral stricture
• sphincter
• prostate (BPH/Cancer)
• bladder neck

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Options???

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Difficult Catheterization

• Lubricant
• Catheter
• Size
• Type eg. Coude (Tieman)
• Filiforms and Followers
• Stylet
• Flexible Cystoscope and Guide Wire
• Suprapubic Tube

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WHERE is Difficulty ??

• Males
• Meatus- dilatation ( sounds, snap), lubricant
• urethral stricture- f f, scope, SP
• Sphincter- lubricant, relaxation
• prostate (BPH/Cancer)- ff, scope, SP
• bladder neck- stylet, ff, scope, SP

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Suprapubic Cystostomy

• should be familiar to all surgeons
• percutaneous approach
• different from OR formal procedure
• 24-32 Fr malecot cut down

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SP Tube

• Indications
• unable to catheterize per urethra
• Traumatic urethral disruption
• Full bladder
• Contraindications
• empty bladder
• known Bladder cancer
• Fem-fem bypass
• extensive scarring (relative)
• clot hematuria (relative)

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SP Tubes

• U/S guided
• MacGyver
• Cystocentesis 22 G spinal needle
• Seldinger- Central line, femoral art line
• SP Kits ( 10 16 Fr)
• Balloon
• Malecot
• Pigtail

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SP Equipment

• sterile procedure tray
• SP kit
• 22 G spinal needle, local anesthetic, scapel
  blade, 3 x 10cc Syringes, nonabsorb. suture
• drainage bag

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SP Procedure

• Landmarks
• Midline, 2 fingerbreaths above symphasis
• Percuss bladder
• Local anesthetic
• Infiltrate skin, then perpendicular to skin,
  aspirate as you go beyond fascia
• 22 G spinal with syringe- to sacrum (perp) and
  aspirate
• Mark depth of bladder with a hemostat

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SP Procedure

• if no urine, try superior approach
• once aspirate, mark with hemostat
• set up SP with trocar and syringe
• aspirate until same distance plus 1 cm
• remove trocar
• malecot / inflate balloon/ tie pigtail
• secure with nonabsorbable suture

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SP Tube Complications

• Bleeding
• urinary (bladder/prostate) or extraurinary
• Catheter Obstruction
• irrigate routine prn
• ensure not displaced
• Adjacent organs i.e. bowel
• use 22 G spinal needle

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SP DEMONSTRATION
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Summary

• select the right catheter
• lots of Lube
• think of where difficulty lies
• SP tube
• Contraindications
• 22 Gauge needle

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To bring to session