Urethral Catheterization: Male (Internal Medicine)

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • Acute urinary retention
  • Urethral or prostatic obstruction leading to compromised renal function
  • Urine output monitoring in any critically ill or injured patient
  • Collection of a sterile urine specimen for diagnostic purposes
  • Intermittent bladder catheterization in patients with neurogenic bladder dysfunction
  • Urologic study of the lower urinary tract
CONTRAINDICATIONS
  • Urethral catheterization should be avoided when other less invasive procedures will be as informative.
  • The only absolute contraindication to urethral catheterization is trauma with suspected urethral injury, as evidenced by blood at the urethral meatus; an abnormal or high riding prostate felt during a rectal examination; or penile, scrotal, or perineal hematoma. These findings dictate the need for retrograde urethrography to define the integrity of the urethra before any attempted urethral catheterization.
EQUIPMENT
  • Foley catheter of appropriate size
  • Water-soluble lubricant for catheter
  • 10-mL syringe of sterile water for Foley balloon
  • Sterile drainage bag with tubing
  • Sterile drapes
  • Sterile gloves
  • Povidone-iodine
  • Sterile gauze pads or cotton balls
  • Sterile specimen cup with lid
  • Cloth, paper, or plastic tape (to secure catheter to trunk or leg)
  • Benzoin (for increasing tape adherence)
  • Forceps
ANATOMY
  • The male urethra is relatively fixed at the level of the urogenital diaphragm and symphysis pubis; traction downward on the penis kinks and promotes urethral folding at the level of the penile suspensory ligament.
  • The normal male urethra is approximately 20 cm long from the external urethral meatus to the bladder neck.
  • The posterior prostatic urethra is approximately 3.5 cm long, and the contiguous external sphincter or urogenital diaphragm that encompasses the membranous urethra is 4 cm from the bladder neck.
  • Table 1 lists the size of catheters and feeding tubes appropriate for all ages.

PROCEDURE
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  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Following placement of the catheter and balloon inflation, slowly withdraw the catheter until the approximation of the balloon with the bladder neck precludes further withdrawal.
  • Connect the catheter to a sterile leg bag or closed-system bedside drainage bag.
  • Secure the catheter to the thigh or place it under the knee to drain into the bedside drainage bag.
  • If the patient will be discharged with an indwelling Foley catheter, it can be connected to a leg bag that is comfortably fastened to the lower thigh and upper calf.
    • The patient and family must be instructed regarding proper care of the catheter and drainage device.
COMPLICATIONS
  • Although urethral catheterization performed by skilled personnel in appropriate circumstances has an acceptable complication rate, untoward sequelae of catheterization are not unusual.
  • Infection
  • Urethral stricture
  • Bladder stones
  • Hematuria
  • Retained catheter
  • Other rare complications of long-term indwelling urethral catheterization include recurring bladder spasm, periurethral abscesses, bladder perforation, and urethral erosion.
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