Male Urethral Catheterisation
💉 Male urethral catheterisation = common procedure to drain urine.
Requires strict aseptic & "no-touch" technique to minimise infection.
Patient consent, proper technique, and post-procedure care are essential for safety.
📌 Indications
- 🚨 Acute urinary retention → confirmed by bedside bladder scan.
- 🩺 Pre-op: urological or pelvic surgery.
- 📊 Accurate urinary output monitoring (e.g., ITU).
- 💧 Measuring post-void residuals.
- ♿ Intermittent self-catheterisation (e.g., neurogenic bladder).
- 🩸 Haematuria with clot retention → requires large-bore 3-way catheter (specialist advice).
⛔ Contraindications
- ⚠️ Suspected urethral injury (blood at meatus, pelvic trauma) → urgent urology referral.
- 💊 Recent thrombolysis (↑ bleeding risk).
⚠️ Complications
- 😣 Pain, discomfort.
- ➡️ Urethral strictures, perforation.
- 🩸 Bleeding (↑ risk with anticoagulation/antiplatelets).
- 🦠 Infection: asymptomatic bacteriuria, cystitis, prostatitis, urethritis, epididymo-orchitis.
- 🫁 Severe infection: pyelonephritis, urosepsis.
📝 Preliminaries
- Gain informed verbal consent.
- Use a chaperone.
- Ensure an assistant is available (sterile support once gloved).
🧰 Equipment
- Sterile gloves + catheterisation pack (drape, antiseptic, receiver).
- 12–14 Fr male Foley catheter.
- Catheter bag + securement device.
- Antiseptic solution (e.g., povidone-iodine, chlorhexidine).
- Instillagel® (lignocaine gel, lubricant + anaesthetic + antiseptic).
- 10 ml syringe prefilled with sterile water (for balloon inflation).
🪛 Steps
- Explain, consent, position patient supine, legs apart. Maintain privacy.
- Hand hygiene → sterile gloves → prepare sterile field.
- Drape patient, expose penis only.
- Clean glans/urethral meatus with antiseptic. Retract foreskin if uncircumcised (⚠️ prevent paraphimosis).
- Instill lignocaine gel into urethra → wait 5 mins for anaesthetic effect.
- Hold penis upright at 60–90° angle. Insert catheter using sheath (“no-touch” technique). Advance slowly until urine drains.
- Advance a further 2–3 cm to ensure balloon is in bladder (⚠️ never inflate in urethra).
- Inflate balloon with 10 ml sterile water (not saline – prevents crystalisation). Gently withdraw until balloon rests at bladder neck.
- Connect to drainage bag, secure catheter, reposition foreskin.
❌ Common Difficulties
- Phimosis → may need urology review.
- Prostatic obstruction → use Coude-tip catheter or larger, stiffer silicone catheter.
- Bladder neck resistance → try smaller catheter size.
📝 Post-procedure
- Document urine volume, colour, clots, and ease/difficulty of insertion.
- Send urine for culture if indicated.
- Always reposition foreskin → prevent paraphimosis.
- Dispose safely, hand hygiene, patient comfort check.
🌟 Teaching Pearls
- “Balloon before bag”: always confirm urine flow before inflating balloon.
- “Foreskin forward”: always reposition foreskin post-procedure.
- Consider suprapubic catheter if repeated urethral catheterisation fails.
📚 References
