Makindo Medical Notes

Male urethral catheterisation is a common medical procedure performed to drain urine from the bladder. Adhering to aseptic and 'no-touch' techniques is essential to minimize the risk of introducing infections. Proper technique, precautions, and post-procedure care are crucial to ensure patient safety and comfort.

Indications

• Acute urinary retention: Confirmed by a post-void bedside bladder scan showing retained urine volume.
• Prior to urological or pelvic surgery.
• Monitoring urinary output.
• Measuring urinary volumes.
• Self-catheterisation for neurological conditions.
• Bowel irrigation: Often for severe haematuria to prevent clot retention, requiring a larger catheter and specialist urological advice.

Contraindications

• Suspected urethral injury (e.g., trauma to the penis or pelvis) - may present with blood at the meatus.
• Recent thrombolysis (e.g., stroke thrombolysis) due to increased risk of localized bleeding.

Complications

• Pain and discomfort.
• Urethral strictures.
• Urethral perforation.
• Bleeding, especially if the patient is on anti-thrombotics or anticoagulants.
• Infections: Asymptomatic bacteriuria, cystitis, prostatitis, urethritis, epididymo-orchitis.
• Severe infections: Pyelonephritis, urosepsis.

Preliminaries

• Obtain verbal consent from the patient.
• Use a chaperone during the procedure.
• Ensure assistance is available once gloves are donned.

Equipment

• Sterile gloves.
• Catheterisation pack: includes antiseptic solution, drape, sterile paper towels, and a container for urine.
• 12-14 Fr male Foley catheter.
• Catheter bag.
• Antiseptic solution (e.g., povidone-iodine).
• Lignocaine gel for local anesthesia.
• 10 ml saline-filled syringe for balloon inflation.

Steps

1. Explain the procedure to the patient and ensure they are comfortable lying supine with legs slightly apart, maintaining privacy.
2. Prepare a sterile field by opening the catheter pack on a flat surface and pouring antiseptic solution into the receiver. Avoid direct contact with sterile components.
3. Wash hands thoroughly with soap and dry them. Put on sterile gloves.
4. Drape the patient with a sterile cover, exposing only the penis.
5. Hold the penis with a sterile swab and clean it thoroughly. In uncircumcised males, retract the foreskin carefully to avoid paraphimosis.
6. Apply lignocaine gel to the urethral meatus and allow it to anesthetize the area for approximately 5 minutes.
7. Hold the penis straight and gently insert the catheter by its plastic sheath, avoiding direct contact with the catheter itself. Advance the catheter slowly until urine begins to flow.
8. Once urine is detected, continue to advance the catheter a few more centimeters to ensure proper placement.
9. Inflate the balloon with 10 ml of saline once urine flow is confirmed, ensuring the catheter is securely in the bladder.
10. Attach the catheter bag and gently pull on the catheter to secure it. Ensure the balloon is properly inflated to prevent accidental removal.

Difficulties

• Phimosis: Tight foreskin making retraction difficult. If the opening is too narrow, consult urology.
• Failure to Pass the Prostate: Try a larger diameter or a more rigid silicone catheter.
• Failure to Pass the Bladder Neck: Use a smaller size catheter.

Post Procedure

• Document the volume of urine and any abnormalities (e.g., blood) in the patient’s notes.
• Send a urine sample for analysis if clinically indicated.
• Ensure the foreskin is repositioned to avoid paraphimosis.
• Dispose of all used materials appropriately and perform hand hygiene.

References

• Male Urethral Catheterisation - NCBI Bookshelf
• Merck Manuals - Male Urethral Catheterization
• American Family Physician - Urethral Catheterization
• UPMC - Male Catheterization Procedure Guide