From basics to referrals.

1. URETHRAL CATHETERIZATION
DR. SURESH KUMAR
MBBS (MAMC)
PG RESIDENT RADIO-DIAGNOSIS (AIIMS NEW DELHI)
FORWARDED FOR REVIEW TO
DR. MANISH KHATTAR
SR UROLOGY (AIIMS NEW DELHI)

2. Introduction
 Putting a hollow tube through urethra in to bladder for
urine drainage
filling of urinary bladder
 Among the most ancient medical devices in the historical record {Hippocratic text on
diseases}
 Avicenna’s Canon of Medicine, mention urethral catheterization as a means to deliver
intravesical therapy
 Early catheters included hollow tubes made of bronze, paper, animal hide, cloth
soaked in wax, lead, silver, brass, and copper
 Self-retaining balloon catheter was introduced in the 20th century by Foley

3. Indications
1. Bladder drainage
2. Instillation of diagnostic or therapeutic agents
 Relief of acute or chronic urinary retention
 Bladder outlet obstruction (BPH)
 Neurogenic bladder dysfunction (stroke, spinal injury)
 Monitoring urinary output
 Bladder drainage in perioperative period
 Healing after lower urinary tract surgery/trauma
 Access to the bladder for urinary tract imaging studies such as cystography
 Instillation of pharmacologic agent (mitomycin, BCG)

4. Basic understanding of urinary
catheters
Size of catheter is denoted in French (Fr) gauze
and it's the outer circumference of catheter
 indicates the total circumference of the catheter and not the lumen
size
1 Fr = 1/3 mm
e.g. 18 French foley's catheter will have outer
circumference of 6 mm.

5. Catheter selection
3-way, 2-way and single lumen cathter

6. Mechanism based classification
1.Urethral catheters -
May be indwelling or
intermittent type. Some
part of catheter resides in
the bladder, urethrally
placed. Commonly known
as Foley's catheter.

7. Short term (Intermittent)
catheters
In home setting, peoples are
trained to apply catheters
themselves,
also known as
CIC (Clean intermittent
catheterization)
Most of these patients have
neurological conditions like
stroke, Multiple sclerosis, Spinal
cord injury and Parkinson's
disease.
Nelaton cathter used for CIC

8. 2.Suprapubic catheters
Placed suprapubically by
urologist or inteverntional
radilogist under USG
guidence.

9. 3. External catheters( condom
catheters )
Used in men who don't have
urianry retention problems but
serious functional or mental
disablities such as dementia.

10. Catheter material
1. Simple rubber catheters
eg. Red rubber catheter
Inexpensive and most commonly
used.
But latex is associated with urethral
inflammation, encrusting on the
surface of catheter. So used for
shorter duration.
After 1 week there is risk of
bacteriuria in more than 50 %
cases.

11. 2. Plastic catheters
eg. Infant feeding tube.
Used in infant and
paediatric population
should be discouraged
because their
stiffness and length can be
a source of complications

12. 3. Silicone catheter
Used for longer durations (
> 1 months)

13. Foley catheter
The name comes from the designer, Frederic Foley,who was a surgeon.

14. Types
1. Double lumen - futher classified in
two types
a) Coudé (elbowed) catheters- have
a 45 degeee bend at the tip that
facilitates easier passage through an
enlarged prostate.
b)Councill tip catheters-have a small
hole at the tip so they can be passed
over a wire.

15. 2.Three way (lumen) foley
catheter
• Has both property of irrigation and
drainage.
• Used to irrigate bladder in cases
of bladder surgery or clots.

16. Basic structure of Foley catheter

17. Foley catheter
 Catheter size is individualized
 In adults generally 14-16 French gauze
foley catheters are used
 In patients with BPH larger size(18 F)
catheter are preferred.
 Even larger size are preferred for drainage
of heamaturia or bladder clots.
 May be Rubber or silicone made.
FOLeY
GOReY

18. Male urethral catheterization
Selection of catheter
Hand wash and wear gloves
Clean the genitalia with soapy antiseptic (betadine)
Insert the lignocaine jelly* till posterior urethra and
Leave the penis clamped for several minutes so that urethra get anesthetized
Attach the uro-bag with foley catheter
Insert the catheter till full length and inflate the balloon according to capacity*
Watch for urine output

19. Female urethral catheterization
Selection of catheter
Hand wash and wear gloves
Clean the genitalia with soapy antiseptic (betadine)
Attach the uro-bag with foley catheter
Insert the catheter till 3-5 cm and inflate the balloon
Watch for urine output

20. Failed urethral catheterization
1. Poor technique.
2. Local anaesthetic failure.
3. Urethral stricture (Ask for history of obstructive symptoms)
4. Large prostatic middle lobe.
Management of failed urethral catheterization
 Suprapubic cystostomy
 Urethral instrumentation

21.  Suprapubic cystostomy
1.Suprapubic puncture with commercially available catheters is
straightforward provided that the bladder is palpable.
a) The skin, fascia and retropubic space are anaesthetised with 0.5% lidocaine. Correct
placement is confirmed by aspiration. A large-bore needle is then placed into the bladder,
down which a fine catheter is passed (Cystofix) and then secured in position.(No trocar)
b) The other option is to place a plastic suprapubic trocar and cannula, which has a removable
plastic strip on the side. A standard 12F Foley catheter can be passed down the cannula,
the balloon is inflated, the cannula is extracted and the strip pulled away from the catheter
(Add-a-Cath). If urine cannot be aspirated through the fine-bore needle, passing a
suprapubic trocar should not be attempt.(With trocar)

24. c) Suprapubic puncture using a Seldinger technique (done by
interventional radiologist)

25.  2.If these devices are not available, a catheter can be placed in the bladder under direct
vision through a small incision under local anaesthetic.
 Urethral instrumentation
In a patient with a known stricture, an experienced urologist may elect to dilate the stricture with
a dilator or to take the patient to theatre to carry out an optical urethrotomy.

26. Removal of foley catheter
• Deflate the balloon with a syringe
up to max. capacity and pull
gently
Mx of burning sensation-
 Apply lignocaine jelly at
exposed/tip of urethra.

27. Failure to remove the catheter
 Encrustation of catheter
 Entrapment by sutures
 Inability to disengage/deflate the retaining balloon.
 due to a faulty valve, inflation channel blockage, or crystallization within the balloon
 Step wise troubleshooting
 gentle traction on the catheter
 place another 1 to 2 mL of fluid in the balloon to ensure normal balloon contour
 cut the inflation port
 insert a surgical steel wire/guidewire through the valve inflation lumen
 ultrasound-guided needle puncture of balloon

28. References
 Up to date.com
 Bailey and love's short practice of surgery (27th edition)
Thank you !