Managing difficult emergency catheterization: what do urologists want?

Abstract

Objectives: Acute urinary retention (AUR) is a common urological emergency; however, when approaching a difficult catheterization, this is an evidence-free zone. Our objective is to investigate current practice with the intent to reach a workable consensus for the management of patients in AUR who cannot be easily catheterized urethrally. Subjects: We performed a hypothetical scenario-based, multideanery survey with urology consultants and ST3+ trainees. Participants were asked how they would manage three patients who prove difficult to catheterize using standard methods: benign prostatic obstruction (BPO), urethral stricture, and meatal stenosis. Results: Of respondents, 38% ( n=23) indicated that a 16F curved-tip silicone catheter would be their first choice in managing a patient with BPO, followed by a suprapubic catheter (SPC) (20%, n=12) if this failed. SPC would be the first-line option for patients with a urethral stricture for 67% ( n=40) consultants, and for those with meatal stenosis, 60% would use a meatal dilator followed by SPC (22%, n=13) if this failed. Conclusion: Although there are general trends in preference towards managing a patient who is difficult to catheterize with AUR, there still remains considerable variation in practice due to lack of evidence in this area. We would recommend further multicentre data determining guidelines for best practice.