Abstract
To determine the prevalence of different approaches to the difficult urethral catheterization (DUC) among urology residents (UR) in the United States (US). An email invitation to participate in an online survey regarding DUC was sent to 267 UR and to 22 urology program coordinators for them to forward to their residents. 142 UR completed the survey. After the initial unsuccessful attempt by a nurse, 92% of UR attempted a catheter prior to resorting to other modalities. The most common choice of the first catheter was a Coude (76%) size 18F (51%). For situations where multiple sizes and types of catheters (12-20F) were used without success, 3 scenarios were proposed: 1) Catheter passed the bulbomembranous urethra (BMU) and patient had previous history of transurethral resection of the prostate or radical retropubic prostatectomy, 2) Catheter passed the BMU and no urologic history, 3) Catheter did not pass the BMU and no urologic history. Flexible cystoscopy was used in 74%, 62% and 63%; blind passage of a glidewire was second with 15%, 23% and 20%; and blind use of filiforms and followers was chosen in 7%, 9% and 9% of the scenarios respectively. The most common approach to the DUC among UR in the US involves using an 18F Coude catheter first. After trying one or more urethral catheters, UR most commonly resort to flexible cystoscopy as opposed to the blind placement of glide wires or filiforms/followers.
Highlights
The difficult urethral catheterization (DUC) is one of the most common consultations for the general urologist
Flexible cystoscopy was used in 74%, 62% and 63%; blind passage of a glidewire was second with 15%, 23% and 20%; and blind use of filiforms and followers was chosen in 7%, 9% and 9% of the scenarios respectively
After trying one or more urethral catheters, UR most commonly resort to flexible cystoscopy as opposed to the blind placement of glide wires or filiforms/followers
Summary
The difficult urethral catheterization (DUC) is one of the most common consultations for the general urologist. Common approaches include trying different sizes/types of catheters, the Liss maneuver [2], catheter guides using lidocaine jelly, filiforms/followers, blind passage of a glidewire [3], flexible cystoscopy to place a glidewire [4], suprapubic catheter, etc. Filiforms/followers and catheter guides were the main invasive devices used by urologists to assist with the DUC. Teaching flexible cystoscopy is easy in the sense that the instructor knows what is happening. This is analogous to the teaching of the use of forceps in obstetrics: any obstetrician would agree that it is easier to teach how to do a C-Section. Our objective was elucidating which approaches are used by UR in the US for the DUC
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