Difficult Urethral Catheterization Research Articles

Use of guidewire in assisted urethral catheterization and urethral dilatation with Cook's S dilators: A viable option in resource limited setting

Difficult urethral catheterization (DUC) is a commonly encountered emergency by urologists. A review of literature describes many techniques which are not readily accessible in resource-limited settings. We present our recent experience with the use of Terumo hydrophilic guidewire in the management of DUCs and planned elective management of urethral strictures presenting this as a viable option in reducing the frequency of emergency suprapubic catheterization with its attendant risks and costs.

Approach to difficult urethral catheterizations in male patients during the Covid-19 pandemic

Background/Aim: Difficult urethral catheterization (DUC) is a frequent urological emergency in daily practice. Anticoagulant and antiaggregant drugs, included in the treatment protocols for COVID-19, tend to increase the risk of possible complications of alternative interventions, such as cystoscopy and suprapubic percutaneous cystostomy. Therefore, a less invasive method is needed in patients with DUC. This study aims to evaluate the results of Foley catheter insertion and urethral dilatation over a hydrophilic guidewire in patients with DUC. Methods: A total of 23 male patients who visited the urology outpatient clinic or were referred due to urinary retention or inability to place a Foley catheter in the last 8 months were included in this case series. The patient charts were evaluated retrospectively. After the hydrophilic guidewire, blindly advanced from the urethral meatus under sterile conditions, reached the bladder, a Foley catheter was placed over the guidewire. In cases of urethral stricture, dilatation was performed over the guidewire with the help of hydrophilic S-Curve dilators, and a Foley catheter of suitable diameter was placed. Results: A Foley catheter was successfully placed in 22 out of 23 patients. Urethral dilatation was performed in 13 patients due to urethral stricture, and a transurethral Foley catheter was placed in the other 10 patients without the need for dilatation. Although most of our patients (17 of 23 patients) were receiving anticoagulant or antiaggregant treatment during the procedure, no significant hemorrhagic complications occurred. A Foley catheter could not be placed in one patient with this technique; a percutaneous cystostomy catheter was placed instead. Conclusion: The results of this study, conducted during the COVID-19 pandemic, show that our technique is safe and successful. We believe that our technique will be useful in preventing additional surgical interventions due to complications, especially during this pandemic.

Totally robotic intracorporeal Monti-Yang continent ileovesicostomy in patient with previous robotic surgery–Technique description

We present a video case report of a pediatric patient with previous robotic abdominal surgery who underwent robotic assisted Monti-Yang continent ileovesicostomy. This 10-year-old female had a history of spina bifida, with previous myelomeningocele repair and ventriculoperitoneal shunt as an infant and robotic-assisted Malone procedure and artificial urethral sphincter placed 4 years ago. After undergoing bilateral hip surgery, she presented with difficult urethral catheterization due to reduced leg mobility. A Monti-Yang ileovesicostomy procedure was planned. A 5mm laparoscopic port placed through the umbilicus followed by four additional DaVinci XI working ports. Twenty centimeters proximal the ileocecal valve, a 3cm segment of ileum was dissected, then transected, detubularized, and retubularized around a 10 Fr catheter. This conduit was reimplanted to the anterior bladder wall. The other edge was fixed to the umbilicus. A 10 Fr Foley catheter was left clamped in the conduit, and a urethral Foley was left to gravity. Total operative time was 3h 56min. The patient did well post-operatively. She was discharged home on POD 6. Starting three weeks after surgery, the patient began catheterizing through the umbilical stoma. At 3 month follow-up, the patient catheterizes through her stoma every 3h without leakage between catheterizations.

Deficits in urological knowledge and skills among family medicine residents in Canada.

The last 10-15 years has seen a decline in formal undergraduate urological education throughout Canada. Given the large volume of urological presentations in family practice, trainees need to acquire the requisite urological knowledge and skills to serve their patients. The objective of this study is to determine the perceived level of urological knowledge and skills among Canadian family medicine residents. A 15-item, anonymous, online survey was distributed via email to all Canadian family medicine program directors from September to December 2018 and distributed to their residents. The survey obtained data on demographics, training, undergraduate urology experience, self-reported proficiency in interpreting urological investigations, performing common urological procedures, and managing common urological conditions. Descriptive statistics were used to summarize data. The questionnaire was completed by 142 family medicine residents with representation from Western Canada (27.5%), Ontario (32.4%), and Quebec (40.1%); 39.4% of respondents had completed a urology rotation during medical school and only 29.1% felt that their medical training prepared them for the urological aspects of family medicine. Although the majority of respondents felt proficient in performing a digital rectal examination (58.5%) or managing urinary tract infections (97.9%), only a minority felt competent in performing male genitourinary examination (40.1%), uncomplicated male (34.5%), female (45.8%) or difficult (9.2%) urethral catheterization. Likewise, the minority of respondents felt comfortable managing erectile dysfunction (41.5%), scrotal swelling (34.7%), and scrotal pain (25.7%). There are significant deficiencies in urological knowledge and skills among family medicine residents in Canada, possibly because of insufficient educational experiences during medical training.

Considerations for Bedside Urologic Procedures in Patients With Severe Acute Respiratory Syndrome Coronavirus-2

ObjectiveTo provide guidance when performing bedside urologic procedures on severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) positive patients and offer considerations to maximize the safety of the patients and providers, conserve supplies, and provide optimal management of urologic issues. MethodsUrologic trainees and attending physicians at our institution, who are familiar with existing safety recommendations and guidelines regarding the care of infected patients, were queried regarding their experiences to determine an expert consensus on best practices for bedside procedures for SARS-CoV-2 positive patients. ResultsOur team developed the following general recommendations for urologic interventions on SARS-CoV-2 positive patients: maximize use of telehealth (even for inpatient consults), minimize in-room time, use personal protective equipment appropriately, enlist a colleague to assist, and acquire all supplies that may be needed and maintain them outside the room. Detailed recommendations were also developed for difficult urethral catheterization, bedside cystoscopy, incision and drainage of abscesses, and gross hematuria/clot irrigations. ConclusionAs patients hospitalized with SARS-CoV-2 infection are predominantly men over 50 years old, there are significant urologic challenges common in this population that have emerged with this pandemic. While there is tremendous variation in how different regions have been affected, the demographics of SARS-CoV-2 mean that urologists will continue to have a unique role in helping to manage these patients. Here, we summarize recommendations for bedside urologic interventions specific to SARS-CoV-2 positive patients based on experiences from a large metropolitan hospital system. Regulations and requirements may differ on an institutional basis, so these guidelines are intended to augment specific local protocols.

Guidelines for difficult urethral catheterization in males.

Urethral characterization can be difficult for patients and providers alike. This article describes an evidence-based protocol for difficult urethral catheter insertions in male patients.

Tips and Tricks for Difficult Urethral Catheterization

Male urethral catheterization may be difficult in patients with enlarged prostate glands or other potentially obstructive conditions as urethral stenosis, after prostatic TUR undermining bladder neck, old and recent false passages, sphincteric spasm among others. Alternative techniques or tricks to surpass problematic urinary catheterization are usually known by experienced nurses and physicians. If repeated catheterization attempts are done, the risk of failing and complications appearing increase significantly. Improper insertion of catheters also may increase healthcare costs due to prolonged hospitalization, immediate and/or delayed surgical interventions transforming a minor technique into a huge problem for the patient, doctors, and healthcare system. Improved techniques for catheter placement are essential for all healthcare personnel involved in the management of the patient needing a urethral catheterization, including nurses and doctors from both primary and hospital medicine. The aim of this article is to show some tips and tricks that may be helpful for the blind placement of urethral catheters. The phrase primum non nocere acquires its maximum meaning in this context. Sanitary personal must be prudent in the number of attempts, have a clear strategy of what can be done in each moment and know how to stop or seek help in case of not being able to probe the patient in 2 or 3 attempts. If all these recommendations fail a urologist have to be required to place a catheter in a safe way including the use of endoscopic optic devices

A novel cannulation technique for difficult urethral catheterization.

To propose a novel cannulation technique for difficult urethral catheterization procedures. The sheath tip of an intravenous catheter is cut off, replaced to the needle tip and pushed through the distal drainage side hole to Foley catheter tip, and finally withdrawn for cannulation. In situations making urethral catheterization difficult, a guide wire is placed under direct vision. The modified Foley catheter is slid successfully over the guide wire from its distal end throughout the urethral passage into the bladder. The modified Foley catheter was used successfully in our clinic in cases requiring difficult urethral catheterization. This easy and rapid modification of a Foley catheter may minimize the potential complications of blind catheter placement in standard catheterization.

Modified sonourethrography assists urethral catheterization.

Sonourethrography (SUG) is an infrequently used modality to observe the male urethra. We modified SUG to examine the reasons for difficulty in urethral catheterization and to determine a safe approach to resolve these problems. Following retrograde urethral jelly injection, modified SUG (mSUG) was performed in male patients with difficulty in urethral catheterization. mSUG was performed using transcutaneous ultrasonography in patients for whom the catheter became lodged in the penile urethra. In other patients, mSUG was performed using transrectal ultrasonography. We divided the causes of difficult indwelling urethral catheterization into physiological and pathological conditions. With regard to physiological conditions, the urethral catheter became stuck in the bulbous portion, membranous urethra, and prostatic urethra. mSUG distinguished the problematic part of the urethra in real time, and it assisted in overcoming the problem. With regard to pathological conditions, urethral stricture after trauma or surgery was clearly demonstrated in the penile and prostatic portions of the urethra. As with physiological conditions, mSUG images assisted in navigating the catheter through the problematic pathological areas or demonstrated the need to abandon the catheterization. mSUG can visualize the male urethra clearly during urethral catheterization and provide real-time assistance with the procedure.

A clever technique for placement of a urinary catheter over a wire.

Objective:The objective was to present a straightforward, step-by-step reproducible technique for placement of a guide-wire into any type of urethral catheter, thereby offering a means of access similar to that of a council-tip in a situation that may require a different type of catheter guided over a wire.Materials and Methods:Using a shielded intravenous catheter inserted into the eyelet of a urinary catheter and through the distal tip, a “counsel-tip” can be created in any size or type of catheter. Once transurethral bladder access has been achieved with a hydrophilic guide-wire, this technique will allow unrestricted use of catheters placed over a wire facilitating guided catheterization.Results:Urethral catheters of different types and sizes are easily advanced into the bladder with wire-guidance; catheterization is improved in the setting of difficult urethral catheterization (DUC). Cost analysis demonstrates benefit overuse of traditional council-tip catheter.Conclusion:Placing urinary catheters over a wire is standard practice for urologists, however, use of this technique gives the freedom of performing wire-guided catheterization in more situations than a council-tip allows. This technique facilitates successful transurethral catheterization over wire in the setting of DUC for all catheter types and styles aiding in urologic management of patients at a cost benefit to the health care system.

Difficult Urethral Catheterization in Cardiovascular Surgery Patients: Do you have a Road Map?

Purpose : To report our approach and findings of intraoperative difficult urethral catheterization in cardiovascular surgery patients. Materials and Methods : A total of 60 male patients who underwent intraoperative urologic consultation during anesthesia preparation for the insertion of Foley catheter where urology team failed to insert the latex Foley catheter by the normal procedure, were enrolled in the study. The kind of problems encountered and the methods employed were considered in this paper. Results : In 4 (6.6%) out of 60 patients 14 F and 12 F silicone Foley catheters and in 6 patients (10%) 16 F Tiemann Foley catheters were inserted. Fifty patients (83%), in whom various types and sizes of Foley catheter could not be inserted, underwent rigid or flexible cystoscopy under endo-camera guidance. Eight of these patients (16%) underwent flexible cystoscopy, and 42 patients (84%) underwent rigid cystoscopy. The distribution of different pathologies seen in 50 patients, who underwent cystoscopy, was as follows: urethral calculi (2 patients), false passage (12 patients), bladder neck contracture or high bladder neck (16 patients), prostatic hypertrophy (8 patients), urethral stricture (12 patients). No micturition problem was observed during the follow-up. Conclusion : We should strive to resolve the problem of urethral catheterization with the least possible trauma especially in patients with increased risk of bleeding who are scheduled for cardiovascular surgery. We think that performing this endoscopic procedure by cystoscopy helps to define the existing pathology and to relieve the problem successfully.

A Hard Mass Discovered in the Corpus Spongiosum after Difficult Urethral Catheterization: Two Case Reports

Male urethral catheterization is a common procedure rarely causing complications. Difficult urethral catheterization, however, can be problematic for both clinician and patient, leading to unexpected complications. This article will present two unreported cases of urethral trauma during difficult catheterization that resulted in the development of a hard, tumor-like mass in the corpus spongiosum. This is a rare complication that if not recognized might lead to unnecessary invasive interventions for the patient.

Utility of a transabdominal ultrasound-guided method with digital rectal examination for difficult urethral catheterization

Utility of a transabdominal ultrasound-guided method with digital rectal examination for difficult urethral catheterization

Silicone Catheters May Be Superior to Latex Catheters in Difficult Urethral Catheterization After Urethral Dilation

Urethral dilation in the setting of difficult urethral catheterization is sometimes necessary to avoid suprapubic catheterization. Anecdotally, we have observed that less dilation is needed when advancing a silicone catheter over a Glidewire compared with a latex catheter of the same size. Our aim was to quantify the difference in the resistance to buckling between silicone and latex catheters. A BOSE Electroforce load testing device was used to test 12F and 16F silicone and latex catheters under tensile and compressive forces. This information was used to characterize the buckling (kinking) behavior of the catheters. Silicone catheters showed more than 50% greater resistance to kinking when compared with regular latex or coude latex catheters. In the setting of the difficult urethral catheterization, silicone catheters should be used after urethral dilation, advanced through a Glidewire, because they offer more resistance to buckling and might necessitate less dilation than conventional latex catheters.

The approach to the difficult urethral catheterization among urology residents in the United States

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.

The difficult urethral catheterization: use of a hydrophilic guidewire

The difficult urethral catheterization: use of a hydrophilic guidewire

A novel technique for difficult male urethral catheterization.

A novel technique for difficult male urethral catheterization.

A simple method using hydrophilic guide wires for the difficult urethral catheterization

A technique is described that enables successful urethral catheterization in difficult cases using a variety of catheter types and sizes. This method utilizes a urethral catheter that is loaded over a hydrophilic guide wire with the aid of an intravenous catheter. The devices utilized are routinely available to the urologist; therefore, the need for obtaining or stocking special equipment is obviated.

Difficult Urethral Catheterization due to Ectopic Ureter: an Unusual Presentation of Ureteral Ectopia in a Man

We report the unusual presentation of an ectopic ureter in a man with a solitary kidney. The presenting symptom was the inability to place a Foley catheter into the bladder because of preferential passage into the ectopic ureteral opening in the prostatic urethra. Flexible cystoscopy was helpful in diagnosis and management of the problem. The differential diagnosis of a difficult urethral catheterization should include occult congenital genitourinary anomalies.

Difficult Urethral Catheterization due to Ectopic Ureter

Difficult Urethral Catheterization due to Ectopic Ureter