Difficult Catheterization Articles


  • The Challenge of Difficult Catheterization in Men: A Novel Technique and Review of the Literature



    Male urethral catheterization can be difficult and is still a familiar problem for urologists. A laborious male urethral catheterization is often consequent to the presence of a bulky prostate due to benign prostatic enlargement, a condition intimately related to aging with an increasing prevalence in elderly people. The task of passing a urethral catheter in this atypical condition often leads to repeated and unsuccessful attempts, which can cause the patient distress, and are often related to a wide range of complications, sometimes leading to medico-legal lawsuits.

    We describe a simple and safe technique only requiring equipment readily available in every urology department. It facilitates the chances of an atraumatic and successful catheter insertion in men suffering from different pathologic or anatomic conditions when a primary attempt of simple transurethral catheterization fails.

    The performance of the technique was tested in 76 patients who required bladder catheterization by a urologic consultant because of failed primary attempts. Difficulties were attributable to past transurethral resection of the prostate in 10 patients, past open radical retropubic prostatectomy in 7, and benign prostate enlargement in 59. Successful catheterization was obtained in 65 patients, 5 patients were otherwise catheterized by a rigid catheter, and 6 required a suprapubic catheter or flexible cystoscopy. Complications comprised self-limiting urethral bleeding in 12 patients, urinary tract infection in 4, and false passage in 2.

    The technique is well tolerated and increases the likelihood of successful primary urethral catheterization in this set of patients; moreover, a hospital admission that is needed in case of placing a suprapubic catheter is not required.

    Mario Gardi, Giulio Massimo Balta, Marcello Repele, Nicola Zanovello, Giovanni Betto, Simonetta Fracalanza, Wanni Battanello, Bruno Santoni, Silvia Secco, Andrea Agostini, Massimo Dal Bianco

    Submitted June 1, 2013 - Accepted for Publication July 31, 2013

    KEYWORDS: Difficult catheterization, bulky prostate, prostate enlargement, complication, malpractice

    CORRESPONDENCE: Mario Gardi, MD, PhD, Urology Unit, Department of Surgery, Ospedale Sant’Antonio, Building G, Via Facciolati, 71, Padova, Italy ()

    CITATION: UroToday Int J. 2013 August;6(4):art 53. http://dx.doi.org/10.3834/uij.1944-5784.2013.08.12

    Published August 11, 2013