Makindo Medical Notes

💉 Male urethral catheterisation = common procedure to drain urine. Requires strict aseptic & "no-touch" technique to minimise infection. Patient consent, proper technique, and post-procedure care are essential for safety.

📌 Indications

• 🚨 Acute urinary retention → confirmed by bedside bladder scan.
• 🩺 Pre-op: urological or pelvic surgery.
• 📊 Accurate urinary output monitoring (e.g., ITU).
• 💧 Measuring post-void residuals.
• ♿ Intermittent self-catheterisation (e.g., neurogenic bladder).
• 🩸 Haematuria with clot retention → requires large-bore 3-way catheter (specialist advice).

⛔ Contraindications

• ⚠️ Suspected urethral injury (blood at meatus, pelvic trauma) → urgent urology referral.
• 💊 Recent thrombolysis (↑ bleeding risk).

⚠️ Complications

• 😣 Pain, discomfort.
• ➡️ Urethral strictures, perforation.
• 🩸 Bleeding (↑ risk with anticoagulation/antiplatelets).
• 🦠 Infection: asymptomatic bacteriuria, cystitis, prostatitis, urethritis, epididymo-orchitis.
• 🫁 Severe infection: pyelonephritis, urosepsis.

📝 Preliminaries

• Gain informed verbal consent.
• Use a chaperone.
• Ensure an assistant is available (sterile support once gloved).

🧰 Equipment

• Sterile gloves + catheterisation pack (drape, antiseptic, receiver).
• 12–14 Fr male Foley catheter.
• Catheter bag + securement device.
• Antiseptic solution (e.g., povidone-iodine, chlorhexidine).
• Instillagel® (lignocaine gel, lubricant + anaesthetic + antiseptic).
• 10 ml syringe prefilled with sterile water (for balloon inflation).

🪛 Steps

1. Explain, consent, position patient supine, legs apart. Maintain privacy.
2. Hand hygiene → sterile gloves → prepare sterile field.
3. Drape patient, expose penis only.
4. Clean glans/urethral meatus with antiseptic. Retract foreskin if uncircumcised (⚠️ prevent paraphimosis).
5. Instill lignocaine gel into urethra → wait 5 mins for anaesthetic effect.
6. Hold penis upright at 60–90° angle. Insert catheter using sheath (“no-touch” technique). Advance slowly until urine drains.
7. Advance a further 2–3 cm to ensure balloon is in bladder (⚠️ never inflate in urethra).
8. Inflate balloon with 10 ml sterile water (not saline – prevents crystalisation). Gently withdraw until balloon rests at bladder neck.
9. Connect to drainage bag, secure catheter, reposition foreskin.

❌ Common Difficulties

• Phimosis → may need urology review.
• Prostatic obstruction → use Coude-tip catheter or larger, stiffer silicone catheter.
• Bladder neck resistance → try smaller catheter size.

📝 Post-procedure

• Document urine volume, colour, clots, and ease/difficulty of insertion.
• Send urine for culture if indicated.
• Always reposition foreskin → prevent paraphimosis.
• Dispose safely, hand hygiene, patient comfort check.

🌟 Teaching Pearls

• “Balloon before bag”: always confirm urine flow before inflating balloon.
• “Foreskin forward”: always reposition foreskin post-procedure.
• Consider suprapubic catheter if repeated urethral catheterisation fails.

📚 References

• NCBI Bookshelf – Male Urethral Catheterisation
• Merck Manual – Catheterisation
• AAFP – Urethral Catheterisation
• UPMC Catheterisation Guide