Transurethral catheterization

Last updated: September 5, 2023

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Summarytoggle arrow icon

Transurethral catheterization is a type of bladder catheterization procedure involving the insertion of a flexible catheter through the urethra into the bladder. It may be used for diagnostic evaluation or for conditions that require urinary drainage. It may be performed in both children and adults. There are no absolute contraindications to transurethral catheterization. It can be performed using an intermittent (straight) catheter (e.g., red rubber catheter) or an indwelling catheter (e.g., Foley catheter). Complications include hematuria, catheter-associated urinary tract infection (CAUTI), urethral injury, and catheter malfunction.

For other methods of urinary drainage, including suprapubic catheterization, see “Urinary drainage procedures.”

Indicationstoggle arrow icon

Diagnostic [2][3]

Therapeutic [2][3]

Contraindicationstoggle arrow icon

We list the most important contraindications. The selection is not exhaustive.

Technical backgroundtoggle arrow icon

Types of transurethral catheters [2]

  • Foley catheter
    • A thin, flexible, sterile tube used for continuous drainage
    • Held in the bladder by a water-filled balloon
    • Three-way Foley catheter: a large-gauge Foley catheter with three channels, allowing for bladder irrigation
  • Straight urinary catheter: a flexible catheter used for intermittent drainage that is removed after use [8]
  • Coude catheter
    • A thin, flexible catheter with a semirigid curved tip used for both intermittent and continuous drainage
    • Most commonly used if there is difficulty inserting a flexible straight tip catheter (e.g., because of prostatic enlargement)

Transurethral catheter selection [2]

General catheter recommendations for different patient groups are shown below; catheter size may vary based on patient anatomy. [9]

Landmarks and positioningtoggle arrow icon

Landmarks [2]

  • Penis
    • Urethral length: ∼ 20 cm
    • The urethra curves in an S-shape and passes through the prostate into the bladder.
  • Vulva
    • The urethral meatus is located between the labia minora, directly superior to the vagina and inferior to the clitoris.
    • Rarely, locating the urethral meatus via palpation may be necessary.

Positioning [2]

Equipment checklisttoggle arrow icon

The following equipment is included in most prepackaged catheterization kits. Become familiar with the equipment available. [2]

  • Sterile gloves
  • Sterile drape
  • Antiseptic and applicator forceps
  • Cotton swabs
  • Lubricating jelly and/or viscous lidocaine
  • Transurethral catheter
  • Syringe containing water or air
  • Collection bag or drainage system

Preparationtoggle arrow icon

  • Gather equipment at the bedside.
  • Ensure that the patient is in a comfortable position and that the urethral meatus is easily accessible.
  • Put on PPE and place the sterile drape.
  • Lubricate the catheter with viscous lidocaine and/or lubricating jelly.

For transurethral catheterization, the patient is draped prior to skin preparation.

Procedure/applicationtoggle arrow icon

Transurethral catheterization of the penis [2]

  1. Uncircumcised or partially circumcised penis: Retract the foreskin with the nondominant hand.
  2. Hold the penis taut and upright.
  3. Cleanse the urethral meatus with antiseptic, moving outwards in a circular motion.
  4. Inject 5–10 mL of viscous lidocaine into the urethra and allow time for the anesthetic to take effect.
  5. Insert the entire length of the catheter into the urethra.
  6. Inflate the catheter balloon using a syringe filled with the recommended volume of water or air.
  7. Withdraw the catheter slowly until resistance is met.
  8. Connect the catheter to a collection bag or drainage system.
  9. Reduce the foreskin.
  10. Attach the catheter to the patient's thigh using tape or a catheter securement device.

Do not attempt to force passage of the catheter through the urethra or inflate the balloon if there is significant resistance or patient discomfort, as this can lead to injury.

If a coude catheter is used, ensure the tip of the catheter points cephalad (toward the dorsum of the penis) during insertion.

Transurethral catheterization of the vulva [2]

  1. Use the nondominant hand to spread the labia. [2]
  2. Cleanse the urethral meatus with antiseptic, moving outwards in a circular motion.
  3. Pass the catheter into the urethra and slowly advance.
  4. Once urine return is noted, advance the catheter multiple centimeters further.
  5. Inflate the catheter balloon using a syringe filled with the recommended volume of water or air.
  6. Withdraw the catheter slowly until resistance is met.
  7. Connect the catheter to a collection bag or drainage system.
  8. Attach the catheter to the patient's thigh using tape or a catheter securement device.

If the catheter enters the vagina, it should be discarded and insertion reattempted with a new catheter to minimize the risk of infection.

Pitfalls and troubleshootingtoggle arrow icon

Problems during insertion [2]

Vulvar urethra

The most common problem is difficulty locating the urethral meatus . Potential solutions include:

  • Placing the patient in the lithotomy position
  • Using a speculum to aid visualization
  • Palpating the urethral meatus to perform blind insertion

Penile urethra

  • Urethral obstruction
    • Try a different catheter (e.g., smaller gauge, coude catheter) or adjust the technique.
    • Avoid using force because of the risk of injury.
    • In patients with external urethral sphincter spasm:
      • Ask the patient to relax the perineum and rectum.
      • Exert constant, soft pressure on the catheter. [2]
    • Consult urology if there is concern for injury or if catheter insertion is still unsuccessful.
  • Difficulty finding the urethral meatus
    • Phimosis
      • Urgently consult urology if a catheter cannot be passed in a patient with phimosis and acute urinary retention.
      • If urology is unavailable, consider dilation of the phimotic opening and blind passage of the catheter.
      • In severe cases, creation of a dorsal slit to expose the urethral meatus may be necessary.
    • Foreskin edema (e.g., in critically ill patients with anasarca)
      • Exclude paraphimosis and other reasons for penile strangulation, e.g., foreign object.
      • Apply a cold compress or compressive dressing for 10 minutes to reduce the swelling.

Balloon inflation

  • Ensure the balloon is in the bladder before inflating.
  • Penis: Insert the entire length of the catheter prior to inflation.
  • Vulva: Advance the catheter multiple centimeters further after urine return is noted prior to inflation.

Avoid inflating the balloon within the urethra as this can cause serious injury.

Problems with indwelling catheters [2][11]

  • Catheter obstruction
    • Attempt catheter irrigation with sterile saline to dislodge the obstruction.
    • If unsuccessful, consider catheter replacement.
  • Leakage around the catheter
  • Balloon will not deflate
    • Cut the inflation port off of the catheter and use a needle and syringe to aspirate fluid.
    • If unsuccessful, attempt to deflate the balloon by passing a guidewire (e.g., from a central line kit) through the inflation channel.
  • Traumatic catheter removal
    • Consult urology.
    • If urology is unavailable, attempt gentle replacement with a new catheter; if any resistance is encountered:

Postprocedural checklisttoggle arrow icon

  • Urine flowing into the drainage system (i.e., catheter and drainage system clamps open)
  • Sterile urine samples obtained and sent for laboratory studies if needed
  • Bladder irrigation initiated if necessary
  • Patient and/or family educated about catheter care

Interpretation/findingstoggle arrow icon

See “Urinalysis” and “Urine culture.”

Complicationstoggle arrow icon

We list the most important complications. The selection is not exhaustive.

Referencestoggle arrow icon

  1. Roberts JR. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. Elsevier ; 2018
  2. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA. Guideline for Prevention of Catheter-Associated Urinary Tract Infections 2009. Infect Control Hosp Epidemiol. 2010; 31 (4): p.319-326.doi: 10.1086/651091 . | Open in Read by QxMD
  3. Jansen SM, Woll A, Brown HW, et al. Can We Trust the Math? Correlation of Objective Postvoid Residual With Calculated Subtraction Postvoid Residual. Female Pelvic Med Reconstr Surg. 2021; 28 (1): p.45-48.doi: 10.1097/spv.0000000000001062 . | Open in Read by QxMD
  4. Shen Z, Shen T, Wientjes MG, O’Donnell MA, Au JLS. Intravesical Treatments of Bladder Cancer: Review. Pharm Res. 2008; 25 (7): p.1500-1510.doi: 10.1007/s11095-008-9566-7 . | Open in Read by QxMD
  5. Brede CM, Shoskes DA. The etiology and management of acute prostatitis. Nat Rev Urol. 2011; 8 (4): p.207-212.doi: 10.1038/nrurol.2011.22 . | Open in Read by QxMD
  6. Thomsen TW, Setnik GS. Male Urethral Catheterization. N Engl J Med. 2006; 354 (21): p.e22.doi: 10.1056/nejmvcm054648 . | Open in Read by QxMD
  7. Hanno PM, Wein AJ, Malkowicz SB. Penn Clinical Manual of Urology. Elsevier Health Sciences ; 2007
  8. Osborn NK, Baron TH. The history of the “French” gauge. Gastrointest Endosc. 2006; 63 (3): p.461-462.doi: 10.1016/j.gie.2005.11.019 . | Open in Read by QxMD
  9. Robson WmLM, Leung AKC, Thomason MA. Catheterization of the Bladder in Infants and Children. Clin Pediatr (Phila). 2006; 45 (9): p.795-800.doi: 10.1177/0009922806295277 . | Open in Read by QxMD
  10. $Contributor Disclosures - Transurethral catheterization. All of the relevant financial relationships listed for the following individuals have been mitigated: Alexandra Willis (copyeditor, was previously employed by OPEN Health Communications). None of the other individuals in control of the content for this article reported relevant financial relationships with ineligible companies. For details, please review our full conflict of interest (COI) policy:.
  11. Choe JM. Paraphimosis: current treatment options.. Am Fam Physician. 2000; 62 (12): p.2623-6, 2628.
  12. Cravens DD, Zweig S. Urinary catheter management. Am Fam Physician. 2000; 61 (2): p.369-76.

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