Urinary Catheter Insertion for Male Patients

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Hi there! Let’s take a look at urinary catheters and catheter insertion for male patients.

A urinary catheter (also known as an ‘indwelling’ or ‘long-term’ catheter) is a hollow, flexible tube inserted through the urethra into the bladder to drain urine into an external collection bag.

Once the catheter has been inserted, a small balloon on the internal end is inflated with sterile water to keep it in situ.

Catheters are used often in healthcare settings to assist with a variety of conditions, such as both urinary incontinence and urinary retention, or by patients who may be unable to go to the toilet without assistance.

Procedure

The following demonstration is based on the Catheterisation Clinical Guidelines by the Australia and New Zealand Urological Nurses Society.

Remember to always refer first to your organisation’s internal policies and procedures when performing any procedure like this one.

• To start, gather all equipment required for the procedure.
• Discuss the procedure with the client. Consider using other educational resources such as brochures or interpreters if needed.
• Obtain the client’s consent.
• Check current medications and any known allergies.
• If the client has a latex allergy, a 100% silicone catheter is needed for this procedure.
• Ensure adequate lighting.
• Maintain the client’s privacy by using means such as hospital screens or bed curtains. Ensure the client is warm and not exposed.
• Have the client lie in their bed on their back.
• Ask the client to slightly flex their knees, with their feet slightly apart.
• Place a waterproof sheet under the client’s buttocks.
• Perform hand hygiene.
• Prepare and sanitise the trolley or a clean surface.
• Using an aseptic technique, open the catheterisation pack, and add sterile equipment such as the catheter.
• Pour cleansing solution onto tray.
• If a specimen is needed, open the specimen container at this time.
• Empty sterile water (which may be included in the package) into tray in preparation for balloon inflation.
• Take covering off the client.
• Perform hand hygiene, and don non-sterile gloves.
• Pull the foreskin back if needed. Cleanse the glans penis with cleansing solution using a circular motion from the penile meatus to the base of the penis.
• Remove non-sterile gloves, perform hand hygiene and don sterile gloves.
• Put the fenestrated drape on the client.
• Apply anaesthetic gel to the catheter length.
• Prepare a syringe to inflate the balloon with by drawing up sterile water into the syringe.
• Advise the client that there is a risk of stinging from the anaesthetic gel.
• With a piece of gauze, hold the penis and apply gel to the meatus, then introduce the remaining gel into the urethra.
• Discard the gel container.
• Hold the penis behind the glans and raise the penis to a 90-degree angle to the body.
• Insert the catheter until resistance is felt at the external urethral sphincter muscle.
• Then gently continue until the ‘Y’ of the catheter tube is at the urethral opening to ensure that the balloon is passed the prostate.
• If the balloon is inflated in the prostatic urethra, this will cause pain and urethral trauma.
• If resistance at the urethral sphincter muscles persists, apply gentle, steady pressure on the catheter and advise the client to take a deep breath, cough or bear down, and/or try to pass urine.
• Gently rotate the catheter and consider using a second tube of lubricant if resistance persists.
• Once inserted successfully, slowly inflate the balloon per manufacturer instructions.
• Do not inflate if the client complains of pain or urine is not flowing freely, as this could indicate incorrect catheter placement or bladder spasm.
• Once correctly inflated, pull on the catheter slightly until resistance is felt.
• Connect the catheter to a drainage system or compatible valve.
• Secure the catheter in place using tape or a catheter strap.
• Leave some slack to ensure that the catheter does not become taut when the client moves to reduce the risk of injury.
• Ensure the glans penis is kept clean and dry to avoid skin irritations or infections.
• Reposition foreskin if necessary.
• Remove gloves and perform hand hygiene.
• Check in regularly to ensure the client is comfortable.
• Dispose of used equipment and gloves in a biohazard bag, and clinical waste bag in an appropriate waste system.
• Remember to maintain hand hygiene and complete any relevant documentation.

How To Do Urethral Catheterization in a Male – Genitourinary Disorders

By

Paul H. Chung

, MD, Sidney Kimmel Medical College, Thomas Jefferson University

Reviewed/Revised May 2023

View Patient Education

Topic Resources

Urethral catheterization is the standard method of accessing the urinary bladder. A flexible catheter is passed retrograde through the urethra into the bladder. Several types of catheters are available. Sometimes the urethra is impassable, requiring suprapubic catheterization of the bladder.

(See also Bladder Catheterization Bladder Catheterization Bladder catheterization is used to do the following: Obtain urine for examination Measure residual urine volume Relieve urinary retention or incontinence Deliver radiopaque contrast agents or… read more .)

• Relief of acute or chronic urinary retention, such as due to urethral or prostatic obstruction (obstructive uropathy Obstructive Uropathy Obstructive uropathy is structural or functional hindrance of normal urine flow, sometimes leading to renal dysfunction (obstructive nephropathy). Symptoms, less likely in chronic obstruction… read more ) or neurogenic bladder Neurogenic Bladder Neurogenic bladder is bladder dysfunction (flaccid or spastic) caused by neurologic damage. Symptoms can include overflow incontinence, frequency, urgency, urge incontinence, and retention…. read more

• Treatment of urinary incontinence

• Monitoring of urine output

• Measurement of postvoid residual urine volume

• Collection of sterile urine for culture (usually for infants and women only)

• Diagnostic studies of the lower genitourinary tract Genitourinary Imaging Tests Imaging tests are often used to evaluate patients with renal and urologic disorders. Abdominal x-rays without radiopaque contrast agents may be done to check for positioning of ureteral stents… read more

• Bladder irrigation or instillation of medication

Absolute contraindications

Relative contraindications

• History of urethral strictures Urethral Stricture Urethral stricture is scarring that obstructs the anterior urethral lumen. Urethral stricture can be Congenital Acquired Anything that damages the urethral epithelium or corpus spongiosum can… read more

• Current urinary tract infection Introduction to Urinary Tract Infections (UTIs) Urinary tract infections (UTIs) can be divided into upper tract infections, which involve the kidneys ( pyelonephritis), and lower tract infections, which involve the bladder ( cystitis), urethra… read more (UTI)

• Prior urethral reconstruction

• Recent urologic surgery

• History of difficult catheter placement

*Urethral injury may be suspected following blunt trauma if patients have blood at the urethral meatus (most important sign), inability to void, or perineal, scrotal, or penile ecchymosis, and/or edema. In such cases, urethral disruption should be ruled out with imaging (eg, by retrograde urethrography Genitourinary Imaging Tests Imaging tests are often used to evaluate patients with renal and urologic disorders. Abdominal x-rays without radiopaque contrast agents may be done to check for positioning of ureteral stents… read more ) before attempting urethral catheterization.

Complications include

• Injury to the urethra, prostate, or bladder with bleeding (common)

• UTI Introduction to Urinary Tract Infections (UTIs) Urinary tract infections (UTIs) can be divided into upper tract infections, which involve the kidneys ( pyelonephritis), and lower tract infections, which involve the bladder ( cystitis), urethra… read more (common)

• Creation of false passages

• Scarring and urethral strictures Urethral Stricture Urethral stricture is scarring that obstructs the anterior urethral lumen. Urethral stricture can be Congenital Acquired Anything that damages the urethral epithelium or corpus spongiosum can… read more

• Paraphimosis Paraphimosis Phimosis is inability to retract the foreskin. Paraphimosis is entrapment of the foreskin in the retracted position; it is a medical emergency. Phimosis is normal in children and typically resolves… read more , if the foreskin is not reduced after the procedure

Prepackaged kits are typically used but the individual items needed include

• Sterile drapes and gloves

• Povidone iodine with application swabs, cotton balls, or gauze

• Water-soluble lubricant

• Urethral catheter* (size 16 French Foley catheter is appropriate for most men; in the setting of prostatic hypertrophy Benign Prostatic Hyperplasia (BPH) Benign prostatic hyperplasia (BPH) is nonmalignant adenomatous overgrowth of the periurethral prostate gland. Symptoms are those of bladder outlet obstruction—weak stream, hesitancy, urinary… read more or urethral stricture Urethral Stricture Urethral stricture is scarring that obstructs the anterior urethral lumen. Urethral stricture can be Congenital Acquired Anything that damages the urethral epithelium or corpus spongiosum can… read more , an alternate size or style of catheter may be required†)

• 10-mL syringe with sterile water (for catheter balloon inflation)

• Local anesthetic (eg, 5 to 10 mL of 2% lidocaine jelly in a syringe [with no needle]) for distention and anesthesia of the male urethra

• Sterile collection device with tubing

*A closed-catheter system minimizes catheter-associated UTI Catheter-Associated Urinary Tract Infections A catheter-associated urinary tract infection (UTI) is a UTI in which the positive culture was taken when an indwelling urinary catheter had been in place for > 2 calendar days. Patients… read more .

†A coudé catheter is curved at the end and may facilitate passage in a male with significant prostatic hypertrophy.

• Sterile technique is necessary to prevent a lower urinary tract infection Introduction to Urinary Tract Infections (UTIs) Urinary tract infections (UTIs) can be divided into upper tract infections, which involve the kidneys ( pyelonephritis), and lower tract infections, which involve the bladder ( cystitis), urethra. .. read more .

• Place all equipment within easy reach on an uncontaminated sterile field on a bedside tray. You may put the box containing the catheter and the drainage system between the patient’s legs, so that it is easily accessible during the procedure.

• If not done already, attach the catheter to the collecting system and do not break the seal unless a different type or size of catheter or irrigation of the catheter is required.

• Test the retention balloon for integrity by inflating it with water, and apply lubricant to the catheter tip.

• Saturate the applicator swabs, cotton balls, or gauze with povidone iodine.

• Place the sterile fenestrated drape over the pelvis so that the penis remains exposed.

• Grasp the shaft of the penis using your nondominant hand, and retract the foreskin if the patient is uncircumcised. This hand is now nonsterile and must not be removed from the penis or touch any of the equipment during the rest of the procedure.

• Cleanse the glans penis with applicator swabs, gauze, or cotton balls saturated in povidone iodine. Use a circular motion, beginning at the meatus, and work your way outward. Discard or set aside the newly contaminated items.

• Inject viscous lidocaine into the urethra. Insert the hub of the lidocaine-containing syringe into the penile meatus and inject about 5 mL. Pinch the meatus closed, to retain the lidocaine within the urethra, for at least 1 minute. The lidocaine distends the urethra, as well as provides some anesthesia, thereby easing catheter passage.

• Hold the catheter in your free hand. If a coudé catheter is being used, the tip should point upward, so as to track the superior urethral wall during insertion.

• Advance the catheter slowly through the urethra and into the urinary bladder. Patient discomfort is common. Ask the patient to relax and take slow deep breaths as you continue to apply steady pressure on the catheter until it is fully advanced to the level of the side port. Urine should flow freely into the collection tubing.

• Slowly inflate the balloon with 5 to 10 mL of water. Obvious resistance or patient discomfort suggests incorrect placement. If this happens, deflate the balloon, withdraw the catheter slightly, and then reinsert the catheter all the way before trying to reinflate the balloon.

• Position the balloon at the bladder neck, after successful balloon inflation, by slowly withdrawing the catheter until you feel resistance.

• To prevent paraphimosis Paraphimosis Phimosis is inability to retract the foreskin. Paraphimosis is entrapment of the foreskin in the retracted position; it is a medical emergency. Phimosis is normal in children and typically resolves… read more , reduce the foreskin after the procedure.

VIDEO

• Remove the drapes.

• Secure the catheter to the thigh with an adhesive bandage, tape, or strap. Some advocate taping the catheter to the lower abdominal wall to minimize pressure on the posterior urethra.

• Place the bag below the level of the patient to ensure that urine can drain via gravity.

• Be sure to maintain strict sterile technique during the procedure to avoid urinary tract infection Introduction to Urinary Tract Infections (UTIs) Urinary tract infections (UTIs) can be divided into upper tract infections, which involve the kidneys ( pyelonephritis), and lower tract infections, which involve the bladder ( cystitis), urethra… read more .

• Be sure to reduce the foreskin after the procedure.

• Be careful not to use excessive force during insertion, which could potentially cause urethral injury.

• Do not continue attempts at catheter placement if significant resistance is met or if the catheter feels to be buckling inside the urethra and not advancing.

• Urine will appear in the catheter before the balloon has advanced beyond the prostate. Continue advancing the catheter completely to the end of the catheter before inflating the balloon, to avoid inflating the balloon in the prostate or urethral lumen, which will cause significant bleeding.

• If the catheter appears to be in the correct position, but urine does not return, lubricant may be obstructing drainage of urine. Flush the catheter with normal saline to dislodge the lubricant and see if urine returns.

• If the balloon is difficult to inflate or the balloon port distends during inflation, the proximal end of the catheter is probably not in the correct position. Deflate the balloon and advance the catheter further into the bladder.

• If correct positioning is questioned, flush the catheter with 30 to 60 mL of normal saline. If the fluid can be flushed and aspirated easily, then the catheter is in the correct position. A catheter that will not irrigate is not in proper position.

• Consult a urologist for any questions regarding catheter size and style or difficulty placing a catheter.

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Bladder catheterization: necessary preparation, course of the surgeon’s appointment and contraindications

Normally, the urinary tract is sterile, and in order to avoid infectious complications, sterility must be observed. Only sterile catheters are inserted. The doctor or nurse puts on sterile gloves. The head of the penis and the foreskin of men, the vulva with the external opening of the urethra in women are treated with furatsilin or other antiseptic solution, also sterile.

The patient (or patient) lies on his back, bending and spreading his legs. The nurse or doctor stands on the right, with his left hand exposes the head of the penis or pushes the labia apart. Sterile tweezers are taken in the right hand. These tweezers capture the catheter closer to the rounded end. In order for the catheter to move smoothly along the urethra and not injure it, the end of the catheter is moistened with a solution of petroleum jelly, which must also be sterile.

Then insert the end of the catheter into the opening of the urethra. Slowly continue insertion, intercepting the catheter with forceps until it is in bladder . Evidence of this will be the release of urine from the outer end of the catheter.

If catheterization is simultaneous, remove the catheter immediately after passing urine. Before extraction, a solution of furacilin is often injected into the lumen of the bladder with a syringe. With prolonged drainage of the bladder, the catheter is fixed with adhesive plaster to the inner surface of the thigh, lengthened by means of tubes and adapters, and connected to a container for collecting urine. In this case, special attention should be paid to asepsis. The catheter is essentially a foreign body, and its prolonged presence can provoke an infectious inflammation.

Since the urinary system of men and women has significant differences, the technique of bladder catheterization in both sexes will also be different. The urethra of women is short, so in order to release urine, it is enough to advance the catheter to a depth of about 5-10 cm. But at the same time, you need to make sure that the end of the catheter enters the opening of the urethra and does not slip into the vagina. In general, the catheterization technique for women is easier than for men.

In men, the urethra is much longer, and therefore the depth of catheter advancement is greater, and is about 20-25 cm. There are physiological constrictions and bends here, which make it somewhat difficult to advance the catheter. Significant difficulties can also be with strictures that develop as a result of inflammatory cicatricial changes in the urethra. An enlarged prostate interferes with the catheter’s progress.

Relatively long urethra with physiological and pathological obstacles creates preconditions for injuries. Therefore, in the event of obstacles, in no case should force be used. In these cases, re-catheterization is resorted to with more rigid or thin products of a different modification. In special cases, the urologist uses metal catheters. If catheterization is fundamentally impossible, they decide on the imposition of an epicystostomy, an opening communicating with the bladder on the anterior abdominal wall.

Despite the apparent ease of the procedure, it is by no means trusted to be performed by the patient on his own, nor are untrained persons involved in the installation of the catheter. Firstly, only a specialist knows about all the stages of installing a catheter, follows the rules of antisepsis, uses petroleum jelly or a special gel for gentle administration, and checks the tightness of the device with a syringe. Also, a nurse or urologist knows how to properly advance the catheter, follows the rules of asepsis. In men, the penis is held in a position perpendicular to the body during insertion and advancement of the catheter. The room itself, in which the catheter is installed, must meet the standards of sterility, so the introduction at home is carried out only in case of emergency.

If a catheter is to be inserted for a long time, then the general condition of the patient also needs to be monitored. The catheter should be emptied of accumulated urine every 8 hours.

If a patient tries to introduce a catheter on his own without proper knowledge and skills, then there is a high probability of damage to the urethra, which will lead to an inflammatory process and the need for treatment. Another likely option is the introduction of an infection, which can also lead to the development of an inflammatory process with the need for therapy under medical supervision.

Once the urine collection bag is in place, the patient or medical staff monitors the progress of the outflow. If the catheter fills with urine earlier than 8 hours, it is emptied. Getting rid of the accumulated urine is carried out before the complete filling of the catheter, as this can disrupt the flow of urine and lead to undesirable consequences. If the progress of the accumulation of urine in the catheter is monitored and full filling is not allowed, the insertion of the catheter is still a safe procedure without any negative consequences.

The specialist also ensures that the place of collection of urine is below the location of the bladder in a person. As a rule, for this it is attached at the hip, fixed and monitored for fullness. The recommended time to empty the device of accumulated urine is when the level is about half full. The patient can empty himself, having received prior instructions from the medical staff on how to do it correctly, and in no case removes the catheter on his own during the emptying procedure.

It is believed that it is easier for patients to insert a catheter than for patients. The reason is not only the greater length of the urethra in men, but also narrowing and expansion, which require sufficient sensitivity and skill from medical personnel when inserting a catheter. In addition, catheters are not only single-channel, but also multi-channel, up to 3. This allows you to enter any drugs directly into the bladder without disturbing the process of urine outflow through another channel.

Catheterization can be used for various diseases, operations and procedures. For example, this is required by an operation to increase the penis in men, therapy during inflammatory processes in the urogenital area. Catheterization is used in all cases of obstructed outflow of urine.

A properly placed catheter does not increase the risk of inflammatory processes and is not a cause of infectious diseases of the urogenital area. Catheterization can be carried out for women, men and children at any age if necessary and at the discretion of the doctor. If performed correctly, catheterization is a painless and safe option for diverting urine in an emergency.

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Bladder catheterization in case of pathological obstruction of the outflow of urine, as well as for diagnostic purposes, involves the use of a catheter in the form of a thin tube into the urethra.

Indications for catheterization

For therapeutic purposes, the installation of a urinary catheter is carried out in the following conditions:

• acute urinary retention;
• the presence of blood clots, mucus and pus in the bladder;
• administration of chemotherapeutic agents;
• after operations to restore the patency of the urethra.

Catheterization is also used for diagnostic purposes.

1. Urine sampling for analysis can be done with a Nelaton urological catheter (it is a thin plastic tube).
2. Ultrasound diagnosis of the pelvic organs should be performed on a full bladder. Catheterization is used if, due to voluntary urination or other pathological conditions, the patient cannot fill it on his own.
3. In case of severe poisoning or comatose conditions of the patient, when it is necessary to control the daily volume of urine (diuresis).

The installation of soft catheters is carried out by paramedical staff: a nurse and a paramedic – catheterization with a rigid catheter is performed by a doctor.

Contraindications

These conditions are considered an absolute contraindication for elective catheterizations:

• acute bacterial infections of the prostate;
• damage to the urethral canal;
• narrowing of the urethra.

In urgent cases, insertion of the catheter with extreme caution is possible.

Features of the catheterization procedure in men

It is more difficult to place a urinary catheter in a man due to the peculiarities of physiology (long curved urethra).

To place a Nelaton or Foley catheter, the healthcare worker should work under aseptic conditions using sterile gloves and dressings.

After treatment with an antiseptic, the catheter is inserted into the glans penis to a depth of 20 cm or until urine appears. To relieve pain, the catheter is pre-lubricated with vaseline oil or glycerin.

A 2% solution of lidocaine can be used as an anesthetic (injected before the procedure in a volume of 2-3 ml).