Male Foley Catheter – My Shepherd Connection

An indwelling catheter is also called a foley catheter or “Foley.” It can be used in males or females. A Foley is usually left in the bladder and drains the bladder continuously.

Foley Catheter: Step by Step Process

1. Gather the Supplies

• Indwelling Foley Catheter Tray with a 10 cc balloon (size 16fr is a common size used for adults.) The tray comes with all the needed supplies
• Syringe to deflate the balloon of the existing catheter (if there is one already in the bladder)
• Soapy wash cloth and wet wash cloth

2. Wash hands with soap and water

3. Prepare all needed supplies

4. Lie flat on back with legs flat

5. If there is already a catheter in place, remove it by deflating the balloon.

• Attach the syringe to the end of the “Y” pigtail (side port).
• Withdraw the plunger of the syringe. This will deflate the balloon on the catheter inside the bladder.
• You will know it is completely deflated when you are unable to pull anymore water into the syringe.

6. Gently pull the catheter out from the bladder. 

 7. Wash penis

Wash with the soapy cloth and rinse with the wet cloth. Dry well.

8. Wash hands again.

9. Open the Indwelling Catheter Tray carefully. Set up the supplies.

• Place paper pad under hips.
• Put on the gloves if this is not a self catheterization.
• Pour the Betadine onto the cotton balls
• Remove the plastic cover from the catheter (be careful not to touch the catheter tube) & squirt the lubricating jelly onto the catheter.
• Remove the rubber cap from the syringe with the water in it.
• Connect the end of the catheter to the drainage bag

10. Choose your “clean” and “dirty” hand.

Whatever hand comes in contact with the body, the one that holds the penis, is dirty. The one that touches the catheter supplies is clean. Never mix clean and dirty hands in regard to the catheter supplies. It is important that this procedure stay “super clean” so as not to allow germs to enter the bladder.

11. Hold the penis.

Remember, the hand touching the body will now be the dirty hand.

12. Clean urinary opening on penis

• Use clean hand to touch items in the kit
• Clean penis with the cotton balls soaked in Betadine.
• Use 1 cotton ball per wipe.
• Always wipe from the tip of the penis toward the shaft of the penis.
• Never re-use a cotton ball.

13. Insert the catheter slowly and gently into the urinary opening on the penis. 

14. See the urine flow into the catheter

Continue to insert the catheter until the “Y” pigtail section of the catheter becomes very close to the end of the penis.

15. Blow up the balloon

While holding the catheter in place, attach the pre-filled syringe in the kit to the “Y” pigtail port and insert all of the water from the syringe. 

If it is easier, you can attach the syringe before you insert the catheter so it is ready when you need it. Do not blow up the balloon until the catheter is in and you see urine flowing.

Below is a picture of a catheter with an inflated balloon…this is what it would look like inside the bladder

16. Wash off the extra Betadine from the penis.

17. Always hang/attach the drainage bag to chair/bed frame below the level of the penis.

This will allow for the best drainage.

18. Consider wearing a leg strap.

The leg strap attaches the catheter to the inner thigh. It helps to keep the catheter secure.

19. If wearing a leg bag, always wear it below the knee.

Real Questions from Real People

1. How often does the catheter need to be changed?

Catheters can stay in for about a month as long as it is not leaking or having crusty areas around it near the urethral opening. You should wash the urinary opening at least twice a day while the catheter is in place. Change the catheter by the schedule given to you by your doctor.

2. Should I save anything from the catheter kit incase problems arise with the catheter?

Yes. Save the syringe so you can deflate the balloon when the catheter needs to be removed.

3. What if touch the catheter with my dirty hand or I drop the catheter on the floor before I have it safely inserted?

Stop and get another catheter or kit. It is important that germs do not enter the bladder during this procedure.

4. What if I have spasms while the catheter is being inserted?

Stop and wait for the spasm to pass; then continue with the insertion.

5. What if the catheter will not go in easily or I feel like I meet resistance when inserting it?

Do not force the catheter in. Call the doctor for further advice.

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 (CAUTI) is a urinary tract infection (UTI) in which the positive culture was taken when an indwelling urinary catheter had been in place for &gt. .. 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.

NOTE:


This is the Professional Version.


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Placement of a urinary catheter for men – MEDIAN

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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 placement of a urinary catheter is carried out in the following conditions:

• acute urinary retention;
• 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 insertion of soft catheters is carried out by paramedical staff: a nurse and a paramedic – catheterization with a rigid catheter is carried out 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 health worker must 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 (administered before the procedure in a volume of 2-3 ml).

Possible complications

In case of violation of the rules for installing a catheter, the following conditions may appear:

• violation of the integrity of the walls of the urethra, prostate gland;
• bleeding;
• damage or rupture of part of the catheter;
• development of an infectious process.

Bladder catheterization in Kyiv is carried out in our clinic by qualified specialists, so that patients can be confident in the correct insertion and the absence of possible complications.

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Bladder catheterization for men, price from 1000 rubles in Moscow, Yuzhny clinic

A number of clinical cases require the introduction of a catheter into the organ of the excretory system for diagnostic or therapeutic purposes. In this case, it is appropriate to talk about bladder catheterization, which can be described as a urological procedure involving the installation of a special medical tube of small diameter through the urethra. It is prescribed by a urologist for a number of reasons and is performed exclusively in a medical facility by a qualified professional using sterile equipment.

Modern medicine provides for the use of anesthetics during ureteral catheterization in men. This eliminates pain or discomfort, so patients should not worry about this. If the manipulation is carried out by an experienced health worker in compliance with all the rules and requirements, then no complications and undesirable consequences will occur.

The procedure has a number of positive factors, including:

1. Sufficiently high level of effectiveness in the absence of complications and side effects, provided that it is carried out by qualified medical staff.
2. The ability to carry out a complete emptying of the bladder in the case when a person for some reason cannot do it on their own in a natural way.
3. Its particular importance in the course of some diagnostic measures.
4. Increasing the degree of effectiveness of the ongoing therapy of various pathologies of the genitourinary system, due to the introduction of drugs intrauretrially.

Bladder catheterization in men is carried out by specialists of the Yuzhny clinic at a professional level and at an affordable cost. Contacting the medical center guarantees an individual approach to each patient and his problem, as well as receiving high-quality medical service.

Indications for the procedure

The need for the procedure for male patients is determined by the urologist. In the case when the installation of a catheter is required for medical purposes, the indications for it are the following conditions:

• retention of urine due to narrowing of the urethral lumen;
• inability to empty the bladder naturally after surgery;
• the need to flush the hollow organ of the excretory system;
• some diseases that require the introduction of drugs directly into the bladder.

Among the indications for bladder catheterization in men, it is also worth noting:

• presence of a tumor in the urinary ducts;
• urinary diverticulosis;
• calculi, the appearance of which led to blockage of the bladder outlet;
• the appearance of edema in the urinary tract;
• trauma to the genitals.

Contraindications for bladder catheterization in men

Due to the fact that the introduction of a medical tube into the urethra is a rather traumatic manipulation, and the risk of infection is very high, there are some restrictions regarding its implementation. The list of contraindications includes:

• violation of the integrity of the urethra;
• bacterial prostatitis;
• sphincter spasm;
• pathologies of the genitourinary system, which are inflammatory in nature and occur in an acute form.

All of the above contraindications are absolute, however, in case of emergency, ureteral catheterization in men is still carried out, but with increased precautions.

Operation

It is important to note that different types of catheters (hard and soft) are used in modern urological practice. The technique of the procedure is determined precisely by what type of catheter will be inserted during it. A detailed description of each of both options is provided below.

Soft catheter

Catheterization using a soft medical tube has received frequent use for the reason that it is simpler, and the average medical staff (paramedic or nurse) can easily cope with its introduction. The most commonly used latex or silicone medical tubes impregnated with antibacterial compounds and coated with silver alloys.

At the preparatory stage, the specialist performs an intraurethral injection of a 2% Lidocaine gel in a volume of 5-10 milliliters. When catheterizing the bladder in men using soft tubes, the following actions are performed:

1. Wrapping the penis with a sterile napkin.
2. Retraction of its extreme cavity, followed by grasping from both sides with the left hand and pulling in a direction perpendicular to the patient’s body, to the maximum possible length. This will straighten the anterior urethra.
3. Treatment of the glans with an antiseptic solution.
4. Lubrication of the medical tube with vaseline or oil.
5. Advance the catheter into the urethra with slight force until it reaches the bladder, as evidenced by the appearance of urine at its outer end.
6. The subsequent advance of the tube a little further – in order to avoid inflating the cuff inside the urethra.
7. Use 10 ml of isotonic sodium chloride solution to inflate the tube cuff. Alternatively, you can attach it to the skin of the penis with a band-aid.
8. Moving the outer end of the catheter with a container designed to collect urine.

Rigid catheter

Due to the fact that the use of a rigid type of catheter greatly increases the risk of damage to the urethra, only a competent doctor can manipulate in this case. The tip of the medical tube is curved. Due to the presence of handles on it, the specialist has the opportunity to get an idea of ​​​​in which area the curved part is located. Its location in the sagittal plane is considered correct, because it is in this case that the passage of the tube through the physiological bend of the membranous part will be painless and will avoid injury.

Treatment of the urethra and penis is performed by analogy with the method described in the previous paragraph. Next, the following steps take place:

1. Retraction of the penis to the anterior abdominal wall with simultaneous elimination of the bending of the spongy part. The head of the penis is in the left hand of the urologist, and with the right he inserts the end of the tube into the urethra.
2. Insertion of the penis on the catheter, which must be parallel to the midline at an angle of less than 90 degrees.
3. Elevation of the medical tube from the abdomen, after which the end of the catheter moves without any effort into the membranous part.
4. Release of the penis from the hands of the doctor, followed by separation of the outer end of the catheter in the direction from the abdominal wall. The medical tube moves inwards with subsequent entry into the bladder.

Diagnostic purposes of bladder catheterization in men

Urological manipulation is also shown as part of the diagnosis.