Female and male catheteraization

• Indications ( high yield ⚠️)  → came in the exams before
• Sterile urine sample collection
• Measurement of urinary output and/or PVR
• Bladder drainage, e.g., for urinary retention, urinary obstruction, patients with impaired mobility
• Access for intravesical therapy, e.g., bladder irrigation, chemotherapy
• Urological studies, e.g., cystography

• Transurethral catheterization (e.g., with a Foley catheter)

• Suprapubic catheterization

Transurethral catheterization 

• Diseases requiring sterile sample collection for urinalysis and/or urine culture, e.g., UTI

• Diseases requiring measurement of postvoid residual volume, e.g., overflow incontinence

• Patients who require measurement of urinary output, e.g., critically ill patients

• residual urine, X-ray

• Conditions requiring complete or intermittent bladder drainage, e.g., urinary retention, urinary obstruction, neurogenic bladder

• Patient resustation

• After diuratic treatment to check the response

• In renal failure stages

• Patients with impaired voiding and/or mobility, e.g., those with paralysis, injury, or receiving end-of-life care

• Bladder access required for treatment, e.g., bladder irrigation for bladder tamponade, intravesical chemotherapy for bladder cancer / Evacuation of the urinary bladder before pelvic/abdominal surgery / after urologic procedures

• Absolute: none

• Relative
• Alternative equally effective, less invasive procedures (e.g., clean catch urine, condom catheter) available
• Acute bacterial prostatitis
• Known or suspected urethral injury
• Use cautiously in patients with a history of pelvic or perineal TRAUMA associated with perineal bruising and swelling and/or blood at the meatus
• Use cautiously in patients with a history of URETHRAL STRICTURES, or symptoms of PROSTATIC ENLARGEMEN
• Hematuria
• Premium swelling
• Bleeding
• Urethral pain or discomfort

• 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

• 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)

• Adults: 14–16 Fr straight urinary catheter or Foley catheter

• Patients with prostatic enlargement: 14–18 Fr coude catheter or 18–22 Fr Foley catheter

• Patients with gross hematuria: ≥ 20 Fr three-way Foley catheter

• Penis
• Urethral length: ∼ 20 cm
• The urethra curves in an S-shape sigmoid course (2 curves) and passes through the prostate into the bladder.



Median section of the male pelvis with detail of a testicle:
The penis is composed of three cavernous bodies: the corpus spongiosum, which contains the urethra, and two corpora cavernosa, each containing a deep artery of the penis.
The male accessory glands are:
• The prostate
• The paired seminal glands
• The bulbourethral glands (paired)
• The small glands of the spermatic duct (not shown)
The testicles and accessory glands are responsible for the production of sperm and androgens, primarily testosterone.

• Vulva
• Urethral length: short ∼ 5 cm straight, directed posteriorly, ^asc. infection
• 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.

• Patients with a vulva: Place the patient in the frog-leg position.( Supine, knees flat & flexed)

• Patients with a penis: Place the patient supine knees raised & flexed, feet apart and hold the penis taut and upright.

• Introduce yourself.

• Confirm patient identity.

• Explain what you are going to do.

• Obtain informed consent.

• Ask for a chaperon to attend.

• Proper communication throughout the procedur.

• Clean trolley

• Open catheter pack, and prepare equipment

• 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. Sanitize your hands and put on sterile gloves

• Drape & clean the area

• Lubricate the catheter with viscous lidocaine and/or lubricating jelly.

• Change gloves

• Open the catheter cover

• Insert the catheter, don’t touch

• Inflate the balloon

• Pull on the catheter

• Attach drainage bag to patient’s thigh

• Thank the patient

• Clean up

• DOCUMENT: Date, time, cath. Size, Urine amount & color of urine collected)

• Catheter-associated UTI

• Urethral injury (males > females)

• Allergic reaction

• Difficult removal (phosphatic encrustations)

• Bladder stone

• Hematuria

• Paraphimosis (if the foreskin is not reduced)

• Catheter malfunction (e.g., catheter obstruction)

• Bladder injury

• Prostate injury

• Post-obstructive diuresis

• Electrolyte imbalance after bladder irrigation