​Clinical Procedures - Male Urethral Catheterization 
Indications
• Relief of acute urinary retention
• Accurate monitoring of urine output in the acutely unwell/those undergoing surgery
• Prevention of complications of chronic urinary retention (e.g. neurological; consider long-term alternatives)
• Urinary incontinence (consider alternatives e.g. convene/pad).
Contraindications
• Urethral/prostatic injury.
Risks
• Urinary tract infection
• Septicaemia
Pain
• Haematuria
• Creation of a 'false passage' through prostate
• Urethral trauma
• © Beware latex allergy.
Procedure Tips
• Difficulty passing an enlarged prostate is a common problem. Tricks to try to ease the catheter past include:
• Ensure the catheter is adequately lubricated
• Try moving the penis to a horizontal position between the patient's legs as prostatic resistance is reached
• Ask the patient to wiggle his toes
• Rotate the catheter back and forth as it advances
• If catheter fails to pass, consider using larger bore catheter (e.g. 16F
instead of 14F) as this may prevent coiling in the urethra
• If urine fails to drain despite the catheter being fully advanced:
•Palpate the bladder: if palpable, the catheter is inappropriately placed
• Manual pressure on the bladder may express enough urine from a near-empty bladder to show itself
• Aspirate with a bladder syringe, or flush with a little sterile saline
• D If it is impossible to pass the catheter, ask for help. If all else fails, it may be necessary to proceed to suprapubic catheterization.


Equipment
• Foley catheter (male) of appropriate French, usually 12-14
• 10mL syringe of sterile water
• Syringe of lidocaine gel 1% (e.g. Instilligel®
• Catheter bag
• Sterile gloves
• Catheter pack containing drape, kidney dish, swabs/cotton balls. and a small dish
• Sterile water/chlorhexidine sachet.
Procedure
• Introduce yourself, confirm the patient's identity, explain the procedure, and obtain informed consent
• Position the patient lying supine with the external genitalia uncovered:
• Uncover from umbilicus to knees
• Using aseptic technique, unwrap the equipment and pour the chlorhexidine or sterile water into the dish
• Wash your hands and put on the sterile gloves
• Tear a hole in the middle of the drape and place it over the genitals so as to allow access to the penis
• Use your non-dominant hand to hold the penis upright
• Withdraw the foreskin and clean around the urethral meatus using the water/chlorhexidine and a swab, moving from the centre outwards
• Instil local anaesthetic via urethral meatus, with the penis held vertically. Wait at least 1 minute for the anaesthetic to act
• Place the kidney bowl between the patient's this
• Remove the tip of the plastic sheath containing being careful not to touch the catheter itself
• Insert catheter into urethra, feeding it out of the plastic wrapper as it is advanced

• Insert the catheter to the 'hilt':
• If the catheter will not advance fully, don't force it.
Withdraw a little, extend the penis fully and carefully try again. See 'tips' for more advice
• At this point, urine may begin to drain:
• Let the end of the catheter rest in the kidney bowl to catch any spills
• Inflate the balloon using sterile water inserted into the catheter side-arm according to the balloon's capacity (written on the cuff of the balloon lumen)
• Watch the patient's face and ask them to warn you if they feel pain
• Once the balloon is inflated, remove the syringe and attach the catheter bag
• Gently pull the catheter until you feel resistance as the balloon rests against the bladder neck
• Replace the foreskin (this is essential to prevent paraphimosis)
• Re-dress the patient appropriately.
Documentation
• Date and time
• Indication, informed consent obtained
• Size of catheter inserted
• Aseptic technique used?
• Volume of water used to inflate the balloon
• Residual volume of urine obtained
• Foreskin replaced?
• Any immediate complications
• Signature, printed name, and contact details.