A Practical Approach to Difficult Urinary Catheterizations Routine placement of transurethral catheters can be challenging in some situations, such as urethral strictures, severe phimosis and false passages. In men, blind urethral procedures with mechanical or metal sounds without visual guidance or guidewire assistance are now discouraged due to the increased risk of urethral trauma and false passages. Newer techniques of urethral catheterization including guidewires, directed hydrophilic mechanical dilators, urethral balloon dilation, and direct vision endoscopic catheter systems are discussed, along with the new standardized protocol for difficult transurethral catheter insertions.
Ghaffary C, Yohannes A, Villanueva C, Leslie SW : A practical approach to difficult urinary catheterizations. Curr Urol Rep. 2013 Dec;14(6):565-79
Current Trends in the Management of Difficult Urinary Catheterizations Best practices for blind catheterizations and algorithm to manage difficult urinary catheterization, including direct visualization of the urethra during placement.
Willette PA, Coffield KS. Current trends in the management of difficult urinary catheterizations. West J Emerg Med 2012, in press
Difficult Catheterization: Tricks of the Trade Solutions to address difficult urinary catheterization, including DirectVision®.
Villanueva C, Hemstreet GP. Difficult catheterization: tricks of the trade. American Urological Association Update Series 2011:30:41-7.
NQF: Progressive Organizations should use Visualization Urethral catheter-related complications increase length of stay and urinary tract infection for the majority of the surgical procedures examined.
National Quality Forum, 2009. Safe Practices for Better Healthcare-2009 Update: A Consensus Report. Washington, DC.
Singer AJ, Richman PB, La Vefre R, et al. Comparison of patient and practitioner assessments of pain from commonly performed emergency department procedures. Ann Emer Med 1999;33:652-8.