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A Practical Approach to Difficult Urinary Catheterizations

  • Office Urology (N Shore, Section Editor)
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Abstract

Routine placement of transurethral catheters can be challenging in some situations, such as urethral strictures, severe phimosis and false passages. Intravaginal retraction of the urethral meatus can complicate Foley placement in postmenopausal females. 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. Suprapubic catheter placement techniques, including percutaneous trocars and the use of the curved Lowsley tractor for initial suprapubic catheter insertion, are reviewed. Prevention and management of common catheter-related problems such as encrustation, leakage, Foley malposition, balloon cuffing and frequent blockages are discussed.

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Conflict of Interest

Dr. Cameron Ghaffary reported no potential conflicts of interest relevant to this article.

Dr. Amanuel Yohannes reported no potential conflicts of interest relevant to this article.

Dr. Carlos Villanueva reported no potential conflicts of interest relevant to this article.

Dr. Stephen W. Leslie reported four patents licensed to Boston Scientific relating to kidney stone baskets and royalties paid to him by Boston Scientific based on sales of kidney stone baskets.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Department of Surgery, Creighton University School of Medicine, 601 North 30th Street, Suite 3700, Omaha, NE, 68131, USA

    Cameron Ghaffary, Amanuel Yohannes & Stephen W. Leslie

  2. Department of Surgery, Children’s Hospital & Medical Center of Omaha, 8200 Dodge Street, Omaha, NE, 68114, USA

    Carlos Villanueva

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  1. Cameron Ghaffary
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  3. Carlos Villanueva
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Correspondence to Stephen W. Leslie.

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Ghaffary, C., Yohannes, A., Villanueva, C. et al. A Practical Approach to Difficult Urinary Catheterizations. Curr Urol Rep 14, 565–579 (2013). https://doi.org/10.1007/s11934-013-0364-3

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