Different Techniques for Management of Problematic Urethral Catheterization in Male Children

Urethral catheterization is very common, considered a minor procedure done by physicians and well-trained nurses. However, in some traumatic or congenital cases, male catheterization is problematic. A multitude of techniques are available and still can utilize the natural urethral opening to manage this distressing situation. Among these techniques, cystoscopic-assisted retrograde catheterization and railroad techniques are reliable options. This article aimed to document application and to evaluate outcomes of both techniques for problematic male urethral catheterization. In our hospitals from February 2015 to March 2020, 167 boys with problematic urethral catheterization underwent cystoscopic-assisted catheterization technique over a guidewire and 6 cases underwent railroad technique due to failed cystoscopic-assisted technique. Both techniques were done under general anesthesia with the patient in supine position and their details will be presented later on. Patients' mean age was 7.2 ± 2.9 years (range = 2-14). One hundred sixty-seven cases (96.5%) underwent cystoscopic-assisted catheterization, while only 6 cases (3.5%) were managed by railroad technique. For cystoscopic-assisted technique, mean operative time was 4 ± 1.5 minutes (range = 6-18). Mean follow-up period was 54 ± 1 months (range 6-60) with only 1 case developed urethral stricture. For the railroad technique, operative time was 7.5 ± 2.6 minutes (range = 10-34), mean follow-up was 45 ± 3 months with 3 cases developed vesicocutaneous fistula, and 4 cases developed residual urethral stricture. Cystoscopic-assisted retrograde catheterization is a minimally invasive, safe, and reliable technique to catheterize the exceptionally difficult male urethra.