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Optimised Protocol for Managing Failed Catheterisation: Leveraging Bedside Retrograde Urethrography and
Basavesh S Patil1, Siddanagouda B Patil1, Vinay S Kundargi1
1Urology, Shri B.M. Patil Medical College Hospital and Research Centre, Bijapur Lingayat District Educational (BLDE) Association (Deemed to be University), Vijayapura, IND.
Cureus
|October 14, 2024
Summary
A new algorithm using bedside retrograde urethrography and urethroscopy successfully enabled 100% of difficult per urethral catheterizations, avoiding suprapubic catheter insertion and its complications.
Area of Science:
- Urology
- Medical Procedures
Background:
- Urethral catheterization is common but can be difficult due to various pathologies.
- Failed attempts often lead to suprapubic catheter (SPC) insertion, which has complications.
- An algorithm was developed to manage difficult catheterization and minimize SPC use.
Purpose of the Study:
- To evaluate causes of difficult urethral catheterization.
- To establish the efficacy of a new algorithm using bedside retrograde urethrography (RGU) and cystoscopy.
- To avoid suprapubic catheter (SPC) placement in non-trauma settings.
Main Methods:
- Prospective observational study (September 2022 - June 2024).
- Included patients with urinary retention or requiring catheterization with one failed attempt.
- Algorithm involved bedside RGU and retrograde urethroscopy (cystoscope or ureteroscope) followed by dilatation and catheterization.
Main Results:
- 55 patients (48 male, 7 female) included.
- Common causes: bulbar urethral stricture (50.9%), meatal stenosis (23.63%).
- 100% successful per-urethral catheterization achieved, avoiding SPC.
Conclusions:
- Bedside RGU and direct urethral visualization improve success rates for difficult catheterizations.
- This algorithm effectively avoids suprapubic catheter (SPC) insertion.
- Implementing this protocol reduces healthcare burden and potential iatrogenic injuries.
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