Difficult urethral catheterisation made safer: visualising the ‘blind’ hydrophilic wire

BACKGROUND

Difficult urethral catheterisation in a male, non-trauma patient with urinary retention is often due to a false passage, urethral stricture or bladder neck contracture. When simple measures¹ have failed, the usual choice is between use of a suprapubic catheter and cystoscopic catheterisation over a guidewire. However, suprapubic catheterisation has its contraindications and the wait for theatre can be long. An alternative strategy is the blind passage of the hydrophilic wire into the bladder in the emergency department,^2–5 which is not without risk as the guidewire can end up in the false passage, ejaculatory duct or ureter. We advocate ultrasonography visualisation of the “blind” wire, which makes this approach safer.

TECHNIQUE

Following the instillation of lubricating gel, a Sensor™ (Boston Scientific, Marlborough, MA, US) wire is passed in the urethra, its advance monitored using ultrasonography (abdominal transducer pointing over the bladder). Once the sufficient length of the wire is in the bladder, the operator can either pass an open tip 16–18Fr Foley catheter over the wire (if false passage is suspected) or perform dilation with S-Curve™ (Cook Medical, Bloomington, IN, US) urethral dilators (in the case of urethral stricture or bladder neck contracture) prior to catheterisation. If dilation is not tolerated, a temporary 6Fr ureteric catheter or 5/8Fr infant feeding tube can be passed instead.

DISCUSSION

The ultrasonography machine is now an indispensable part of the equipment of many emergency departments. The echogenicity of the guidewires makes it easy to ultrasonically visualise their passage into the full bladder. In our hands, this technique proved to be safe and effective.