Emergency catheter insertion with a tight urethral stricture and empty bladder

Attempts at urethral catheterisation using Foley's catheter invariably fails in patients with tight urethral strictures. However, a lubricated fine bore infant feeding tube can usually be negotiated through the stricture. Once urine is noticed, up to 1l of normal saline can be infused through the tube. The bladder distension can be confirmed by percussion or using a standard bladder scanner. A suprapubic catheter can then be inserted in the usual way. This procedure can be very useful in critically ill patients, particularly when specialist urological advice is not available, where a urinary diversion is required along with urine output measurements.