The inability to pass a urethral catheter is a common urological emergency. A flexible cystoscope is not always available for direct visualisation, insertion of a guidewire and railroading of a catheter in the event of a difficult catheterisation. We describe a technique using a hydrophilic guidewire (Glidewire®; Terumo, Somerset, NJ, US; Fig 1) that may reduce the need to perform emergency suprapubic catheterisation in cases where the cystoscope is not available immediately.1,2
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Insert a soft ended hydrophilic guidewire through the urethral meatus following the application of topical local anaesthetic and wetting of the wire with sterile water. Advance the guidewire down the urethra as far as it will go. This is unlikely to cause urethral trauma owing to the flexible, soft nature of the tip. If the wire is feeding through steadily, it is safe to presume the wire is in the bladder. If the wire cannot pass, it will recoil out of the meatus. If this occurs, pass the guidewire back down and manipulate it gently by rotating it at the point at which resistance is felt, which in turn will hopefully enable it to glide past the point of obstruction.
Pass an open ended catheter over the guidewire. Alternatively, use a cannula needle to pierce a hole at the end of the catheter, ensuring no disruption to the balloon. This will enable a standard catheter to be fed over the guidewire.
Objectives: To evaluate the efficacy of urethral catheterisation using a hydrophilic guidewire under fluoroscopic guidance in patients with urethral trauma after a failed attempt at blind catheterisation.
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Methods: A diagnosis of urethral trauma was made in 39 cases in 38 men. Patients ranged in age from 41 to 85 years (mean age, 60 years). Causes of the urethral injuries were iatrogenic urethral injury during catheter placement (n = 18), traumatic self-removal of a catheter (n = 12), straddle injuries (n = 6) and motor vehicle accidents (n = 3). All patients underwent failed blind urethral catheterisation. After urethrography, we attempted to insert a hydrophilic guidewire through the urethra into the urinary bladder, and then to place a 3-way balloon retention urethral catheter into the bladder guided by prior passage of the guidewire under fluoroscopy.
Results: Of 39 attempts of inserting the urethral catheter into the urinary bladder, 34 (87.2%) were successful. Of 5 failures (12.8%), 2 were American Association for the Surgery of Trauma (AAST) urethral injury type 3 and 3 were type 4/5. Among these, there were 3 cases of pseudolumen formation.
Conclusions: Hydrophilic guidewire-assisted urethral catheterisation in patients with urethral trauma is a safe, simple technique for relieving acute bladder retention after a failed attempt at blind catheterisation.
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