Urinary catheterization involves temporarily inserting a flexible, hollow tube into the bladder to drain urine through the urethra. This procedure, most commonly performed as clean intermittent self-catheterization (ISC), is a standard method for managing bladder function when the body cannot fully empty the bladder naturally. The need for this technique often arises from conditions like urinary retention, neurogenic bladder dysfunction, or following certain surgical procedures. ISC helps prevent the bladder from becoming overly full, which protects the upper urinary tract, reduces the risk of infection, and supports kidney health.
Essential Preparation and Necessary Supplies
Before beginning the process, gather the correct supplies on a clean surface. The items required include the prescribed catheter size and type, water-soluble lubricating jelly, antiseptic wipes or soap and water for cleaning, and a container or toilet for urine collection. Only water-soluble lubricants should be used, as petroleum-based products can damage the catheter material and may not dissolve safely within the body.
Proper hygiene begins with washing the hands thoroughly before touching any supplies, preventing the introduction of pathogens. Next, clean the genital area, specifically the glans penis and the urethral opening (meatus), using soap and water or an antiseptic wipe. If uncircumcised, the foreskin must be fully retracted and the area beneath it washed before insertion.
Prepare the catheter by applying water-soluble lubricant to the tip and the first 5 centimeters (about 2 inches) of the tube. Hydrophilic catheters come pre-coated and become slick when activated by sterile water, eliminating the need for separate lubricant. This lubrication helps the catheter glide smoothly, minimizing friction and reducing urethral irritation.
Detailed Steps for Male Catheter Insertion
Insertion requires a comfortable and stable position, such as sitting on the toilet or standing in front of it. With the non-dominant hand, hold the penis straight out from the body, taut but not squeezed, to straighten the natural curve of the male urethra. This positioning is essential for navigating the approximately 20 to 25-centimeter (6 to 8-inch) length of the urethra.
Using the dominant hand, gently insert the lubricated catheter tip into the meatus (the opening at the tip of the penis). Advance the catheter slowly and steadily through the spongy and bulbous portions of the urethra. Resistance may be encountered as the catheter progresses, most commonly at the external urethral sphincter.
If resistance is felt, do not force the catheter, which could cause injury to the urethral wall. Instead, take a slow, deep breath to help relax the sphincter muscle, and apply gentle, continuous pressure. Changing the angle of the penis slightly may also help the catheter pass this point and slide easily into the bladder.
Continue insertion until urine begins to flow, confirming the tip has entered the bladder cavity. Once flow is established, advance the catheter approximately 2 to 2.5 centimeters (about 1 inch) further. This ensures that all drainage eyelets are fully inside the bladder and can drain completely. The penis can then return to a natural, downward position while the urine drains.
Post-Procedure Steps and Recognizing Complications
Once the catheter is correctly placed, allow the bladder to empty completely into the designated container or toilet. To ensure full drainage, shift position slightly or apply gentle pressure over the lower abdomen. The catheter is ready for removal when the flow of urine slows and stops.
Withdraw the catheter slowly and smoothly. If urine begins to flow again during removal, pause until the flow ceases. Just before pulling the catheter out fully, pinch the end to prevent residual urine from dripping. After removal, wash the penis to remove lubricant, and return the foreskin to its normal position if retracted.
The used catheter is either disposed of or cleaned, depending on the type prescribed. Reusable catheters require washing with soap and water, rinsing thoroughly, air-drying, and storing in a clean, dry container.
Immediate complications requiring medical consultation include an inability to pass the catheter after multiple gentle attempts, or persistent, bright red blood in the urine. While urethral bleeding or spotting is common when first starting ISC due to minor irritation, persistent or heavy bleeding should be reported.
Recognizing Complications
The most frequent long-term complication is a urinary tract infection (UTI), signaled by:
- Fever
- Chills
- Cloudy or foul-smelling urine
- Increased bladder spasms
Chronic issues like urethral strictures (narrowings of the urethra) can develop over time due to repeated trauma or friction, emphasizing the need for proper lubrication and gentle technique.