Predictors for failed Initial Urethral Catheterization in Patients with Acute Urinary Retention

Abstract

Objectives: The aim of this study was to find the predictors for failed initial per urethral catheterization in patients with acute urinary retention.

Methods: Patients with acute urinary retention with failed per urethral catheterization were evaluated and followed prospectively. A detailed history, physical examination and investigations were done. An attempt was made to catheterization by a senior urologist. Failed cases underwent suprapubic diversion. Urethro-cystoscopy was done within 48 hours to determine the cause of failed catheterization.

Observations and results: A total of 47 patients were studied. Of the 47 patients who were referred for failed catheterization, 24 were readily catheterized by urology senior resident. In 16 patients supra pubic urinary diversion was done while the remaining 7 were catheterized under Cystoscopy guidance. In our study improper technique was the most significant predictor for failed catheterization. 51.06% of patients who were referred for failed catheterization were readily catheterized while practicing proper technique. Other causes were analysed.

Conclusion: Technique of urethral catheterization is the most important predictor for failed attempts at catheterization. Improper multiple attempts at catheterization leads to significant urethral injuries which cause significant pain and distress to the patients. Moreover such iatrogenic injuries are the leading cause for urethral stricture development later on. As such it is imperative for all emergency health care professionals to have proper training in the technique for urethral catheterization.