IDC insertion

Anatomical considerations

• Average male urethra accomodates
  • Meatus: 24Fr
  • Prostatic urethra: 32Fr
  • Bladder neck: 28Fr
• Female urethra - normal calibre is 22Fr

Indications

• Retention
• Therapeutic eg bcg
• Etc
• Extraperitoneal bladder injury and SOME intraperitoneal bladder injury
• Small vesicovaginal fistulae

Contraindications

• Absolute
  • Suspected or confirmed urethral injury
  • History of bladder neck closure or repair
• Relative
  • Recent urethral surgery
  • Urethral stricture
  • Artificial urinary sphincter - needs special technique, need to discuss with urologist

Difficulties

• Prostatic obstruction
  • Often gets stuck with BPH and a smaller (14 or 16Fr) catheter. Try 18Fr ideally with a coudé tip (point the tip anteriorly) - normally goes through with gentle sustained pressure.
• Urethral stricture
  • Occasionally, gentle pressure will dilate the stricture
  • Beware strictures at level of membranous urethra - more likely to lead to false passage due to angulation
  • Either pass a guidewire or go straight to cystoscopy for guidewire placement, then dilators would be passed over the guidewire. Dilation is needed to one size higher than the planned catheter (i.e. dilate to 18Fr if planning 16Fr catheter)
  • I think a stricture at the meatus could be dilated under vision, or perhaps a urethrotomy
• Urethral trauma
  • Posterior injury - one gentle passage of catheter may be permitted, but stop if ANY resistance
  • You could consider using guidewire
• Blood in catheter - suspect false passage - probably needs endoscopic insertion
• In children, especially male, there is often intense urinary sphincter contraction - normally resolves with gentle steady pressure and deep breathing
• Don’t force foreskin to retract if it won't go easily