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How To Catheterize the Bladder in a Male Child


Keara N. DeCotiis

, MD, Nemours/Alfred I. duPont Hospital for Children

Reviewed/Revised Sep 2023

Urethral catheterization is insertion of a flexible catheter through the urethra into the urinary bladder.

Indications for Bladder Catheterization: Male Child

Bladder catheterization can be done for diagnosis and/or treatment.

The main reason to insert a bladder catheter in male children is to

  • Collect a sterile urine sample for testing in very young children who cannot void on command

Less common reasons include

Contraindications for Bladder Catheterization: Male Child

Absolute contraindications

In trauma patients, lower urinary tract disruption (suggested by perineal hematoma, bleeding from the meatus, or pelvic bone injury) should be ruled out by retrograde urethrography (and sometimes cystoscopy) before doing bladder catheterization

Relative contraindications

Complications for Bladder Catheterization: Male Child

Equipment for Bladder Catheterization: Male Child

Sometimes prepackaged kits are available; if not, equipment required typically includes

  • Sterile drapes and gloves

  • An absorbent underpad

  • Antiseptic solution (eg, povidone-iodine, chlorhexidine) with applicator sticks, cotton balls, or gauze pads

  • Sterile water-soluble lubricant (with or without 2% lidocaine)

  • Sterile cup for collecting urine specimen

  • Urethral catheter size varies with age: neonate (full term) to 6 months—5 to 6 French (Fr); infant or toddler—6 to 8 Fr; prepuberal child—10 to 12 Fr; adolescent—12 to 14 Fr

  • Washcloth for removing antiseptic solution after the procedure

Additional Considerations for Bladder Catheterization: Male Child

Relevant Anatomy for Bladder Catheterization: Male Child

  • The pediatric male anatomy is similar to the adult's, with a difference in size.

  • The male urethra bends acutely at the pubis. Hold the penis straight and upright, to smooth out the curve, when passing a catheter through the urethra.

Positioning for Bladder Catheterization: Male Child

  • Position the patient supine with hips comfortably abducted, knees bent in frog position (hips and knees partially flexed, heels on the bed, hips comfortably abducted).

  • A clinical assistant should hold the legs or knees.

Step-by-Step Description of Bladder Catheterization: Male Child

The in-and-out insertion of a catheter is described here.

  • Allow one or both parents or caretakers to remain present to comfort the child. Having them hold the child's hand, provide a stuffed animal for the child to play with, or engage in other distraction techniques can help. Occasionally sedation is needed.

  • Place all equipment within easy reach on an uncontaminated sterile field on a bedside tray.

  • Open the prepackaged kit, taking care not to contaminate the contents.

  • Place the absorbent underpad with the plastic side down beneath the buttocks.

  • Remove diaper if present and clean the area with a wet washcloth using soap and water. Dry the area with a dry towel. Then wash your hands with soap and water.

  • Put on gloves using sterile technique.

  • Apply the sterile lubricant to the end of the catheter and place on the sterile field.

  • Saturate the application sticks, cotton balls, or gauze pads with povidone-iodine.

  • Place the sterile fenestrated drape over the pelvis so that the penis remains exposed.

  • Grasp the shaft of the penis using your nondominant hand, hold the penis perpendicular to the abdominal wall, and apply gentle traction. Retract the foreskin enough to visualize the urethral meatus if the patient is uncircumcised. Do not force the foreskin to retract. Remember to hold the sides of the penis and not directly underneath; the urethra runs through here and you may compress the area, making it difficult to advance the catheter. This hand is now nonsterile and must not be removed from the penis or touch or any of the equipment during the rest of the procedure. If needed, new sterile gloves can be used.

  • Cleanse the glans penis with each application stick, gauze pad, or cotton ball saturated in povidone-iodine. Use a circular motion, beginning at the meatus, and work your way outward. Discard or set aside the newly contaminated application sticks, gauze pads, or cotton balls. If using povidone-iodine, cleanse 3 times then allow the area to dry.

  • Hold the catheter in your dominant free hand.

  • Advance the catheter slowly through the urethra just until urine is obtained. If the patient is old enough to cooperate, ask him to relax and take slow deep breaths as you continue to apply steady pressure. There may be some resistance due to bladder sphincter contraction during insertion of the catheter. Maintain steady gentle pressure so the catheter will advance when the sphincter relaxes. Do not poke repeatedly or force the catheter. Urine should flow freely.

  • Collect urine in the specimen container. If the volume is insufficient, gently massage the lower abdomen over the bladder (suprapubic area).

  • Remove the catheter by pulling out gently.

  • Remove all remaining povidone-iodine with a wet washcloth.

  • Reposition the foreskin in the uncircumcised male over the glans to avoid paraphimosis.

How To Catheterize the Urethra of a Male Infant or Small Child

Aftercare for Bladder Catheterization: Male Child

  • Reduce the foreskin of uncircumcised patients by returning it to its normal position over the glans, to prevent paraphimosis.

  • Remove the drapes.

Warnings and Common Errors for Bladder Catheterization: Male Child

Tips and Tricks for Bladder Catheterization: Male Child

  • If the foreskin cannot be fully retracted, do not force it. A little gentle retraction may be enough to adequately see the meatus.

  • Remember to hold the sides of the penis and not directly underneath; the urethra runs through here and you may compress the area, making it difficult to advance the catheter.

  • Do not proceed with continued attempts at catheter placement if significant resistance is met or if the catheter feels as if it is buckling inside and not advancing.

  • If the catheter appears to be in the correct position but urine does not return, lubricant may be obstructing the drainage of urine. With the catheter held in the current position, flush the catheter with normal saline to dislodge the lubricant and see if urine returns prior to proceeding with the remaining steps.

  • If the catheter appears to be in the correct position but urine does not return and there is the possibility of anuria due to dehydration, consider providing hydration (appropriate to patient's clinical condition) before the procedure is attempted again.

  • Consult urology for any issues with catheter placement or guidance on catheter size and style in select clinical scenarios. In certain situations where a catheter cannot be placed, a suprapubic percutaneous aspiration may be indicated.

Drugs Mentioned In This Article

Drug Name Select Trade
Betadine, Betadine Prep, First Aid, GRx Dyne, GRx Dyne Scrub, Povidex , Povidex Peri
Betasept, Chlorostat, Hibiclens, Oro Clense , Peridex, Periogard, PerioRx , Perisol
7T Lido, Akten , ALOCANE, ANASTIA, AneCream, Anestacon, Aspercreme with Lidocaine, Astero , BenGay, Blue Tube, Blue-Emu, CidalEaze, DermacinRx Lidogel, DermacinRx Lidorex, DERMALID, Ela-Max, GEN7T, Glydo, Gold Bond, LidaMantle, Lidocan, Lidocare, Lidoderm, LidoDose, LidoDose Pediatric, Lidofore, LidoHeal-90, LIDO-K , Lidomar , Lidomark, LidoReal-30, LidoRx, Lidosense 4 , Lidosense 5, Lidosol, Lidosol-50, LIDO-SORB, Lidotral, Lidovix L, LIDOZION, Lidozo, LMX 4, LMX 4 with Tegaderm, LMX 5, LTA, Lydexa, Moxicaine, Numbonex, ReadySharp Lidocaine, RectaSmoothe, RectiCare, Salonpas Lidocaine, Senatec, Solarcaine, SUN BURNT PLUS, Tranzarel, Xyliderm, Xylocaine, Xylocaine Dental, Xylocaine in Dextrose, Xylocaine MPF, Xylocaine Topical, Xylocaine Topical Jelly, Xylocaine Topical Solution, Xylocaine Viscous, Zilactin-L, Zingo, Zionodi, ZTlido
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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