How To Catheterize the Bladder in a Male Child

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

Relief of acute or chronic urinary retention (obstructive uropathy Obstructive Uropathy Obstructive uropathy is structural or functional hindrance of normal urine flow, sometimes leading to renal dysfunction (obstructive nephropathy). Symptoms, less likely in chronic obstruction... read more )

Intermittent catheterization of a neurogenic bladder Neurogenic Bladder Neurogenic bladder is bladder dysfunction (flaccid or spastic) caused by neurologic damage. Symptoms can include overflow incontinence, frequency, urgency, urge incontinence, and retention.... read more

Instillation of contrast agent for cystourethrography

Bladder irrigation

Instillation of a medicine

Monitoring of urine output in certain hospitalized patients (indwelling catheter; not discussed here)

Suspected urethral disruption from recent urethral trauma Urethral Trauma Urethral injuries usually occur in men. Most major urethral injuries are due to blunt trauma. Penetrating urethral trauma is less common, occurring mainly as a result of gunshot wounds, or alternatively... read more

Known major abnormalities of the lower urinary tract

History of urethral strictures Urethral Stricture Urethral stricture is scarring that obstructs the anterior urethral lumen. Urethral stricture can be Congenital Acquired Anything that damages the urethral epithelium or corpus spongiosum can... read more

Prior urethral or bladder neck reconstruction

History of difficult catheter placement

Superficial urethral Urethral Trauma Urethral injuries usually occur in men. Most major urethral injuries are due to blunt trauma. Penetrating urethral trauma is less common, occurring mainly as a result of gunshot wounds, or alternatively... read more or bladder injury Bladder Trauma External bladder injuries are caused by either blunt or penetrating trauma to the lower abdomen, pelvis, or perineum. Blunt trauma is the more common mechanism, usually by a sudden deceleration... read more with bleeding (common)

Urinary tract infection Urinary Tract Infection (UTI) in Children Urinary tract infection (UTI) is defined by ≥ 5 × 10⁴ colonies/mL in a catheterized urine specimen or, in older children, by repeated voided specimens with ≥ 10⁵ colonies/mL... read more (UTI; common)

Creation of false passages

Scarring and strictures Urethral Stricture Urethral stricture is scarring that obstructs the anterior urethral lumen. Urethral stricture can be Congenital Acquired Anything that damages the urethral epithelium or corpus spongiosum can... read more

Bladder perforation (rare)

Paraphimosis Paraphimosis Phimosis is inability to retract the foreskin. Paraphimosis is entrapment of the foreskin in the retracted position; it is a medical emergency. Phimosis is normal in children and typically resolves... read more , if the foreskin is not reduced after the procedure

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

Sterile technique is necessary to prevent a lower UTI Urinary Tract Infection (UTI) in Children Urinary tract infection (UTI) is defined by ≥ 5 × 10⁴ colonies/mL in a catheterized urine specimen or, in older children, by repeated voided specimens with ≥ 10⁵ colonies/mL... read more .

Ensure the patient is not allergic to latex or povidone-iodine.

If doing multiple procedures, do bladder catheterization first as the child may void during the other procedures.

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.

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.

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.

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

Remove the drapes.

To prevent causing a UTI Urinary Tract Infection (UTI) in Children Urinary tract infection (UTI) is defined by ≥ 5 × 10⁴ colonies/mL in a catheterized urine specimen or, in older children, by repeated voided specimens with ≥ 10⁵ colonies/mL... read more , maintain strict sterile technique during the procedure.

To prevent causing paraphimosis Paraphimosis Phimosis is inability to retract the foreskin. Paraphimosis is entrapment of the foreskin in the retracted position; it is a medical emergency. Phimosis is normal in children and typically resolves... read more , reduce the foreskin after the procedure by returning it to its normal position over the glans.

To prevent causing blind passages and urethral injury, do not use excessive force during insertion.

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.