Glidewire-assisted Foley catheter placement: a simple and safe technique for difficult male catheterization (2022)

  • Journal List
  • Can Urol Assoc J
  • v.3(3); 2009 Jun
  • PMC2692169

Can Urol Assoc J. 2009 Jun; 3(3): 189–192.

PMCID: PMC2692169

PMID: 19543460

(Video) Male Foley Catheter Application Demonstration

Language: English | French

Rei K. Chiou, MD, Himanshu Aggarwal, MD, and Wen Chen, APRN

Author information Copyright and License information Disclaimer


Difficulty in Foley catheter placement is a frequently encountered problem. We describe a simple and safe technique for this condition. Rather than using force, which may lead to the formation of a false passage, one should place a glidewire into the bladder through the area of resistance, followed by the placement of a Foley catheter over the glidewire. This is a very easy procedure and can be taught to nurses and nurse practitioners to avoid an unnecessary call for a urologist in the emergency department.


Il arrive fréquemment que des difficultés surviennent durant l’installation d’une sonde de Foley. Nous décrivons ici une technique simple et sûre pour remédier à la situation. Plutôt que d’utiliser la force, qui peut entraîner la formation d’un faux passage, nous conseillons d’insérer un fil-guide dans la vessie par la zone de résistance suivi de l’installation de la sonde de Foley par-dessus le fil-guide. Cette intervention est très facile à réaliser et peut être enseignée aux infirmières et aux infirmières praticiennes en cas de difficulté lors de l’insertion de la sonde et ainsi éviter de devoir faire venir un urologue à la salle d’urgence.


The placement of a Foley catheter is a common procedure and an essential skill for nurses.13 Difficulty in placing a Foley catheter is a commonly encountered problem among nurses and nurse practitioners. When one encounters difficulty in placing a Foley catheter using a regular technique, it has been recommended to use a reinforced tip catheter, such as a Coudé tip catheter for patients with benign prostatic hyperplasia (BPH).4 It is also a common tendency to push harder when one encounters difficulty in placing a Foley catheter. However, in the presence of a urethral stricture, the use of excessive force or reinforced catheters increases the risk of false passages. If a false passage is created, patients may require a more complicated endoscopic procedure or suprapubic catheter placement.

(Video) Emergency Suprapubic Catheter Placement

We describe a simple and safe technique that we have taught to several nurse practitioners, urology nurses and non–urology specialized physicians to successfully place Foley catheters in difficult cases. This technique can help avoid unnecessary emergency department visits for urologists. This technique has been used in more than 150 cases of difficult catheterization without any complications.


When encountering difficulty in placing a Foley catheter in a male patient, one should ensure that the urethra is lubricated adequately. This can be better achieved by instilling lubricants into the urethra rather than solely dipping the tip of the catheter in the lubricant. If the patient experiences substantial pain during a Foley catheter placement, the intraurethral instillation of topical anesthetics (2% xylocaine jelly) is also helpful. This alleviates pain and decreases sphincter contraction that creates resistance to the catheter placement.

If, after these manoeuvres, one cannot place the Foley catheter, then a glidewire-assisted technique should be used rather than forcefully pushing the Foley catheter. Examples of such a glidewire are the angled tip, 0.038 inches, 150 cm, No. 630–103 wire (Boston Scientific Inc.) or the straight tip, 0.038 inches, 150 cm, No. HW-038150 Hi-wire (Cook Medical Inc.). Glidewires and Hi-wires are hydrophilic coated smooth surface wires that have very soft ends, which makes it safe to pass through a strictured or distorted urethra with minimal risk of injury. When a hydrophilic glidewire comes in contact with water it becomes slippery and the Foley catheter can easily be slid around it because of its smooth and wet surface. The glidewire comes in different sizes and lengths. We commonly use a 0.038-inch glidewire with 150 cm length for this technique.

After moisturizing the glidewire with sterile water by injecting water into the plastic sheath that contains the glidewire and then using a wet sponge to keep the glidewire moist during use, the soft floppy end of the glidewire or Hi-wire (not the stiff end of the wire) should be placed into the urethral meatus and then gently advanced to pass through the urethra into the bladder. If there are no false passages, this soft and slippery wire can easily be placed up to the level of the bladder negotiating even a very tight stricture or distortion of the urethra.

The next step is to use a No. 10 blade to cut a slit on the Foley catheter tip to expose the lumen (Fig. 1). Care must be taken to avoid cutting the lumen that leads to the balloon. Testing leakage of the balloon after cutting is recommended. The Foley catheter can then be placed around the wire through the stiff outer end of the glidewire. After that, the Foley catheter can be advanced through the urethra into the bladder (Fig. 2). With the glidewire in place, one can push somewhat harder, in case resistance is met, when passing the Foley catheter because the passage has already been established with the glidewire.

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Fig. 1.

Use of No. 10 blade to cut a slit on the tip of the Foley catheter (A). The lumen of the Foley catheter is exposed (B).

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Fig. 2.

Placement of the Foley catheter around the wire through the stiff outer end of the glidewire (A). The Foley catheter is advanced through the urethra and into the bladder (B).

(Video) Core Videos (2019): Simple Guidewire and Angiocatheter Technique for Difficult Urethral Catheter

If a regular Foley catheter (16 Fr or 18 Fr) cannot be placed around the glidewire, one can try passing a smaller and stiffer catheter such as a 12 Fr or 14 Fr silastic Foley catheter over the glidewire. If the resistance is still met, the patient probably has a very severe stricture or a false passage due to failed previous attempts. A urologist should best address this problem by performing a flexible endoscopy to determine the pathology and to evaluate the need for suprapubic catheterization or urethral dilatation. Sometimes flexible cystoscopy can be passed into the bladder, facilitating passage of a glidewire, which can then be followed by a Foley catheter.


The placement of a Foley catheter is a very common procedure for urinary retention. Difficult catheterization can be very troublesome in inexperienced hands in the absence of the proper technique. The underlying causes of difficulties include poor lubrication, pain (leading to sphincter contraction and resistance), meatal stenosis, urethral stricture, urethral distortion, distortion of prostatic urethra due to prostate enlargement or surgery, or bladder neck contracture. When encountering difficulties, first of all one should ensure adequate lubrication of the urethra because solely dipping the tip of the Foley catheter in lubricant may not be adequate. Instillation of lubricant into the urethra is always better (most Foley catheter trays have a syringe of lubricant that can be used to instill lubricants into the urethra). If the patient has pain during an attempt to place the Foley catheter, there may be tightening of sphincter muscles against the catheter. Instillation of a topical anesthetic (2% xylocaine jelly) inside the urethra may help with this condition. If the catheter cannot be placed after adequate lubrication, one must assess the underlying causes of the problem.

On initial diagnosis, meatal stenosis is easily identifiable, and the catheter cannot be placed into the stenotic meatus. In such cases meatal dilatation needs to be performed. Other than meatal stenosis, the main differential diagnosis for difficult catheterization in a male patient is a urethral stricture or a prostate problem. Most urethral strictures in patients without any prior prostate surgery are at the pendulous or bulbous urethra. By simply knowing where the catheter meets resistance, one should be able to determine the underlying cause of the problem. If the catheter stops at the penile, scrotal, or perineal levels, it is probably stricture. If the catheter hits the level of the prostate (beyond the urogenital diaphragm or the perineal level), but cannot pass through, it is probably caused by a prostate problem. In the absence of prior prostate surgery, the resistance at the prostate level usually results from BPH or a bulky prostate cancer. In patients who have had prior prostate surgery, the obstruction is usually due to bladder neck contracture.

After encountering difficulty in placing a regular Foley catheter, a Coudé tip catheter can be used in patients with BPH.4 With adequate lubrication and keeping the curved Coudé tip pointing upwards, one can negotiate the distorted prostatic urethra and elevation of the bladder neck created by BPH. However, a Coudé tip catheter should only be used in patients with prostate problems, and not in cases of urethral stricture. If a patient has a urethral stricture, the use of a Coudé tip catheter can create a false passage as the catheter tip points toward the side. The strictured lumen of the urethra is usually very resistant to passage of a Coudé catheter. A Coudé tip catheter usually cannot achieve the goal of dilating the stricture and tends to pierce the delicate urethral wall at the side of the strictured lumen, creating a false passage. The glidewire-assisted technique that we described is useful both in patients with urethral strictures and prostate problems. It also minimizes the risk of a false passage. If the patient has a history of prostate surgeries such as transurethral resection of the prostate for BPH or radical prostatectomy for prostate cancer, the common cause of obstruction is usually a bladder neck contracture or vesicourethral anastomotic stricture, respectively. The glidewire-assisted technique is still appropriate and useful in these patients.

Some early studies have recommended flexible cystoscopy by a urologist after initial failed catheterization to evaluate the exact pathology and passage of a glidewire into the bladder under direct vision so that a Foley catheter can be passed around it.5 However, in our experience and in other studies6 the blind use of the glidewire can be safely attempted as a second-line treatment, and this is very effective in most of the difficult cases of catheterization, including urethral stricture and prostatic problems. The technique we described can be easily and safely used by any trained nurse or a family physician in peripheral hospitals. If even the glidewire cannot be placed, a flexible cystoscopy should be performed by a urologist to diagnose underlying pathology and to evaluate for the need of suprapubic catheterization or urethral dilation. Also in cases of intraoperative difficulty in placing a Foley catheter, urethroscopy or endoscopy can be performed to evaluate the need for suprapubic tube placement of urethral dilation.7 If a urethral dilation is required, we prefer to carry out a balloon dilation around the glidewire. The Foley catheter can then be placed around the glidewire using the technique we described.

We also recommend watching for any urethral bleeding during the initial attempt of Foley catheter placement, as this usually indicates some degree of urethral tear or false passage. One should stop any further attempt on the first sign of false passage and call for the help of a specialist because a false passage complicates further management.


When encountering difficulty in Foley catheter placement in a male patient, we recommend a simple and safe technique of a glidewire-assisted Foley catheter placement. This technique minimizes the risk of a false passage that is created by forcing catheters or using Coudé tip catheters in case of urethral stricture. This is an easy, safe and very effective procedure that can be taught to nurses or family practioners and can avoid unnecessary emergency calls for urologists, especially in peripheral hospitals.


Competing interests: None declared.

(Video) Pigtail Catheter Insertion- A Live Demonstration on Patient /Pigtail Chest Drain


1. Hardy J. Urinary catheterisation in male patients. Nurs Stand. 2006;21:59. [PubMed] [Google Scholar]

2. Robinson J. Urethral catheter selection. Nurs Stand. 2001;15:39–42. [PubMed] [Google Scholar]

3. Doherty W. Male urinary catheterisation. Nurs Stand. 2006;20:57–63. [PubMed] [Google Scholar]

4. Clinical Practice Guidelines Task Force, Society of Urologic Nurses and Associates Male urethral catheterization. Urol Nurs. 2006;26:315. [PubMed] [Google Scholar]

5. Krikler SJ. Flexible urethroscopy: use in difficult male catheterisation. Ann R Coll Surg Engl. 1989;71:3. [PMC free article] [PubMed] [Google Scholar]

6. Villanueva C, Hemstreet GP., III Difficult male urethral catheterization: a review of different approaches. Int Braz J Urol. 2008;34:401–11. [PubMed] [Google Scholar]

7. Jordan GH, Winslow BH, Devine CJ., Jr Intraoperative consultation for the urethra. Urol Clin North Am. 1985;12:447–52. [PubMed] [Google Scholar]

Articles from Canadian Urological Association Journal are provided here courtesy of Canadian Urological Association

(Video) My Foley Catheter Balloon Won't Deflate


What are the steps in inserting the Foley catheter in a male patient? ›

Use your nondominant hand to lift the penis perpendicular to your patient's body, apply slight traction, and gently press both sides to help open the meatus. Encourage your patient to breathe deeply as you gently insert the catheter tip into the meatus.

What is the best position for male during urinary catheterization? ›

Place the patient in the supine position with legs extended and flat on the bed. Prepare the catheterization tray and catheter and drape the patient appropriately using the sterile drapes provided. Place a sterile drape under the patient's buttocks and the fenestrated (drape with hole) drape over the penis.

What is a common cause for difficulty inserting a catheter in a man? ›

Strictures are the most common cause of difficult catheterization. They create narrowing in the lumen, leading to resistance during catheterization that can be anxiety-provoking to both the health care provider and patient.

What can go wrong with male catheterisation? ›

Risks and potential problems

The main problems caused by urinary catheters are infections in the urethra, bladder or, less commonly, the kidneys. These types of infection are known as urinary tract infections (UTIs) and usually need to be treated with antibiotics.

What is the difference between a Foley catheter and an indwelling catheter? ›

An indwelling urinary catheter is inserted in the same way as an intermittent catheter, but the catheter is left in place. The catheter is held in the bladder by a water-filled balloon, which prevents it falling out. These types of catheters are often known as Foley catheters.

What is the size of male catheter? ›

The average catheter size used by adult men is between 14FR to 16FR. Most men use 14FR catheters. The average catheter size used by adult women ranges from 10FR to 12FR.

How can correct urinary catheter placement be confirmed? ›

An ultrasound of the bladder can be performed to confirm the location of the catheter and its balloon.

What happens if you come while wearing a catheter? ›

In this study, we show that ejaculation can be achieved while the Foley catheter is instilled in the urethra without any detrimental effect on the sperm. Therefore, we recommend not removing the Foley catheter while performing electroejaculation.

Can you accidentally pull out a catheter? ›

Medical studies have shown that 11–17 percent of all catheters are unintentionally torn out and 5% of all urological catheters are traumatically pulled.

What to do if Foley catheter is leaking? ›

There is urine leaking around the catheter

Check for and remove any kinks in the catheter or the drainage bag tubing. This could also indicate your catheter is blocked (see above). Go to your local emergency department immediately as the catheter may need to be changed.

How often should a male catheter be changed? ›

The catheter itself will need to be removed and replaced at least every 3 months. This is usually done by a doctor or nurse, although sometimes it may be possible to teach you or your carer to do it.

Can a Foley catheter be put in wrong? ›

Accidental placement of Foley catheter in ureter is a rare phenomenon. It is more common in females with neurogenic bladder who have hypocontractile bladder or there can be iatrogenic placement during surgical procedures.

How do you put a catheter comfortably in? ›

Wearing it properly

Tape the Foley catheter comfortably to your upper thigh. The tube should not be pulled tight. Always keep the drainage bag below your bladder (when you are lying, sitting or standing). Keep the catheter tube free of kinks and loops so the urine can flow easily.

Can you insert a catheter too far? ›

You cannot puncture a hole through the bladder. It is a very strong, tough muscle. The catheter will just coil up inside the bladder if it is pushed in too far. You should never force the catheter if you meet resistance and are unable to pass the catheter into your child's bladder.

How long should a Foley catheter be left in? ›

Most indwelling catheters are not suitable to remain in place for longer than 3 months, so will need to be changed regularly.

What happens if catheter bag is full? ›

If your leg bag becomes full and you do not wake up, there is a chance that your bladder will become full and the urine may reflux (flow) back to your kidneys. This may cause infection which can make you very unwell. To attach your overnight drainage bag or bottle: Wash and dry your hands thoroughly.

How long do you need a catheter after bladder surgery? ›

CATHETER REMOVAL: You should remove your catheter 10 days after surgery. You will find enclosed, instructions to remove your catheter. If you have any questions regarding this you should call Dr.

Is there an alternative to a male catheter? ›

Men's Liberty – one of the best catheter alternatives

An external collection system with significantly less risk for rash and urinary tract infection. This type of external catheter is effective for all male anatomy, regardless of size. You can even use it effectively whether or not you had a circumcision.

What length of catheter is suitable for male catheterisation? ›

Recommended Sizes of Catheter

For urethral use: Female length - 12-14ch. Standard (male) length - 12-16ch. Standard length catheters must always be used for males (National Agency for Patient Safety 2009)

What is the recommended size and length of insertion of male Foley catheterization? ›

Insert the catheter for about 15–25cm or until you see urine flow. Insert it almost to its bifurcation before inflating the balloon to ensure it has cleared the prostatic bed and is in the bladder (Fig 6, attached). Inflation of the balloon in the urethra is painful (Dougherty and Lister, 2015).

What can you not do with a catheter? ›

Don't change catheters or urine collection bags at routine, fixed intervals.
  1. Don't administer routine antimicrobial prophylaxis.
  2. Don't use antiseptics to cleanse the periurethral area while a catheter is in place.
  3. Don't vigorously clean the periurethral area.
  4. Don't irrigate the bladder with antimicrobials.

What happens if catheter Cannot be inserted? ›

Repeated and unsuccessful attempts at blind urinary catheterization result in stress and pain for the patient, injury to the urethra, potential urethral stricture requiring surgical reconstruction, and problematic subsequent catheterization.

How long do you clamp a Foley catheter for bladder training? ›

Clamping causes the bladder to feel the urge to urinate before removing the catheter, decreasing incidence of urinary retention and, therefore, decreasing the need for catheter reinsertion. The catheters were clamped for 4 hours, and then unclamped for 15 minutes, allowing them to drain completely.

Can you remove a Foley catheter without a syringe? ›

Using a Pair Of Scissors

This valve is what keeps the water balloon on the end of the catheter inflated with water. To remove your catheter, you simply must use scissors to cut the valve off, just behind the valve. When done, water will come out (not urine).

Can you sleep with catheter leg bag? ›

Can I Sleep With a Catheter Bag? Yes you can! There are larger capacity catheter bags that are designed for overnight drainage. Their larger capacity means you won't have to worry about getting up in the night to drain them.

How do you insert a Foley catheter? ›

Female Foley Insertion (Urinary Catheter) [How to Insert Nursing ...

What is the procedure of catheterization? ›

One end of the catheter is either left open-ended to allow drainage into a toilet or attached to a bag to collect the urine. The other end is guided through your urethra until it enters your bladder and urine starts to flow. When the flow of urine stops, the catheter can be removed. A new catheter is used each time.

Which action should the nurse implement when inserting an indwelling catheter for an uncircumcised male client? ›

Inserting a foley catheter in an uncircumcised male
  1. Place the patient in the supine position with legs extended and flat on the bed.
  2. Prepare the catheterization tray and catheter and drape the patient appropriately using the sterile drapes provided. ...
  3. Apply water-soluble lubricant to the catheter tip.
9 Aug 2015

How do they insert a catheter? ›

Most often, the catheter is inserted through the urethra. This is the tube that carries urine from the bladder to the outside of the body. Sometimes, the provider will insert a catheter into your bladder through a small hole in your belly. This is done at a hospital or provider's office.

How much urine should be in bladder before catheterization? ›

For bladder volume >600 mL, urethral catheterization is recommended to prevent development of POUR [19]. However, that volume is somewhat high for adult patient group whose maximum bladder volume is 400 to 500 mL and in present study, bladder volume of 600 mL was accepted as catheterization cut-off value.

How often should Foley catheter be changed? ›

The catheter itself will need to be removed and replaced at least every 3 months. This is usually done by a doctor or nurse, although sometimes it may be possible to teach you or your carer to do it. The charity Bladder and Bowel Community has more information on indwelling catheters.

What helps Foley catheter pain? ›

Use lubrication with your uncoated catheters.

Catheter lubricating jelly helps reduce friction and discomfort during the insertion and withdrawal of your catheter.

When should you not catheterize a patient? ›

Contraindications to bladder catheterization include:
  • Blood at the meatus. Insertion of the catheter can worsen an underlying injury.
  • Gross hematuria.
  • Evidence of urethral infection.
  • Urethral pain or discomfort.
  • Low bladder volume/compliance.
  • Patient refusal [11]

What length of catheter is suitable for male catheterisation? ›

Recommended Sizes of Catheter

For urethral use: Female length - 12-14ch. Standard (male) length - 12-16ch. Standard length catheters must always be used for males (National Agency for Patient Safety 2009)

When preparing to insert an indwelling urinary catheter in a male patient it is important for the nurse to do what? ›

When preparing to insert an indwelling urinary catheter in a male patient, it is important for the nurse to do what? Remove the cotton balls from the kit for later use. Advance the catheter 10 to 12 inches or until urine flows. Lubricate the first 5 to 7 inches of the catheter.

What can you ask a male patient to do to facilitate insertion of an indwelling catheter? ›

Hold the catheter 2" to 3" (5 cm to 7.6 cm) from the tip and prepare to insert the lubricated tip into the urinary meatus. To facilitate insertion by relaxing the sphincter, ask the patient to cough as you insert the catheter. Tell him to breathe deeply and slowly to further relax the sphincter and prevent spasms.

What is nursing responsibilities in urinary catheterization? ›

Nurses are often responsible for the initiation of catherization procedures for patients within the hospital or community setting. This nursing role requires contemporary information on catheter selection and problem solving in the maintenance of urinary catheters.

How do I completely empty my male bladder? ›

Techniques for Complete Bladder Emptying
  1. Timed voids. ...
  2. Double void. ...
  3. Drink plenty of fluids. ...
  4. Have a bowel movement every day. ...
  5. Comfort and privacy are necessary to empty completely. ...
  6. Leaning forward (and rocking) may promote urination.

What is the maximum amount of urine to be removed at one time? ›

With acute overdistention of the bladder, no more than 1000 cc of urine should be removed from the bladder at one time. The theory behind this is that removal of more than 1000 cc suddenly releases pressure on the pelvic blood vessels.

Can a catheter cause erectile dysfunction? ›

Having a catheter in place should not affect an erection or ejaculation.


1. Foley Catheter Not Working or Draining? How to Flush a Foley Catheter
(Dr. Robert Chan)
2. FPMRS Fellows Webinar, May 5: Intraoperative Care and Management of Lower Urinary Tract Injuries
3. Central Venous Catheter (CVC )/ Central line insertion- Internal Jugular Vein (USG guided)
(Intellect Medicos)
4. Using the Axillary Artery for Alternative Large Bore Access, Dr. Amir Kaki
(MonteHeart Lectures)
5. Core Videos (2019): A Stepwise Demonstration of Foley Catheter Placement Over a Guidewire and Suprap
6. Central Venous Catheter Insertion Demonstration
(Royal Berkshire NHS Foundation Trust)

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