Procedure · Bedside procedures

Urinary catheterisation

Also known as: urinary catheter, Foley catheter, indwelling catheter, intermittent self-catheterisation, suprapubic catheter

A soft tube passed along the urethra into the bladder to drain urine, held in place by a small balloon inflated inside the bladder. Used for hours during surgery, days on a ward, or long term when the bladder cannot empty. A suprapubic catheter enters through the lower abdominal wall instead; intermittent catheterisation passes a tube several times a day and removes it each time.

Open in the 3D explorerUrinary bladder & urethra anatomy
3D model of the Urinary bladder & urethra in the Anatomy Nexus anatomy atlas
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What it is

A soft tube passed along the urethra into the bladder to drain urine, held in place by a small balloon inflated inside the bladder. Used for hours during surgery, days on a ward, or long term when the bladder cannot empty. A suprapubic catheter enters through the lower abdominal wall instead; intermittent catheterisation passes a tube several times a day and removes it each time.

Why it is done

  • Acute urinary retention (usually from an enlarged prostate) or chronic retention with kidney damage
  • Measuring urine output hour by hour in critical illness and major surgery
  • Neurological bladder problems (spinal cord injury, multiple sclerosis), often by self-catheterisation
  • Bladder irrigation after prostate or bladder surgery, or with clots
  • Incontinence with skin breakdown when other measures fail (last resort)

Before the procedure

  • Explanation and consent; checking for latex allergy and previous difficult catheters
  • Sterile technique: hand hygiene, gloves, cleaning the urethral opening
  • Anaesthetic lubricant gel instilled into the urethra and left for a few minutes

Step by step

  1. The catheter (usually 12-16 Fr) is advanced gently along the urethra; in men the penis is held upright to straighten the first bend, then lowered to pass the prostate
  2. Urine flows once the tip is in the bladder; the catheter is advanced further before the balloon is inflated with 10 mL of sterile water
  3. It is drawn back until the balloon rests at the bladder neck and connected to a drainage bag or valve
  4. The volume drained is recorded; very large volumes are drained in stages if chronic retention is suspected
  5. The catheter is secured to the thigh to prevent traction

Afterwards

  • Daily cleaning of the meatus, keeping the bag below bladder level and changing bags on schedule
  • Removal (trial without catheter) as soon as it is no longer needed, usually within days
  • Long-term catheters are changed every 4-12 weeks; bacteria in the urine are expected and not treated unless there are symptoms

Recovery

Slight stinging on first passing urine after removal is normal; a failed trial without catheter leads to re-catheterisation and urology review.

Risks

  • Urinary tract infection, rising with each day in place, and catheter-related sepsis
  • Urethral trauma, bleeding and false passage, especially in men with strictures or enlarged prostates
  • Blockage by debris or clots; bypassing; bladder spasm
  • Long term: strictures, stones, bladder cancer risk after many years

Alternatives

  • Bladder scan and watchful measures for mild retention
  • Alpha-blocker tablets before a trial without catheter in prostatic retention
  • Intermittent self-catheterisation or suprapubic catheter for long-term needs
  • Sheath (condom) drainage or pads for incontinence
Educational content. A general description of how a procedure is usually done. Details vary between hospitals, surgeons and patients; the treating team explains the specifics and the consent.