My clinical approach
Urinary catheterisation may seem like a “routine” procedure, but proper technique, catheter choice, and patient education significantly determine outcomes. Catheter-associated UTI (CAUTI) is one of the most common hospital-acquired infections — and it is largely preventable.
For patients requiring long-term catheterisation, CIC (clean intermittent catheterisation) is the safest and most physiological method — significantly reducing infection and bladder damage risk compared to an indwelling catheter.
What urinary catheterisation is
Urinary catheterisation is the insertion of a thin flexible tube (catheter) into the bladder through the urethra (or through the abdominal wall in suprapubic cystostomy) to allow urine drainage. It is used for:
Types of catheters
Foley catheter
Two-lumen urethral catheter with balloon — the most common. Placed transurethrally, balloon inflated with saline for retention. Used for short and long-term indwelling drainage.
Nelaton (straight) catheter
Short single-use catheter for single bladder emptying (no balloon). Used for urodynamics, sterile urine sample collection, and for patient CIC training.
Suprapubic catheter (cystostomy)
Inserted through the abdominal wall above the pubis into the bladder under local anaesthesia and ultrasound guidance. Indicated when urethral access is impossible.
CIC (clean intermittent catheterisation)
Patient-performed self-catheterisation multiple times daily for complete bladder emptying. Gold standard for neurogenic bladder. Compatible with active lifestyle.
Indications for catheterisation
Foley catheter placement
Suprapubic catheter (cystostomy)
Suprapubic cystostomy involves inserting a catheter directly into the bladder through a small incision above the pubis. It is performed under local anaesthesia with ultrasound guidance for safety. It is indicated when urethral catheterisation is impossible or contraindicated:
Catheter care
Complications
CAUTI (catheter-associated UTI)
Most common complication. Prevention: aseptic technique, use smallest gauge, remove as soon as possible.
Urethral irritation / trauma
Rare with proper technique and adequate lubrication.
Haematuria
Usually mild and resolves with hydration. Caused by mucosal friction during placement.
Catheter blockage
Due to deposits or clots. Requires catheter irrigation or replacement.
Bladder spasm
Bladder contractions around the catheter balloon. Managed with antispasmodics.
When to call the urologist
Seek medical advice immediately if:
- Fever > 38°C or chills
- No urine output (catheter obstruction)
- Heavy haematuria with clots
- Severe burning, pain, or abdominal distension
- Accidental catheter dislodgement
- Leakage of urine around the catheter
Frequently Asked Questions (FAQ)
Does urinary catheter placement hurt?
Urethral (Foley) catheter placement causes mild discomfort — not severe pain. Local anaesthetic gel (lidocaine) is applied in the urethra before insertion. The procedure takes 1–2 minutes. Suprapubic catheter placement is performed under local anaesthesia using ultrasound guidance.
How long does a catheter stay in?
Depends on the indication. After surgery, usually 1–7 days. Chronic retention patients may use CIC (clean intermittent catheterisation) indefinitely. Suprapubic catheters may be permanent if voiding cannot be restored.
What is CIC (clean intermittent catheterisation)?
CIC is a technique where the patient inserts a thin catheter themselves several times a day to empty the bladder, then removes it. It is the gold standard for neurogenic bladder and chronic retention. Much safer than indwelling catheters (lower infection risk).
Why is catheterisation indicated?
Urinary catheterisation is indicated for: acute urinary retention, surgery, urodynamic testing, urinary incontinence monitoring, bladder irrigation after endoscopic surgery, and chronic retention due to neurogenic bladder or severe BPH.
What is a suprapubic catheter?
A suprapubic catheter (cystostomy tube) is a catheter inserted directly into the bladder through the abdomen, above the pubis, under local anaesthesia and ultrasound guidance. Indicated when urethral access is impossible (urethral stricture, trauma, major surgery).
How is catheter-associated infection (CAUTI) prevented?
CAUTI prevention: use smallest catheter gauge, maintain closed drainage system, proper aseptic technique, regular catheter care, avoid unnecessary urethral manipulation, and catheter removal as soon as clinically indicated.
Book your appointment in Rhodes
If you need urinary catheterisation, CIC training, or suprapubic catheter management, contact the urology practice in Rhodes for a professional and personalised assessment.
References
- EAU Guidelines on Urological Infections 2024 — uroweb.org
- EAU Guidelines on Neurogenic Lower Urinary Tract Dysfunction 2024 — uroweb.org
- CDC Guideline for Prevention of CAUTI 2009 (updated 2017) — cdc.gov
Medical review
Dr. Marinos Vasilas, Urologist – Andrologist
Dr. Vasilas manages urinary catheterisation — from simple Foley placement to suprapubic cystostomy and CIC training — with emphasis on patient safety and CAUTI prevention.
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