Efficacy of urethral catheterisation with a hydrophilic guidewire in patients with urethral trauma for treating acute urinary bladder retention after failed attempt at blind catheterisation.

OBJECTIVES: To evaluate the efficacy of urethral catheterisation using a hydrophilic guidewire under fluoroscopic guidance in patients with urethral trauma after a failed attempt at blind catheterisation.
METHODS: A diagnosis of urethral trauma was made in 39 cases in 38 men. Patients ranged in age from 41 to 85 years (mean age, 60 years). Causes of the urethral injuries were iatrogenic urethral injury during catheter placement (n = 18), traumatic self-removal of a catheter (n = 12), straddle injuries (n = 6) and motor vehicle accidents (n = 3). All patients underwent failed blind urethral catheterisation. After urethrography, we attempted to insert a hydrophilic guidewire through the urethra into the urinary bladder, and then to place a 3-way balloon retention urethral catheter into the bladder guided by prior passage of the guidewire under fluoroscopy.
RESULTS: Of 39 attempts of inserting the urethral catheter into the urinary bladder, 34 (87.2%) were successful. Of 5 failures (12.8%), 2 were American Association for the Surgery of Trauma (AAST) urethral injury type 3 and 3 were type 4/5. Among these, there were 3 cases of pseudolumen formation.
CONCLUSIONS: Hydrophilic guidewire-assisted urethral catheterisation in patients with urethral trauma is a safe, simple technique for relieving acute bladder retention after a failed attempt at blind catheterisation. KEY POINTS: Hydrophilic guidewire-assisted urethral catheterisation is useful following failed blind catheterisation. Immediate management of urethral injury is important to reduce morbidity. Hydrophilic guidewire-assisted urethral catheterisation can be applied immediately after diagnostic urethrography.