Cathing past an enlarged prostate... HELP!

[NurseSTEAM]

I need some tips, ya'll...

I am a school nurse on a secondary campus (6th-8th grade.) I have a student who has spina bifida and requires BID intermittent catheterization. His mom and I both have been having a really hard time cathing him lately. He just went to see his urologist and we discovered his prostate is enlarged due to puberty. We switched over to using coude tip catheters, but it is still proving to be difficult. Does anyone have any tips on how to cath past an enlarged prostate??

[blondy2061h, MSN, RN]

What recommendations did the urologist have? I would think continuously trying to intermittent Cath around it would be traumatic and worsen the problem. Perhaps temporarily switching to an indwelling catheter may help?

When I have to cath someone with bph I use a coude tip, firmly grip the member and gently pull it taut, use a ton of lube, and slowly rotate the catheter while continuing to apply steady pressure once I meet resistance. I've had good luck with this technique.

[brillohead, ADN, RN]

Are you using the clear silicone catheters? Those tend to be stiffer throughout the body of the catheter, instead of just at the Coude tip. I had a private duty client whose anatomy would actually cause the Coude tip to fold over completely inside the urethra (thank goodness the client couldn't feel it!!!!) because the Coude tip was stiff, but the catheter behind it was still pretty weak. We switched to using the stiffer clear catheters, and that didn't happen anymore.

I think this was the type that we used with that client, but it's been over a year so the brand may not be right.