Difficulty cathing a male pt

[heather2084, BSN]

I work in the OR, and was trying to catheterize a male pt today. pulling back the covers and holding the member there was a LOT of excess foreskin hanging at the end. I began pulling it back only to realize that the meatus was minuscule. It appeared barely bigger than the head of a pin. With the help of a CRNA, we attempted to cath him, but there was no way. I have never seen such a site!

Then later as we were doing another case, the floor paged the same dr asking what he wanted to do since they as well were unable to insert a foley. I'm wondering if anyone else has come upon this situation and/or if anyone knows if it's a condition or result of some procedure.

[leslie :-D]

when you opened the meatus, do you think a pedi cath would have fit?

leslie

[heather2084, BSN]

i havent seen many pedi caths, but i highly doubt anything was going to fit. it appeared as if there was no opening

[leslie :-D]

hmmmm....wonder if there's a stricture, or even adhesions, in the canal.

sounds like a need for a stat urology consult.

never had this happen.

leslie

[EmmaG, RN]

i havent seen many pedi caths, but i highly doubt anything was going to fit. it appeared as if there was no opening

I saw something like this in a patient from a nursing home. It was explained to me that it was stenosis due to chronic catheterization.

He had a fistula of sorts far down on the underside of the member where the urine would come out; the actual meatus on the glans was barely there, like you describe.

[skuterkomputer rn]

You cant cath them all. Sometimes you need a urology consult. Experience will tell you when you can and cant cath someone. Even then one of your coworkers may be able to finesse one in. Honestly, the fact that you are still thinking about it means that you probably gave it all you had. Better than trying to force it past a stricture/ prostate/ or whatever it was that you couldnt pass.

[llg, PhD, RN]

I've cathed premature babies ... usuing a very small feeding tube. By all means, get the urology consult, but in an emergency ....

[biker nurse]

Afriend of my husband's had to get the opening to his member made bigger it would take him 3x as long to pee. he was just born that way

[Jo Dirt]

I have seen these little quick cath kits where the catheter was literally about the diameter of an ice pick.

[leslie :-D]

I have seen these little quick cath kits where the catheter was literally about the diameter of an ice pick.

ouch....as i carefully cross my legs.

leslie

[Tweety, BSN, RN]

More than likely it's a genetic thing. It could be something he's had his whole life and has adjusted too (i.e. taking longer to urinate than the average male). It doesn't have to be too big to pass urine as long as the bladder empties). Men's meatus come in all sizes and places. I have had to use a smaller cath on a male once whose meatus was very small and midway his shaft well away from this glans. In the real world he learned to live with it.

[GadgetRN71, ASN, RN]

I was always taught never to force it. I'll fiddle gently with it, if that doesn't work we've called a urologist into the room(usually one around)-many of these guys have prostate issues or strictures.