What to do when urine cannot be drained during intermittent catheterization?

When performing intermittent catheterization, there are occasional situations where the bladder is clearly in a distended state, but urine cannot be drained after catheter insertion. Although this situation is uncommon, it is a problem that troubles some patients. Today we will discuss how to handle this situation.

Generally speaking, excluding catheter obstruction itself and incorrect catheter placement (such as inadvertent vaginal insertion in female patients), failure to drain urine has two possible causes:

**Cause One:**

The catheter has entered the bladder. If the patient has prostatic hypertrophy, long-term bladder outlet obstruction will cause elevation of the interureteric ridge. Combined with middle lobe enlargement of the prostate, sometimes after the catheter enters the bladder it becomes pushed upward. At this point, although the catheter is in the bladder, because it has been pushed up, the catheter tip ends up against the anterior bladder wall, causing poor drainage. In this case, the catheter in the bladder is often not at the lowest position, but may be at the highest position.

**Cause Two:**

The second situation is actually a contraindication for intermittent catheterization and requires switching to other voiding methods such as indwelling catheterization. We will not elaborate further on this here. Below, we will focus on discussing the first situation. When encountering the first situation, the following measures are recommended:

(1) Ensure adequate lubrication of the catheter and maximum relaxation of the urethra to achieve successful catheterization on the first attempt as much as possible.

(2) First insert the catheter deeper, then gently pull it outward to position the catheter in a location with better drainage.

• When unable to drain urine, do not rush to remove the catheter. First, inject water to check whether the catheter is patent. If it feels obstructed, gently advance the catheter deeper into the bladder, then test again for patency. If this still doesn't work, the catheter can be removed and reinserted. Sometimes the reason for draining only 200 ml before flow stops is simply something like a small blood clot blocking the catheter, or the catheter position being slightly off. Adjusting the catheter position can resolve the problem.

When unable to drain urine, first assess the cause yourself: is it obstruction or another reason? If there is obstruction causing catheterization difficulty, you should first estimate the location of the obstruction. If the obstruction is at the prostate or bladder neck due to prostatic hypertrophy, switching to a prostatic catheter (a catheter with a sharper curved tip) and properly controlling the direction of the curve offers hope for successful catheterization.

If you can clearly determine that the catheter has been inserted but no urine is coming out, first perform manual bladder irrigation to check for solid material blockage. Sometimes flocculent material or urinary sediment forms in the bladder, blocking the drainage holes and preventing urine flow. In this situation, try using a catheter one size larger. If a catheter one size larger is too thick and difficult to insert, a catheter with enlarged drainage holes would be more suitable. If testing shows the catheter is not blocked, adjust the catheter angle and try changing body positions, which should basically resolve the issue. Of course, if conditions permit, it's best to seek help from a professional physician.

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2. The medical information provided here is for reference only and should not be used as a basis for clinical diagnosis or treatment.