Objectives: Acute urinary retention (AUR) is a painful subacute emergency that is frequency seen in the general practice of urology. Urethral catheterization to drain the bladder can usually be performed successfully, safely, and with minimal discomfort using standard balloon retention catheters. In a small percentage of cases, however, abnormal urethral anatomy precludes passage of catheters of any size. In these situations, the urologist has a variety of more invasive and complex tools available for draining the bladder. With the introduction of hydrophilic catheters and their prominent use in children receiving intermittent catheterization, we have developed a protocol extrapolating our knowledge in children to the older male in AUR in whom a traditional catheter could not be placed. Methods: A total of 44 men in AUR in whom placement of a traditional catheter had failed were recruited into our study in an attempt to avoid more invasive bedside maneuvers or surgical intervention. A hydrophilic catheter that had been modified to allow the throughput of a wire was used to attempt bladder catheterization. Results: Of the 44 men, 34 (72%) had successful placement of the hydrophilic catheter, relieving their discomfort and AUR. Of the 34 successful catheterizations, 30 (88%) resulted in successful placement of an indwelling Council catheter after removal of the hydrophilic catheter. Long-term drainage was accomplished in 30 (68%) of the 44 men in whom initial catheter placement for AUR had failed. Conclusions: We propose that the hydrophilic catheter should be a part of the urologist's armamentarium whenever treating men with AUR.
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