Male urinary catheterisation (model)
PLAB 2 & PRES 3 · practical skills / surgery · medium · 8 minutes
Candidate brief
You are an FY2 doctor on a surgical ward. Mr Edward Byrne, 78, is one day post-operative following bowel surgery. He has not passed urine for 10 hours, is uncomfortable, and a bladder scan shows 850 ml. His abdomen is distended suprapubically. The nurse has asked you to catheterise him. A male catheterisation model is provided for the practical procedure. The patient is present: please gain his consent and explain the procedure to him, then perform the catheterisation on the model, verbalising each step as you go.
What examiners look for
Urine first, balloon second — this ordering is the station. The balloon is inflated only when urine is flowing and the catheter has been advanced to the bifurcation, because an intra-urethral balloon causes pain, bleeding and false passages. If the patient reports sharp pain on inflation, the balloon is in the wrong place: deflate, advance, reassess. The foreskin step is the most-forgotten safety point in male catheterisation. A foreskin left retracted behind a swollen glans becomes paraphimosis — a urological emergency created entirely by the person who catheterised. Examiners listen for it specifically. Anaesthetic gel needs time. Instilling lignocaine gel and proceeding immediately is performing the ritual without the anaesthesia; the several-minute wait is part of the technique, and examiners notice candidates who state it. Never force a catheter. Resistance in a man with prostatic enlargement calls for a pause, more gel, gentle steady pressure — and then senior or urology help, possibly a different catheter (e.g. coudé tip by experienced hands), not brute force. A false passage converts a ward problem into a urological injury. The procedure does not end when urine flows. An 850 ml retention needs a recorded residual volume, ongoing urine-output monitoring, and renal function checks: post-obstructive diuresis after relieving large retentions can quietly dehydrate and derange electrolytes if nobody is watching. Asepsis here is a sterile procedure, not a clean one: sterile gloves, sterile field, sterile cleaning. Breaking the field and carrying on anyway seeds a catheter-associated infection into a bladder that will host the catheter for days — CAUTI prevention starts at insertion.
Guideline references
- https://geekymedics.com/penile-catheterisation-osce-guide/
- https://www.nhs.uk/tests-and-treatments/urinary-catheters/
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