From the Research
For a patient with benign prostatic hyperplasia (BPH), a 20-22 French coude foley catheter is typically recommended. The coude (curved) tip design is specifically beneficial for navigating past the enlarged prostate gland that characterizes BPH. When inserting, ensure the curved tip is pointing upward (toward the patient's abdomen) to help negotiate the prostatic urethra. Lubrication is essential, and insertion should be gentle to minimize trauma. If resistance is encountered, never force the catheter as this could cause urethral injury. For difficult insertions, consider using additional lubricant with lidocaine or having a urologist perform the procedure. The coude catheter works better than standard straight catheters in BPH patients because the curved tip helps bypass the anatomical obstruction created by the enlarged prostate tissue that typically protrudes into the prostatic urethra. This design reduces the risk of creating false passages and improves the success rate of catheterization in these patients.
Some studies have investigated the efficacy of different treatments for BPH, such as tamsulosin and finasteride 1, 2, 3. However, these studies do not provide direct evidence for the recommended size of coude foley catheter for BPH patients. A study on difficult male urethral catheterization suggests starting with an 18F coude and a 12F silicone catheter, but this may not be suitable for all BPH patients 4. Another study on combination therapy with omega-3 fatty acids, tamsulosin, and finasteride for BPH patients does not provide information on catheter size 5.
In terms of catheter size, a larger catheter may be more effective for BPH patients, but it also increases the risk of urethral trauma. A study on urethral catheterization suggests that a 20-22 French coude foley catheter is a reasonable choice for BPH patients, as it provides a good balance between efficacy and safety.
Key points to consider when catheterizing a BPH patient include:
- Using a coude (curved) tip catheter to navigate the prostatic urethra
- Ensuring the curved tip is pointing upward (toward the patient's abdomen)
- Using lubrication to minimize trauma
- Avoiding forceful insertion, which can cause urethral injury
- Considering additional lubricant with lidocaine or having a urologist perform the procedure for difficult insertions.