From the Guidelines
Straight catheterization is recommended when bladder fluid retention exceeds 500 cm3 in asymptomatic patients or 300 cm3 in symptomatic patients, as indicated by a bladder scanner. This is based on the most recent guidelines from the International Society for Infectious Diseases, updated in 2024 1. The guidelines emphasize the importance of appropriate indications for catheterization, including management of acute urinary retention, which is indicated by newly developed retention of urine with a postvoid residual bladder volume exceeding the specified thresholds.
Key considerations for straight catheterization include:
- Asymptomatic patients with a postvoid residual bladder volume > 500 cm3
- Symptomatic patients with a postvoid residual bladder volume > 300 cm3
- Symptoms may include bladder pain or fullness, persistent urge to void, new incontinence or leaking, or being only able to have frequent small voids
- The use of a bladder scanner to detect postvoid residual bladder volume is recommended
The procedure involves inserting a thin tube through the urethra into the bladder to drain urine, using sterile technique with an appropriate catheter size. This intervention helps prevent complications like bladder distension, urinary tract infections, and kidney damage that can result from prolonged retention. The frequency of catheterization depends on individual circumstances, but the goal is to keep bladder volumes below the threshold that causes discomfort or risks bladder damage, as recommended by the guidelines 1.
From the Research
Bladder Fluid Retention and Straight Catheterization
- The amount of bladder fluid retention that requires straight catheterization is not strictly defined, but several studies provide guidance on this issue 2, 3, 4, 5, 6.
- A study published in 2015 found that post-void residual volumes of 150 mL or more were common in geriatric hospitalized patients, and that volumes of 500 mL or more were associated with a higher frequency of indwelling catheters 2.
- Another study published in 2024 recommended clean intermittent catheterization for acute or chronic urinary retention with post-void residual volumes greater than 300 mL 3.
- A 2016 study found that indwelling urinary catheters were placed in patients with modest post-void residual urine volumes in the 100 to 150 cc range, as well as in those with volumes greater than 500 cc 4.
- A 2024 study developed an algorithm for screening and management of urinary retention among adult inpatients, which recommended catheterization at scanned bladder volumes of 300 mL or greater in symptomatic patients and 500 mL or greater in asymptomatic patients 5.
- A 2010 study compared two techniques for predicting voiding efficiency after inpatient urogynecologic surgery, and found that a back fill technique (filling the bladder with 300 cc saline before removing the Foley catheter) was a better predictor of adequate postoperative bladder emptying than an auto fill technique (allowing the bladder to fill spontaneously) 6.
Guidelines for Straight Catheterization
- The studies suggest that straight catheterization may be considered for patients with post-void residual volumes greater than 300 mL 3, 5 or 500 mL 2, 4, 5.
- However, the decision to perform straight catheterization should be based on individual patient factors, including symptoms, medical history, and overall clinical condition 2, 3, 4, 5, 6.