Management of Foley Catheter Balloon Lodged in the Prostate
When a Foley catheter balloon is lodged in the prostate, the first intervention should be to attempt passage of a stylet wire in the balloon lumen to clear any material that may be obstructing the deflation channel. 1
Initial Assessment and Approach
- Evaluate for signs of urethral trauma including bleeding, pain, or difficulty with catheter manipulation 2
- Determine if the catheter is truly in the prostatic urethra versus properly positioned in the bladder but with a non-deflating balloon 3
- Assess for complications such as urethral injury, which may present with hematuria or blood from the urinary meatus 2
Management Options
For Non-Deflating Balloon in Proper Position
- Insert a fine stylet or guidewire into the inflation channel to clear potential blockage 1, 3
- If unsuccessful, consider using a small-gauge needle to puncture the balloon via the suprapubic approach under ultrasound guidance 3
- Avoid excessive force during manipulation to prevent further urethral trauma 4
For Balloon Inflated in Prostatic Urethra
- Do not attempt to forcibly remove the catheter as this may cause significant urethral trauma 4
- Surgical intervention may be required to safely remove the catheter under direct visualization 5
- In cases of significant urethral injury, the AUS should be explanted with the urethral catheter left in place for a few weeks to allow the urethral defect to heal 6
Special Considerations
- Patients with spinal cord injury are at higher risk for this complication due to lack of sensation, urethral sphincter spasm, and possible false passages from previous trauma 4
- In post-TURP patients, improper catheter placement can lead to urinary incontinence and other complications 5
- For patients with prostatic enlargement, ensure proper catheter placement by directing the catheter tip upward during insertion to avoid the prostatic urethra 7
Prevention Strategies
- Use proper technique during catheter insertion, especially in patients with known prostatic enlargement 7
- Consider using cystoscopic guidance for difficult catheterizations 4
- For suprapubic catheter placement, keep the direction of the cannula slot toward the umbilicus to prevent inadvertent migration of the catheter into the prostatic urethra 7
Follow-up Care
- After resolution of a lodged catheter, follow-up imaging should confirm proper healing before any replacement catheter removal 1
- In cases of urethral trauma, consider urologic consultation for assessment of long-term complications 5
- For patients with recurrent issues, consider alternative methods of bladder drainage such as suprapubic catheterization 4