A urinary catheter is a flexible, hollow tube designed to be temporarily or continuously inserted into the bladder to manage the flow of urine. For males, this device provides a necessary solution when the body cannot effectively empty the bladder, a condition known as urinary retention, which can be caused by an enlarged prostate or nerve damage. Catheters are also routinely used to monitor urine output during and after major surgery or for individuals with chronic health conditions preventing voluntary voiding. The goal of using a catheter is to ensure complete bladder drainage, which helps prevent kidney damage and reduces the risk of bladder infections.
How the Catheter Drains Urine
The catheter creates a continuous drainage pathway from the bladder using simple fluid dynamics. The tip, which rests inside the bladder, has one or two small openings, known as eyelets. Urine flows naturally through these eyelets into the central channel, or lumen, of the catheter.
For indwelling catheters, a small, inflatable retention balloon is situated just behind the eyelets. This balloon is inflated with sterile water via a separate channel once the tip is positioned correctly, securing the catheter against the internal neck of the bladder.
The urine follows gravity, traveling down the tube into an external collection device. The collection bag (either a leg bag or a larger bedside bag) must always be positioned below the level of the bladder. This lower placement ensures gravity maintains a constant downward flow, preventing urine from backing up, or refluxing, toward the bladder.
Key Differences Between Male Catheter Types
Male catheters are categorized by their use and duration of placement. The indwelling catheter, often called a Foley catheter, is designed for continuous drainage over an extended period. It remains inside the urethra and bladder and is connected to a closed drainage system.
In contrast, the intermittent catheter is a straight tube used only long enough to drain the bladder completely, after which it is immediately removed. This “in-and-out” method, often performed several times daily, is favored for long-term bladder management as it can lower infection risk compared to continuous indwelling models. Intermittent catheters are typically single-use devices and do not feature a retention balloon.
The external catheter, or condom catheter, is non-invasive. This device fits over the penis like a sheath and connects to a drainage bag, making it suitable for managing urinary incontinence without urinary retention. Furthermore, some catheters feature a specialized curved tip, known as a Coudé tip, designed to navigate the natural upward curve of the male urethra and bypass potential obstructions, such as an enlarged prostate.
The Process of Placement and Removal
Placement of an indwelling catheter requires strict adherence to sterile technique to minimize the introduction of microbes. The genital area is cleansed with an antiseptic solution, and a sterile lubricating gel is applied to the catheter tip and often instilled directly into the male urethra. This lubrication is important because the male urethra is long, requiring a significant length of tube to be passed.
During insertion, the penis is held upward at a 90-degree angle to the body to straighten the urethra’s natural curves, facilitating smoother passage. The catheter is gently advanced until the tip reaches the bladder, confirmed by the appearance of urine flowing through the tube. Once urine is seen, the catheter is advanced slightly further to ensure the retention balloon is fully inside the bladder cavity, preventing inflation within the sensitive urethral passage.
For removal, the sterile water holding the retention balloon in place must be completely withdrawn using a syringe inserted into the inflation port. Once the balloon is deflated, the catheter is gently pulled out of the urethra. Intermittent catheterization follows a similar insertion process but is removed immediately after the bladder is drained, eliminating the need for balloon inflation and deflation steps.
Necessary Care and Infection Prevention
Ongoing daily management is necessary to maintain the catheter system and reduce the likelihood of a Catheter-Associated Urinary Tract Infection (CAUTI). The area where the catheter enters the body, the urethral meatus, must be cleaned thoroughly with soap and water at least once daily. Good hand hygiene, including washing hands before and after handling the catheter or drainage system, is essential to prevent the transfer of bacteria.
The drainage system must be kept closed to maintain sterility, meaning the connection between the catheter and the collection tube should not be routinely disconnected. It is necessary to ensure the tubing is free from kinks or sharp bends that could obstruct the flow, which can lead to urine backing up into the bladder. The collection bag should be emptied when it is approximately half to three-quarters full, and must be kept below the level of the bladder at all times to promote gravity drainage and prevent reflux.
Securement devices are used to anchor the catheter to the thigh or abdomen, which prevents traction or pulling on the urethra that could cause trauma or dislodge the tube. If the drainage bag must be placed on the floor, it should be done so with a dedicated stand, and contact with the floor itself must be avoided to prevent contamination. Any sign of leakage, pain, or cloudy and foul-smelling urine should be reported to a healthcare provider immediately, as these may indicate a developing infection or blockage.