Introduction: The use of point-of-care ultrasound (POCUS) has become ubiquitous within medicine and can be utilized in numerous clinical scenarios. Various studies have shown the benefits of training urologists to use ultrasound (US), but there is currently scant literature regarding its use in difficult urinary catheterization (DUC). The goal of this video is to demonstrate the equipment and US-guided techniques we used to aid in DUC. Methods: We present the case of an 89-year-old who developed oliguria and fecaluria after placement of a urinary catheter. Two days later, he underwent a CT which showed evidence of a urethral false passage and urethrorectal fistula with the catheter balloon inflated within the rectum. Urology was consulted to evaluate the patient. Due to the trauma caused by initial failed catheter placement, the decision was made to place a new catheter under direct vision via flexible cystoscopy. For our US, we used a Mindray TE5 with a C5-2s convex transducer. After successfully advancing a sensor guidewire into the bladder under cystoscopy, we were able to visualize the wire as a hyperechoic structure under US. Next, the wire was exchanged for a 5 French open-ended catheter in order to obtain a clean urine specimen. To confirm appropriate placement of the open-ended catheter in the bladder, we injected 10 ml of normal saline to visualize flow using the color doppler feature of the US. After we exchanged the open-ended catheter for a guidewire, we used a 16 gauge angiocatheter to bore a hole into an 18 French foley to create a council tip, which was advanced into the bladder. Lastly, we inflated the catheter balloon to the recommended maximum capacity of 30 ml in order to aid in easier identification under US. Results: The patient underwent successful placement of a urinary catheter using US assistance and he immediately drained of 700 ml of purulent urine. A CT obtained after the procedure showed a decompressed bladder with the catheter tip in appropriate position. Our video demonstrates three techniques using US guidance to help aid DUC: 1.) visualization of the wire, 2.) use of doppler flow, and 3.) visualization of the foley balloon. Conclusions: Our video demonstrates how POCUS can be used in a safe and reproducible manner to aid DUC. US-guided catheter placement may improve the likelihood of successful catheterization in other complex cases such as those where blind wiring or urethral dilation are used. More studies will be necessary to validate these techniques. SOURCE OF Funding: None
