2026 Clinician Corner - The rigid ureteroscope-guided Seldinger technique: a novel and effective method of Foley catheter deployment in patients with challenging transurethral access

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Abstract 

Transurethral Foley catheterization is the preferred method of bladder drainage in acute urinary retention. Various anatomical factors can make urethral access challenging, making perurethral catheterization impossible on occasions. In these instances, suprapubic catheterization or cystoscopic catheter deployment is often required. We describe an exceptionally difficult case in which transurethral catheterization remained unsuccessful despite cystoscopic visualization and establishing guidewire access. A Seldinger-like approach was used to safely deploy a Foley catheter over a semirigid ureteroscope, supporting the use of this alternative technique to secure bladder access while avoiding invasive suprapubic catheterization.  

Keywords:  Foley catheterization; ureteroscopy; urethra; urinary retention

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Faculty credentials/disclosure 

The planners and faculty for this activity have no relevant financial relationships to disclose. The patient consented to the publication of this report.

Process

Click the "add to cart/begin" button, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit.  You must achieve 100% on the quiz with unlimited attempts available.

  • By completing this process, you are attesting that you have read the journal article.

Expiration date: 

Credit eligibility for this article is set to expire on November 1, 2027.

Learning Objectives

After completing the article, the learner should be able to:

  • Identify several urologic etiologies that may contribute to difficult transurethral catheterization. 

  • Describe different maneuvers that can be utilized to assist with catheter placement. 

Key Points 

  • Bladder outlet obstruction may occur due to urethral stricture disease, calculi, or prostatomegaly, complicating routine Foley catheter placement.  

  • Access to the bladder can be obtained via urethral guidewire placement or direct visualization with cystoscopy, but this does not always guarantee correct Foley catheter placement. 

  • Rigid ureteroscope-guided Foley deployment serves as a late salvage option in patients with gross prostatomegaly, preventing Foley catheter deployment over a guidewire and thereby avoiding suprapubic tube placement. 

Course summary

Available credit: 
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

  • 1.00 American Board of Surgery (ABS) Accredited CME

    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance
Course opens: 
11/01/2026
Course expires: 
11/01/2027
Cost:
$25.00

Cole Nelson, BSa, Priscilla Anderton, MDb, Marawan M. El Tayeb, MDa,b, and  Abhishek Bhat, MDa,b 

a Baylor College of Medicine, Temple, Texas, USA 

b Division of Urology, Baylor Scott & White Medical Center – Temple, Temple, Texas, USA 

Corresponding author:  Abhishek Bhat, MD, Baylor Scott & White Medical Center, 2401 S. 31st St., Temple, TX 76508 (e-mail: [email protected]; X/Twitter drabhishekbhat)  

The planners and faculty for this activity have no relevant financial relationships to disclose. The authors report no funding. The patient consented to publication of this case report. 

Accreditation

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation

AMA PRA Category 1 Credit™

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABS CC

Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

ABIM MOC

 Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Available Credit

  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

  • 1.00 American Board of Surgery (ABS) Accredited CME

    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance

Price

Cost:
$25.00
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