Catheters and Drainage Tubes
Urological drainage devices each have a job — Foley, coudé and council-tip catheters, the three-way for irrigation, suprapubic catheters, nephrostomy tubes, ureteric stents and surgical drains — and choosing the right one for the situation (e.g. a three-way for clot retention) is core practical urology.
The big picture
Drainage devices differ by route and purpose. Urethral catheters: the standard Foley (balloon-retained), the coudé (curved tip to negotiate a prostatic obstruction), the council-tip (railroaded over a guidewire), and the three-way (a third channel for continuous irrigation). The suprapubic catheter drains the bladder through the abdominal wall when the urethral route is unavailable. Upstream, the nephrostomy tube drains the kidney percutaneously and the ureteric (JJ) stent drains the ureter internally. Surgical drains remove fluid/blood from operative spaces.
Pick the device for the job — three-way for clot retention, coudé/council-tip for a difficult prostate, stent vs nephrostomy for upper-tract drainage — and troubleshoot non-draining tubes by position, patency and balloon.
Procedure chooser
- Cystoscopic/guidewire-assisted catheter placement when blind attempts fail
Complications
- Untreated retention/obstruction if drainage fails
- Catheter-associated UTI, urethral trauma/false passage, stricture
- Stent encrustation/migration, nephrostomy dislodgement/bleeding
- Right device, atraumatic insertion, remove when no longer needed, planned stent exchanges
- Treat infection, replace/exchange devices, manage trauma
Memory hooks
Three-way = irrigation (clot retention/post-TURP).
Coudé = curved tip for the prostate.
Council-tip = railroad over a wire.
Suprapubic when the urethra won't do.
Not draining? Position, patency, balloon.
Board traps
Clot retention → three-way catheter (not a small two-way).
Difficult prostatic catheterisation → coudé/council-tip over a wire.
Suspected urethral injury → no blind catheter.
Clinical cases
A man with heavy haematuria has clot retention. The on-call team has placed a 14 Fr two-way Foley, which keeps blocking with clot.
Which device is appropriate and why?