• 
  

  • Diagnostic evaluation.

  
  

  • Temporary relief of urinary retention.

Absolute

• 
  

  • Suspected urethral injury (eg, blood at meatus, laceration).

  
  

  • Unable to identify urethra (eg, labial adhesion).

  
  

  • Neutropenia.

• 
  

  • Catheter.

  
  
  
  
  • 
    

    • Feeding tube (4–5F).

    
    

    • Urinary catheters (6F and up).

  
  

  • Sterile collection cup.

  
  

  • 10% povidone-iodine (or equivalent).

  
  

  • Castile soap.

  
  

  • Sterile gloves, drapes, and gauze.

  
  

  • Lidocaine (2%) anesthetic jelly or water-based lubricant.

  
  

  • Catheter sizing estimates:

  
  
  
  
  • 
    

    • Infant: 5F feeding tube or 6F catheter

    
    

    • Toddler: 6–8F catheter

    
    

    • Older child: 8F catheter

    
    

    • Adolescent: 8–10F catheters

• 
  

  • Urethral trauma.

  
  
  
  
  • 
    

    • Hematuria.

    
    

    • Pain (common).

  
  

  • Psychological stress (common, as child is restrained for procedure).

  
  

  • Catheter mishaps (eg, knot forms in bladder) (very rare).

• 
  

  • Because spontaneous voiding may occur during skin preparation or as the procedure is initiated, have a sterile container available to collect the urine.

  
  

  • When labial adhesions are present, holding the child in a frog-leg position and rocking the hips back and forth may line up the opening in the adhered labia with the urethral opening.

  
  

  • Cotton gauze pads are useful to hold the penis or to apply traction to the labia once the skin has been prepared and is slippery.

  
  

  • Remember that many of the newer, non-latex gloves fit poorly, making holding a slippery skin surface nearly impossible; wear tightly fitting non-latex gloves when possible.

  
  

  • Although 1 study showed that pain was reduced by applying lidocaine topically and injecting anesthetic into the urethra, this does not represent typical use of lidocaine jelly in clinical practice.

• 
  

  • Keep the patient covered until ready to begin.

  
  

  • Good lighting is helpful.