This course is all about solving the medical emergency of difficult or failed urethral catheterisation, which in most cases happens in elderly men

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3 This course is all about solving the medical emergency of difficult or failed urethral catheterisation, which in most cases happens in elderly men due to an enlarged prostate

4 Part 1 1. Development and Rationale behind UCD 2. Managing Difficult Catheterisation 3. Identify patients who need referral for specialist intervention Part 2 Hands-on-UCD Practice

5 Part 1 1. Development and Rationale behind UCD 2. Managing Difficult Catheterisation 3. Identify patients who need referral for specialist intervention Part 2 Hands-on-UCD Practice

6 Traumatic urethral catheterisation turns a simple procedure into an emergency 1. Development and Rationale behind UCD

7 1. Development and Rationale behind UCD Traumatic urethral catheterisation turns a simple procedure into an emergency 3 per 1000 retrospective data 7 per 1000 prospective data 7 in 100 high-risk patients 4 Mio catheters inserted in UK/year 25% patients have urethral catheterisation during Hospital stay

8 1. Development and Rationale behind UCD Traumatic urethral catheterisation turns a simple procedure into an emergency 3 per 1000 retrospective data 1 7 per 1000 prospective data 2 7 in 100 high-risk patients 3 4 Mio catheters inserted in UK/year 25% patients have urethral catheterisation during Hospital stay Each case of Urethral Catheterisation Injury (UCI) is associated to significant short-term morbidity with 80% of patients experiencing Clavien 2 or greater complications 2 1. Kashefi C, Messer K, Barden R et al: Incidence and prevention of iatrogenic urethral injuries. J Urol 2008; 179: Davis NF, Quinlan MR, Bhatt NR, Browne C et al: Incidence, Cost, Complications and Clinical Outcomes of Iatrogenic Urethral Catheterization Injuries: A Prospective Multi-Institutional Study. J Urol 2016; 196: Mistry K, Roberts, N, Mundy et al. A new urethral catheterisation device (UCD ) to manage difficult urethral catheterization. WJUR 2018; (in press)

9 1. Development and Rationale behind UCD Traumatic urethral catheterisation turns a simple procedure into an emergency 3 per 1000 retrospective data 7 per 1000 prospective data 7 in 100 high-risk patients Urethral Catheterisation Injury (UCI) 215Mio / year problem in the UK exclusive of any potential medico-legal costs Urinary infection Sepsis1/3 of patients* Fournier s gangrene Urethral stricture 8000/UCI (mortality %) long-term burden to individuals who experience UCI is potentially life altering * 5% required inotropic support in the Intensive Care Unit after a misplaced urethral catheter

10 Guide wire catheterisation techniques 1. Development and Rationale behind UCD guide wires well established in Medical Practice so far no ready-touse catheter with integrated guide wire available Healthcare Professionals forced to improvise

11 Problems with DIY - guide wire catheterisation techniques 1. Development and Rationale behind UCD difficult to make hole exactly at tip damage balloon inflation channel Needle stick injury risk!

12 Problems with DIY - guide wire catheterisation techniques 1. Development and Rationale behind UCD difficult to make hole exactly at tip damage balloon inflation channel Needle stick injury!

13 Problem Solution 1. Development and Rationale behind UCD Urethral Catheterisation Device (UCD ) Indication: difficult/failed, or anticipated difficult male urethral catheterisation Urethrotech s NICE-approved UCD integrates a non-traumatic guide wire into a 3-way urethral catheter design Seldinger Technique principle

14 Problem Solution 1. Development and Rationale behind UCD Urethral Catheterisation Device (UCD ) Indication: difficult/failed, or anticipated difficult male urethral catheterisation Large side holes good urine drainage Guide wire exit at round Nelaton tip Attached plug after guide wire removal Foley balloon Valve 5-10cc Guide wire luer-lock stopper for lubrication and safety Integrated non-traumatic 90cm hydrophilic Nitinol guide wire

15 Problem Solution 1. Development and Rationale behind UCD Urethral Catheterisation Device (UCD ) Indication: difficult/failed, or anticipated difficult male urethral catheterisation Difficult Trauma

16 Part 1 1. Development and Rationale behind UCD 2. Managing Difficult Catheterisation 3. Identify patients who need referral for specialist intervention Part 2 Hands-on-UCD Practice

17 1. Take patient history? LUTS lower urinary tract symptoms 2. Managing Difficult Catheterisation TWOC-Clinic BCG-Clinic Emergency Department ITU/wards Community Hospice care

18 1. Take patient history LUTS lower urinary tract symptoms 2. Managing Difficult Catheterisation Ageing population!

19 2. Managing Difficult Catheterisation Standard Approaches

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21 Go to to view the video

22 UCLH-New Male Catheterisation Algorithm First pass Urethral Catheter Resistance/failure to pass into bladder Successful Insertion Second line UCD Guide wire turns and exits at meatus (>2x) Resistance/buckling of UCD -catheter Successful UCD Insertion Specialist / Cystoscopy

23 2. Managing Difficult Catheterisation - with the UCD

24 Go to to view the video

25 Part 1 1. Development and Rationale behind UCD 2. Managing Difficult Catheterisation - with the UCD 3. Identify patients who need referral for specialist intervention Part 2 Hands-on-UCD Practice

26 UCLH-New Male Catheterisation Algorithm First pass Urethral Catheter 3. Identify patients who need referral for Specialist intervention Resistance/failure to pass into bladder Successful Insertion Second line UCD Guide wire turns and exits at meatus (>2x) Resistance/buckling of UCD -catheter Successful UCD Insertion Specialist / Cystoscopy

27 Go to to view the video

28 Go to to view the video

29 UCLH-New Male Catheterisation Algorithm First pass Urethral Catheter 3. Identify patients who need referral for Specialist intervention Resistance/failure to pass into bladder Successful Insertion Second line UCD Guide wire turns and exits at meatus (>2x) Resistance/buckling of UCD -catheter Successful UCD Insertion Specialist / Cystoscopy

30 Urethral Stricture 3. Identify patients who need referral for specialist intervention <60y idiopathic bulbar urethral stricture > 60y iatrogenic TURP/post-surgery/catheterisation stricture Normal vascular urethral wall stricture Bladder Prostate Urethral sphincter stricture

31 Stricture Dilatation Management 3. Identify patients who need referral for specialist intervention We can dilate safely blind over guide wire Urethrotech UCD Cook S-shape dilator

32 Stricture Dilatation Management 3. Identify patients who need referral for specialist intervention safely dilate over guide wire 1. Urethrotech UCD Soft stricture

33 Stricture Dilatation Management 3. Identify patients who need referral for specialist intervention safely dilate over guide wire 2. Cook S-Dilator Hard stricture

34 UCLH-New Male Catheterisation Algorithm First pass Urethral Catheter 3. Identify patients who need referral for Specialist intervention Resistance/failure to pass into bladder Successful Insertion Second line UCD Guide wire turns and exits at meatus (>2x) Resistance/buckling of UCD -catheter Successful UCD Insertion Specialist / Cystoscopy

35 Guide Wire Turns.. 3. Identify patients who need referral for specialist intervention Cystoscopically insert guide wire into bladder

36 UCLH Service Innovation Male Catheterisation Supporting the delivery of high-quality, cost-effective Health Care Catheterisation Trolley 1st & 2nd line safe urethral catheterisation Mandatory staff hands-on training (AMUC) basic life support model Advanced Clinical Nurse Practitioner bed-site Flexible cystoscopy for failed UCD Stream lined Urology referrals Urology follow-up

37 UCLH-New Male Catheterisation Algorithm First pass Urethral Catheter Resistance/failure to pass into bladder Successful Insertion Second line UCD Guide wire turns and exits at meatus (>2x) Resistance/buckling of UCD -catheter Successful UCD Insertion Specialist / Cystoscopy

38 UCLH Service Innovation Male Catheterisation Supporting the delivery of high-quality, cost-effective Health Care Incidence of difficult re-catheterisation in Nurse-led Trial Without Catheter (TWOC) and catheter change clinics: Does the recatheterisation using a guide wire make a difference? Dragova M 1, Bamfo A 1,Kevin Holmes 2, Kirk Attard 2, Bugeja S 2, Lock A 1, Frost A 1, Mundy A 1 1 University College London Hospitals NHS Foundation Trust. Urology, London, UK 2 Mater Dei Hospitals, Urology, Msida, Malta User Patient feed-back Questionnaire V2.10/17 UCD - TWOC-Clinic Service Innovation CS abled wire catheterisation to failed r -wire-, e Introduction The use of guide wires is well established in surgical practice, but relatively new in Nurse-led services. The aim of this study was to investigate Results the incidence I Retrospective Audit (Sept August 2017) of difficult re-catheterisation and whether guide wire based urethral catheterisation technique reduces the incidence of disrupted patient care pathways. HCS A HCS B HCS B DIY- guide wire Before UCD After UCD catheter system implementation implementation Patients attending n=540 n=1002 n=194 for TWOC Materials and Methods Retrospective Audit (September 2016-August 2017) Prospective Audit (September 2017-Decmeber 2017) Two Health Care Services (HCS) HCS A: Mater Dei Hospital, Malta HCS B: UCLH, London, UK Failed n=169 TWOC Service delivered by Clinical Nurse Specialist s in both HCS Successful TWOC n=371 n=776 n=158 Results I Retrospective Audit (Sept August 2017) TWOC HCS A : DIY-guide wire - catheterisation enabled HCS B: Retrospecitve Sept2016-Aug % not guide wire enabled until UCD implementation Sept 2017 Successful UCD Advantages - catheter n=163 with integrated (of guide 169) wire re-catheterisation 96% with standard catheter Difficult n=6 Integrated non-traumatic hydrophilic Nitinol guide wire into re-catheterisation standard 3-way silicone Foley catheter 4% with Facilitates standard safe second-line urethral catheterisation after failed catheterisation attempt and prevents urethral trauma catheter Ready-to-use Single medical device when needed, 5-year shelf life Avoids needle-stick injury risk associated with 'DIY'-guide-wirecatheterisation of Bleeding Complications Easy-to-use without assistance, requires minimal training, difficult empowers Nurse-led recatheterisation invasive second-line catheterisation under vision, or SPC services 0% Avoids Patient Care delays and Urologist referral for more insertion Urologist Called 0% Retrospecitve Sept2016-Aug 2017 n=226 23% Patients attending HCS A DIY- guide wire catheter system Retrospecitve Sept2016-Aug 2017 for TWOC n=169 (of 226) 75% HCS B Before UCD implementation Retrospecitve Sept2016-Aug 2017 Bleeding 0% 18% Bleeding 0% Results 40% II 0% Prospective Audit (September December 2017) HCS-B was attended by 194 men for TWOC. All 19% (36/194) who failed Urologist Called Urologist Called the TWOC were now managed successfully by the CNS, and 3 UCD were used as a second-line catheter on three occasions. No urology referrals had to be made and no bleeding occurred as a result of catheterisation. 18% 0% Conclusions Difficult re-catheterisation is a frequent occurrence and has a significant risk of urethral trauma. Traumatic catheterisation can be avoided by passing a catheter over a guide-wire, thus reducing patient care delays. Prevents unnecessary hospital referrals for more invasive specialist interventions. HCS B After UCD implementation Prospecitve n=540 n=1002 n=194 Successful TWOC n=371 n=776 n=158 Sept2017-Dec 2017 The Urethrotech UCD offers a purpose built 2 nd line catheterisation solution which is easy and safe to use with high user and patient satisfaction. Failed TWOC Successful re-catheterisation with standard catheter n=57 Difficult 25% re-catheterisation with standard catheter Complications of difficult re- n=169 31% n=163 (of 169) 96% n=6 4% Bleeding 0% Urologist Called Prospecitve Sept2017-Dec 2017 n=36 19% N=33 (of 36) 91% n=226 23% n=169 (of 226) 75% n=36 19% N=33 (of 36) 91% n=3 (à UCD for n=57 n=3 (à UCD for 25% re-catheterisation) 8% Bleeding 40% Urologist Called Bleeding 0% Urologist Called Results II Prospective Audit (September December 2017) HCS-B was attended by 194 men for TWOC. All 19% (36/194) who failed 8% [Patient Label] for further information contact: info@urethrotech.com [Hospital Address / ward] Nurse feed-back:...please tick all that apply Technical skill requirement UCD training the UCD is easy to use and I am happy to use the UCD independently I had problems to insert UCD guide wire I feel I need more practice I couldn t use UCD I didn't like it and I won't use the UCD again I've done hands-on Advanved Male Urethral Catheterisation (AMUC) course I've seen the YouTube Advanved Male Urethral Catheterisation (AMUC) course I'd say I want to use UCD.. once.... before feeling confident! 2-5 times.. >5 times.. I think the UCD is brilliant & very helpful device may be helpful in some circumstances don't think it is helpful for my practice I'd recommend the UCD to a colleague.. Please comment and allow us to learn from your experience:.. highly.. may be.. won't Patient feed-back:...please tick all that apply UCD device feed-back Recommendation to another patient Please comment and allow us to learn from your experience: it was a very good experience and not painful I could not comment.. one way or the other it was just as bad an experience as with previous standard catheters I would highly recommend the UCD.. to other patients May be, but not sure whether I would recommend the UCD I would not recommend the UCD to other patients Instruction of Use Video please scan and form to: PMS@urethrotech.com

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40 Photomicrograph of Fournier gangrene (necrotizing fasciitis). Note the acute inflammatory cells in the necrotic tissue. Bacteria are located in the haziness of their cytoplasm. Courtesy of Billie Fife, MD, and Thomas A. Santora, MD Quiz

41 Urethral Catheterisation Injury (UCI) is a preventable patient care error! Quiz Fournier gangrene (necrotizing fasciitis) due to misplaced catheter!

42 Quiz Golden Rule - if in doubt Cystoscopically insert guide wire into bladder

43 Conclusion Traumatic urethral catheterisation turns a simple procedure into an emergency info:

44 Conclusion Traumatic urethral catheterisation turns a simple procedure into an emergency Urethral Catheterisation Injury (UCI) is associated to significant short-term morbidity and long-term complications info:

45 Conclusion Traumatic urethral catheterisation turns a simple procedure into an emergency Urethral Catheterisation Injury (UCI) is associated to significant short-term morbidity and long-term complications UCI 215Mio / year problem in the UK info:

46 Conclusion Traumatic urethral catheterisation turns a simple procedure into an emergency Urethral Catheterisation Injury (UCI) is associated to significant short-term morbidity and long-term complications UCI 215Mio / year problem in the UK The UCD is easy to use and empowers nurses to manage difficult catheterisation independently and safely in any clinic environment info:

47 Conclusion Traumatic urethral catheterisation turns a simple procedure into an emergency Urethral Catheterisation Injury (UCI) is associated to significant short-term morbidity and long-term complications UCI 215Mio / year problem in the UK The UCD is easy to use and empowers nurses to manage difficult catheterisation independently and safely in any clinic environment The UCD catheterisation solution avoids unnecessary referral to hospital specialists and patient care is not delayed info:

48 AMUC Training Certificate please Lecture available at

49 Please collect Hands-on Practical Part Vouchers at Urethrotech booth

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