68.4 ’Railroading’

This is a method of passing a catheter through a patient’s urethra when it is torn, and when the two ends of the urethra are widely separated. ’Railroading’ is not easy, and should very rarely be necessary. If there is much fibrosis, you will have to use sounds, but you should start by using a catheter. Pass one catheter up his urethra from below, feel for it in his retropubic space and bring it out into the wound. Pass another catheter down through his bladder from above. Find it in his prevesical space and bring it too out into the wound. Push the end of the lower catheter into the cut end of the upper one, and stitch them if necessary. Then use the upper one to pull the lower one through into his bladder.

If you use sounds, pass one sound up his urethra from below, and another down through his bladder from above. You will feel them meeting in the blood clot where his posterior urethra should be. Use the upper sound to guide the lower one up through his prostatic urethra into his bladder. When the lower sound is in his bladder, fix a rubber tube to it and use this to pull a Foley catheter up into his bladder. There is a great danger that you will create false passages, so be careful!