A practical approach to the difficult urethral catheterization for urology trainees.

Urethral catheterization is an important skill to develop as consultations for "difficult catheterization" are common in practice. Developing a broad approach to difficult urethral catheterization is crucial to improve trainee success rates. Strategies and techniques to improve catheterization success are often passed down and shared between trainees without formal documentation or dissemination of techniques. Herein, we present a framework for difficult urethral catheterization based on clinical history and patient examination, while also providing additional techniques and troubleshooting to overcome common challenges with urethral catheterization in adult and pediatric patients.