Improvisation

Urethral Lubrication/Anesthesia

Anesthetic jellies (gels), such as lidocaine 2%, reduce the discomfort of male catheterization, although this is not true in women.1,2 Lidocaine jelly may not be available, so it helps to know about the alternatives.

Diphenhydramine (e.g., Benadryl) and promethazine (e.g., Phenergan) may be used effectively as urethral anesthetics. The dose is the same, or less, than would be used orally. Inject the drug into the urethra using a bulb syringe, and keep it in place for about 5 minutes using a penile clamp or equivalent. Some patients experience an initial burning sensation. The anesthesia lasts about 1 hour. To obtain more extensive anesthesia, coat a small urethral sound with an ointment of these medications and leave in it place about 5 minutes before passing larger sounds.3

Use mineral oil to lubricate urethral catheters if standard lubricating jellies are unavailable.4 In women, apply 10% cocaine jelly with a cotton-tipped applicator for an effective urethral anesthetic. Leave this in place for 5 minutes.¹