Guidewire-First Rescue Versus Direct Suprapubic Cystostomy After Failed Urethral Catheterisation: A Propensity-Weighted Cohort Study
- 1Department of Urology, Karamanoğlu Mehmetbey University Training and Research Hospital, Üniversite Mahallesi, Şehit Ömer Halis Demir Caddesi No: 7/1, 70100 Karaman, Türkiye
- 2Department of Urology, Tekirdağ Dr. İsmail Fehmi Cumalıoğlu City Hospital, İstiklal Mahallesi, Yemen Sokak No: 13, 59030 Tekirdağ, Türkiye
- 3Department of Urology, University of Health Sciences, Ümraniye Training and Research Hospital, Elmalıkent Mahallesi, Adem Yavuz Caddesi No: 1, 34760 Istanbul, Türkiye
Abstract
Background/Objectives: When urethral catheterisation fails in acute urinary retention, clinicians may pass a guidewire or go directly to suprapubic cystostomy. No published series compares the two after a failed attempt, and comparative trials enrol men in whom either route remains available. We compared the two. Methods: We studied 352 consecutive men at one centre from 2019 to 2025: 246 went directly to cystostomy, 106 to an ultrasound-confirmed bedside guidewire attempt. Time zero was the documented failure of catheterisation, and patients were analysed by the strategy first attempted. The primary outcome, overall strategy-associated complications, was any new Clavien–Dindo grade II or higher complication within 30 days, whichever route produced it; conditions present at time zero did not count. Overlap weighting on 19 covariates gave risk differences with operator-level bootstrap intervals. Follow-up used the hospital and national health records for every patient. Results: The guidewire attempt placed a catheter in 84.9% of men (95% confidence interval [CI] 76.9 to 90.5). After weighting, overall strategy-associated complications affected 17.6% of the cystostomy arm and 5.3% of the guidewire-first arm (−12.2 points, 95% CI −19.0 to −5.5). Grade III or higher events occurred in 7.7% (19/246) of the cystostomy arm and none of the guidewire-first arm. Shared complications, those either route could produce, affected 9.5% and 5.3%, respectively, a difference of −4.2 (−11.2 to 3.8) after weighting and −0.3 (−6.0 to 5.4) when unweighted. Conclusions: An ultrasound-confirmed bedside guidewire attempt was associated with fewer overall strategy-associated complications at 30 days. For shared complications the difference was smaller and no longer excluded zero. Ascertainment was record-based and asymmetric: cystostomy-specific harms are readily recorded, whereas urethral harms such as false passage or later stricture were not captured, and time to definitive drainage was not measured. These findings describe initial rescue strategies and do not establish that either procedure is intrinsically safer.
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BibTeX
@article{sanlı2026guidewirefirst,
title = {{Guidewire-First Rescue Versus Direct Suprapubic Cystostomy After Failed Urethral Catheterisation: A Propensity-Weighted Cohort Study}},
author = {Ahmet Şanlı and Serhat Göçer and Hasan Samet Güngör},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15207792},
url = {https://www.mdpi.com/2077-0383/15/20/7792},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Guidewire-First Rescue Versus Direct Suprapubic Cystostomy After Failed Urethral Catheterisation: A Propensity-Weighted Cohort Study
AU - Ahmet Şanlı
AU - Serhat Göçer
AU - Hasan Samet Güngör
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15207792
UR - https://www.mdpi.com/2077-0383/15/20/7792
AB - Background/Objectives: When urethral catheterisation fails in acute urinary retention, clinicians may pass a guidewire or go directly to suprapubic cystostomy. No published series compares the two after a failed attempt, and comparative trials enrol men in whom either route remains available. We compared the two. Methods: We studied 352 consecutive men at one centre from 2019 to 2025: 246 went directly to cystostomy, 106 to an ultrasound-confirmed bedside guidewire attempt. Time zero was the documented failure of catheterisation, and patients were analysed by the strategy first attempted. The primary outcome, overall strategy-associated complications, was any new Clavien–Dindo grade II or higher complication within 30 days, whichever route produced it; conditions present at time zero did not count. Overlap weighting on 19 covariates gave risk differences with operator-level bootstrap intervals. Follow-up used the hospital and national health records for every patient. Results: The guidewire attempt placed a catheter in 84.9% of men (95% confidence interval [CI] 76.9 to 90.5). After weighting, overall strategy-associated complications affected 17.6% of the cystostomy arm and 5.3% of the guidewire-first arm (−12.2 points, 95% CI −19.0 to −5.5). Grade III or higher events occurred in 7.7% (19/246) of the cystostomy arm and none of the guidewire-first arm. Shared complications, those either route could produce, affected 9.5% and 5.3%, respectively, a difference of −4.2 (−11.2 to 3.8) after weighting and −0.3 (−6.0 to 5.4) when unweighted. Conclusions: An ultrasound-confirmed bedside guidewire attempt was associated with fewer overall strategy-associated complications at 30 days. For shared complications the difference was smaller and no longer excluded zero. Ascertainment was record-based and asymmetric: cystostomy-specific harms are readily recorded, whereas urethral harms such as false passage or later stricture were not captured, and time to definitive drainage was not measured. These findings describe initial rescue strategies and do not establish that either procedure is intrinsically safer.
SN - 2077-0383
ER -