Randomized, single-blind comparison of sidehole and end-hole v end-hole ureteral catheters

Flexible 5F, open-ended ureteral catheters are currently available only with an end hole, which can lead to difficulties during retrograde pyelography and when aspirating urine for culture or cytology, as the hole frequently sucks up urothelium or debris and becomes occluded. We compared the traditional end-hole ureteral catheter with a catheter having a sidehole as well. Twenty-two patients requiring aspiration of urine from the renal pelvis for cytology study or culture or to empty the collecting system during retrograde pyelography or prior to percutaneous nephrolithotomy were enrolled. Both end-hole-only and end-hole + sidehole catheters were employed in each patient, but the order of use was randomized, and the endourologist was blinded to the catheter type. Catheters were placed in the renal pelvis under fluoroscopy, and the renal collecting system was filled with 5 mL of contrast medium. The catheters were compared on volume aspirated initially, volume aspirated after repositioning, and ease of use judged on a three-item adjectival scale. The end-hole + sidehole catheters were able to aspirate more fluid initially (5.1 mL v 2.6 mL; P < 0.001) and after repositioning (6.0 mL v 3.4 mL; P < 0.001). In addition, blinded urologists rated these catheters easier to use (12.0 v 3.0; maximum score 15; P < 0.001). The addition of a sidehole to ureteral catheters offers significant advantages to the endourologist seeking to aspirate urine from the upper collecting system for culture or cytology or during retrograde pyelography and in preparation for stone removal. The sidehole prevents occlusion of the catheter when it sucks up the urothelium and provides more efficient drainage of the upper tract.