Guidewire-First Rescue Versus Direct Suprapubic Cystostomy After Failed Urethral Catheterisation: A Propensity-Weighted Cohort Study

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.