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I'm supposed to be placing a catheter in my daughter who whas female hypospadias to void her bladder from any urine that might reflux up into her kidneys, I'm having a lot of trouble locating her urethra with a 10fr coude catheter any advice???

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Hi! Here's what I found. Spread the labia and locate the meatus. Insert the catheter into the meatus carefully and slowly. Advance the catheter gently. After urine begins to flow, advance the catheter another 2 inches. Hold the catheter in place while you inflate the balloon using a syringe with clean, sterile water. Ensure that the catheter is in the bladder. Pull the catheter gently until the inflation balloon sits snugly against the bladder's neck. Attach the drainage bag and secure it to the patient's thigh or abdomen. In both males and females, the patient should be positioned supine (lying flat). Females should be placed in the frog-leg position so you can more easily access the urethral meatus. Be sure to distinguish the meatus from the vaginal introitus. In the human female, the urethra is about 1.5–2 inches (4–5 cm) long and exits the body between the clitoris and the vagina, extending from the internal to the external urethral orifice. It is placed behind the symphysis pubis, embedded in the anterior wall of the vagina, and its direction is obliquely downward and forward; it is slightly curved with the concavity directed forward. Its lining is composed of stratified squamous epithelium, which becomes transitional near the bladder.
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Where Do I Pee From? (How to Find Someone's - or Your Own - Urinary Meatus / Urinary Opening / Pee Hole) -- 

Female hypospadias, as you know, is a condition in which the urinary opening (meatus) is NOT on the outside of the body where it is supposed to be (between the vagina and the clitoris), but is instead inside the vaginal opening. It may be inside near the opening of this "urogenital sinus" or it may be farther up in the vagina. Depending on your daughter's age, she can find her urethral opening / urethral meatus herself or you can do it if it's not too far up.

She needs to be sitting/lying naked in the bathtub or in a basin. Confirming your results in Stage 2 has to be done when she has enough urine in her bladder to be able to urinate.

The tools you need are (1) lamp, (2) flashlight, (3) old towel or T-shirt, and (4) camera (protect from urine); plus (5) mirror and (6) magnifying glass if you are doing this on yourself.

STAGE 1 (camera only, no urinating): (a) Shine the flashlight hands-free at the vaginal opening. (b) With one hand, spread the labia. (c) With the other hand, take photos. If you have a non-digital camera (35 mm, disposable), get the film developed and examine the photos before you continue this search (don't use a mail-order developer; take it to a 1-hour photo center where you know a woman will be developing the film; explain that you're not taking obscene pictures). (d) If you see something that looks like the tip of a "little penis" inside the vagina, it's probably the opening of the urethra. (If you see nothing at all, then the opening is too far back in the vagina for you to see and you need professional help to find it.)

Verify your findings as follows:

STAGE 2 (take photos of the urine stream): 

(a) Shine light on the vagina. (b) Spread open the labia. (c) Tell your daughter to urinate a little bit if she is old enough to cooperate with that. (If she's too young, you can't use this method. You should get professional help to find the meatus.) Have your towel ready to catch the urine. (d) Tell her to urinate a little, but enough to create a stream. As she urinates, keep the towel in place with one hand and take photos of the urine stream with the other hand so you can later look at them and see (without worrying about getting wet) where the urine came from. (e) Repeat "d" till you have enough photos.

With these pictures you can see where to insert the catheter.

For other women reading this post who have no external urinary opening, you can follow these instructions to find your own elusive "Number 1" urinary hole ... inside Number 3 the vagina (Number 2 is your anus). If you have no camera, you can use a magnifying glass and a hand mirror to get a better look while shining the flashlight hands-free on your private parts.

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Can it be corrected in adults ? And where ? What are the long term effects?
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Hi I am to a mother of a daughter with these issues. I’m not sure if you will ever see this but I’ve been searching all over the internet for someone else going through this. We were sent home with catheter today. It’s so overwhelming. If you are willing to connect with me and chat about this condition I’d be more than grateful to exchange email.

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If I may ask what is your daughter's condition? My daughter has female hypospadias, bilateral hydronephrosis, VUR grade 5 and a bladder hat doesn't void. What has worked for you when catheterizing?
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