Suprapubic tube placement is indicated in when bladder catheterization is indicated and not technically possible due to urethral obstruction. In many cases suprapubic catheter placement may be avoided by applying established techniques for difficult urethral catheterization.

If an initial attempt at Foley catheter insertion is, it is worthwhile to enquire if 12 mL of lidocaine jelly were gently injected per urethra prior to the catheter placement attempt. Remarkably often, the addition of this one step in Foley catheter placement can make the procedure a success. If the patient is in urinary retention and is a male over 50 years old, then using an 18 Fr Coude catheter is the best option, since the Coude tip will provide better purchase to slide the catheter past an obstructing prostatic urethra. The Coude tip should always be facing upward while the catheter is being placed. The balloon port on the Coude catheter is oriented in the same direction as the curve of the catheter tip. Keeping the balloon port facing upwards assures correct upward positioning of the catheter tip. If catheter placement fails using these techniques, then the decision must be made to either transfer the patient to a hospital where a urologist is available or perform suprapubic catheter placement.