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Self-Retaining Catheters — Malecot & de Pezzer

Self-retaining catheters use tip geometry rather than an inflatable balloon to stay in place within a viscus. Once pulled into position, the flexible tip expands and resists withdrawal. Mostly supplanted by Foley catheters for urinary drainage but retained in specific reconstructive and diversion contexts.

Malecot Catheter​

  • 4-winged flexible tip — the tip has four "petals" that collapse when tensioned over a stylet and expand when the stylet is withdrawn
  • Placement: pulled into position over a stylet; the stylet is withdrawn and the wings expand in the lumen
  • Removal: gentle traction collapses the wings through the tract

Uses​

  • Suprapubic bladder drainage — occasionally preferred for more complete drainage than a balloon catheter
  • Cecostomy tube — appendiceal or cecal tract stabilization for antegrade continence enema (ACE) programs and Malone procedures
  • Historical open-cystotomy drainage

de Pezzer (Pezzer) Catheter​

  • Mushroom-shaped tip — single bulbous expansion
  • Similar placement technique (over a stylet)
  • Also called "mushroom-tip" catheter

Uses​

  • Nephrostomy tract drainage — large-bore mushroom tip resists dislodgement
  • Gastrostomy (historical) — original G-tube design
  • Open-cystotomy drainage when a Foley balloon is contraindicated
  • Tract maturation after PCNL

Current Niche​

Largely replaced by Foley-balloon catheters and pigtail drains for routine use. Persist in:

  • Continent catheterizable channels (Mitrofanoff / Monti) during early post-op period
  • Cecostomy and ACE tube management
  • Nephrostomy with unusual anatomy
  • Settings without balloon-catheter availability

Considerations​

  • Dislodgement in the immature tract is catastrophic — can be difficult to replace
  • Removal trauma — forceful removal can tear the tract
  • Exchange — typically with a Foley or pigtail after tract maturation

See also: Foley Catheter, Nephrostomy Tube, Suprapubic Catheter.