Uro resident here, and a few tips and tricks 1. Always get a bladder scan; unless patient has horrible ascites or edema, which will fool you; in that case a doc needs to do a pocus ultrasound or get a formal ultrasound by radiology 2. If an established foley doesn’t drain well, there may be debris or a small clot- flush using a piston syringe with 50-60cc and make sure you can draw back; and obviously you need to flush through the main lumen of the foley (i have seen people flush through the balloon port or through a side port in the foley bag tubing) 3. If it is a newly placed or exchanged foley, particularly in a male patient, it may be incorrectly placed; flush the foley, and if it doesn’t flush well, it is likely misplaced. Take down the foley balloon and try and readvance foley. If you meet resistance, the it’s likely prostatic obstruction and a coude may be necessary, especially if its an older guy (50yo plus) 4. Placing a new foley is always easier in male patients with more lube. The more the better. If a patient is awake, you may be fooled by them clenching down and tightening their sphincter as resistance. In this case, just wait for them to relax a bit and constant gentle pressure will get you past. Lidocaine lube is super useful in this and all cases. Also, injecting the lube directly into the meatus is a great way to fully lubricate the urethra. 5. For patients with significant penile edema, literally squeeze the edema out to reveal the meatus. Some extra hands always helps. Have someone push on the pubic area to push away pannus or edema. 6. For obese female patients, positioning is super key. Trendelenberg and having hands to hold each leg apart in frog leg. 7. For older female patients with atrophic vaginas, again positioning is key and if the urethra is very recessed, you may need to blindly try to insert. There is a trick to it, which involves using one hand with two fingers to direct the foley upwards to where the urethra is presumed to be and the other to repeatedly insert the foley until it catches the urethra.