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Suprapubic catheterization is performed as an alternative approach to urinary drainage in patients for whom standard urinary drainage catheters are contra-indicated.


Definitions and Terms


  • ▪  Suprapubic catheter: A catheter inserted into the bladder through the anterior abdominal wall (Figure 49-1).
  • ▪  Phimosis: Constriction of the foreskin of the penis.

Figure 49-1.
Graphic Jump Location

Anatomic placement of a suprapubic catheter.




  • ▪  Indications:
    • —Phimosis
    • —Urethral stricture
    • —Chronic urethral infection
  • ▪  Contraindications:
    • —Coagulopathy
    • —Infected skin over proposed cannulation site
    • —Intra-abdominal pathology (ie, peritonitis, scarring, wound)
    • —Bladder tumor
  • ▪  Prior to urinary catheterization, patient consent should be obtained, the urethra and surrounding areas prepped and draped, and the universal protocol performed as described in Section I.
  • ▪  Ultrasound and/or physical examination should be used to identify the location of the bladder.
  • ▪  Local anesthetic should be infiltrated into the skin over the proposed insertion site.
  • ▪  A small bore needle or Angiocath is inserted into the bladder and aspirated.
  • ▪  Aspiration of urine indication successful bladder cannulation and a urinary drainage catheter can be inserted using Seldinger technique or a peel-away introducer sheath.
  • ▪  Complications:
    • —Bowel perforation
    • —Bladder injury
    • —Hematuria
    • —Infection


Clinical Pearls and Pitfalls


  • ▪  Failure to aspirate urine following several attempts suggests aberrant anatomy and the procedure should be abandoned in favor of alternative approaches.
  • ▪  Suprapubic catheters, while more invasive, may be associated with lower rates of infections.


Suggested Reading

O’Kelly TJ, Mathew A, Ross S, Munro A. Optimum method for urinary drainage in major abdominal surgery: a prospective randomized trial of suprapubic versus urethral catheterization. Br J Surg. 1995;82: 1367–1368.  [PubMed: 7489167]
Sethia KK, Selkon JB, Berry AR, Turner CM, Kettlewell MG, Gough MH. Prospective randomized controlled trial of urethral versus suprapubic catheterization. Br J Surg. 1987;74:624–625.  [PubMed: 3304522]

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