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Introduction

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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.

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Definitions and Terms

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

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Figure 49-1.
Graphic Jump Location

Anatomic placement of a suprapubic catheter.

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Techniques

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  • ▪  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

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Clinical Pearls and Pitfalls

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  • ▪  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.

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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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