Suprapubic catheterization is performed as an alternative approach
to urinary drainage in patients for whom standard urinary drainage
catheters are contra-indicated.
- ▪ Suprapubic catheter: A catheter inserted into the
bladder through the anterior abdominal wall (Figure 49-1).
- ▪ Phimosis: Constriction of the foreskin of the penis.
Anatomic placement of a suprapubic catheter.
- ▪ Indications:
- —Urethral stricture
- —Chronic urethral infection
- ▪ Contraindications:
- —Infected skin over proposed cannulation site
- —Intra-abdominal pathology (ie, peritonitis, scarring,
- —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
- ▪ 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
- ▪ 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
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
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.
Sethia KK, Selkon JB, Berry AR, Turner CM, Kettlewell MG, Gough
MH. Prospective randomized controlled trial of urethral versus suprapubic
catheterization. Br J Surg.