Chapter 49. Suprapubic Catheterization

Introduction

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.

Techniques

• ▪  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.

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