Suprapubic Catheterization

Suprapubic catheterization is the medical term for the surgery performed to relieve urinary retention when placing a urethral catheter is unsuccessful or is contraindicated because of certain reasons.During this surgery, a thin, sterile suprapubic catheter is inserted into the urinary bladder through an incision on the lower intra-abdominal wall. Once the tube has been inserted, a small bulb on its distal end is inflated to keep the catheter in place. The proximal end of the catheter is connected to a urinary bag which collects the urine.

Indications for suprapubic catheterization

Suprapubic catheterization is performed when transurethral catheterization is not possible or is contraindicated. The common indications for this procedure are:

• Injuries of the urethra

• Obstruction of the urethra
• Tumor in the neck of the bladder
• Prostate cancer
• Benign prostatic hypertrophy

Anesthesia for suprapubic catheterization

Suprapubic catheterization is a painful procedure which should not be taken under proper anesthesia. It is an invasive procedure and there are high chances of damage to the bladder if the patient is agitated and moving.A patient undergoing suprapubic catheterization is usually calmed with the help of parenteral analgesia with or without sedation.

Procedure for suprapubic catheterization

It is advisable to localize the urinary bladder with the help of ultrasonography before undertaking the procedure. One should not attempt blind catheterization in people who have undergone previous lower abdominal surgery. Even if a patient has not undergone any lower abdominal surgery, if the distended bladder is not palpable because of obesity, blind catheterization should not be done.Once the urinary bladder has been localized with the help of ultrasound, the patient is anesthetized. The surgeon then gives an incision on the abdominal wall overlying the bladder. The suprapubic catheter is then introduced into the bladder under all aseptic precautions.

Contraindications for suprapubic catheterization

Suprapubic catheterization is contraindicated in certain conditions. These include:

• Absence of easily palpable bladder or if the bladder is not seen to be distended during ultrasonography, this is an absolute contraindication for suprapubic catheterization.
• It should be avoided.in case of any coagulative disorder.
• It should be avoided in case of previous lower abdominal surgery as there are chances of bowel adhesions. Open cystostomy is the preferred way of relieving the bladder in such cases.
• It should be avoided in case of pelvic cancers with or without radiation because of increased chances of adhesions.

Complications seen during or because of suprapubic catheterization

Some of the complications that may arise because of suprapubic catheterization include:

• Blood in urine, also known as gross hematuria in medical parlance, is commonly seen for a few days after the insertion of suprapubic catheter.
• Post-obstruction diuresis is seen in certain cases. Therefore, patients should be kept under observation for 2-3 hours after the procedure. In case this complication arises, intravenous fluids should be administered and electrolyte balance should be maintained.
• Cellulitis and abscess formation may occur if the site of insertion of the suprapubic catheter is not cleaned properly.
• In case of obstruction of the suprapubic catheter, simple irrigation with normal saline should relieve it. If one suspects displacement of the catheter, cystography should be done to visualize its correct position.
• A catheter left for a long time increases the risk of urinary tract infection. Hence, it should be replaced from time to time.

Reference:http://emedicine.medscape.com/article/145909-overview