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Suprapubic catheter

What is a suprapubic catheter?

A catheter is a narrow plastic tube that can be put into the bladder to allow drainage of urine. The catheter is usually put in along the urethra or water-pipe (urethral catheter), but sometimes it can go directly into the bladder though the lower abdomen and this is a suprapubic catheter.

How is a suprapubic catheter put in?

Sometimes, the suprapubic catheter is put in under local anaesthetic (while awake). However, it is often necessary to have an anaesthetic to allow the catheter to be put in safely. There are many ways of inserting a suprapubic catheter and the choice will depend on each patient's circumstances - your surgeon will discuss the advantages and disadvantages with you.

If you have had previous surgery to the lower abdomen, it is advisable to use an ultrasound scan during the procedure to reduce the risk of complications such as bowel injury (see below). If your bladder is very small and difficult to fill up with fluid, it is occasionally necessary to make a cut on the lower abdomen to be certain that the catheter is in the right place.

Most people can go home either on the same day the catheter has been put in, or the next day.

What are the alternatives to a suprapubic catheter?

If you need a catheter because your bladder doesn't empty properly it can be put in through the urethra (water-pipe). This is an easier way to put the catheter in, but some people find urethral catheters uncomfortable, especially when they are being changed. Suprapubic catheters are more difficult to insert the first time, but are generally much easier to change and can be more comfortable. In the long-term, urethral catheters can cause problems with the water-pipe becoming over-stretched which can mean the catheter is expelled (falls out) regularly. This is not a problem with a suprapubic catheter. Suprapubic catheters may also block less often, but infections are just as likely as with urethral catheters

Another alternative is intermittent self-catheterization (ISC) which means learning to pass a catheter into the urethra yourself. The catheter is put in every time you want to pass urine and then removed when the bladder is empty which means you don't have the catheter in except when you go to the toilet. This method had various advantages: less infections, less irritation to the bladder, no blocked catheters. However, no everyone is able to do ISC as it does require some dexterity and good eyesight.

If you need a catheter because of incontinence, then pads or a convene sheath (for men) can be used instead of a catheter.

What are the complications of a suprapubic catheter?

Inserting the catheter can cause the following problems

  • blood in the urine (common, but usually temporary and mild)
  • discomfort during catheter insertion (if done under local anaesthetic)
  • infection
  • failure to get the catheter into the bladder
  • damage to the bowel (rare but can be very serious)

Bowel damage can occur during insertion of a suprapubic catheter. When the instrument is put though the abdominal wall into the bladder, if a loop of bowel (intestine) gets in the way, it can be damaged and a hole made. This can lead to very serious complications and even death, but this is a very rare complication. Particular care is needed in people who have had previous surgery to the lower abdomen as they are at higher risk of this problem.

In the long-term, there are the following considerations:

  • The catheter needs changing every 3 months (just like an ordinary catheter)
  • recurrent infections can occur
  • the catheter may irritate the bladder and cause pain or spasms
  • the catheter may block up with debris and need changing more often (but perhaps less so than ordinary urethral catheters)
  • if the catheter comes out, it must be put back in straight away or else the hole will heal up and it will be more difficult to replace

What drainage systems are available?

Just like an ordinary urethral catheter there are a number of types of drainage system. The catheter tube is often connected to a bag system so that urine drains out and is collected. When the bag if full, it is emptied into the toilet by a valve at the bottom of the bag. There are a number of types of bag to suit different patients' needs. Commonly the bag is worn on a strap around the leg.

An alternative is a flip-flow valve. This is a valve which fits on the catheter tube. When it is closed, the catheter does not drain and you bladder fills up. When your bladder is full you can go to the toilet and open the valve to drain the catheter into the toilet. This avoids the need for a bag but may not be appropriate if you have difficulty holding on.