The insertion of a suprapubic catheter (SPC) (also referred to as a “suprapubic tube” or “SP tube”) is an alternative to a transurethral (urethral) indwelling catheter (IUC) and is used either short-term (e.g. emergency, following surgery) or as long-term bladder drainage when urine diversion is needed.2 However, compared with the use of urethral catheters, several advantages of their use have been identified, including: lower risk of urethral trauma, necrosis, catheter-induced urethritis and urethral strictures; greater comfort in certain patients (e,g, wheelchair users); easier access to the insertion site for cleaning and catheter changes; reduced risk of catheter contamination with microorganisms; and greater independence. In this location, there is less risk of interference with sexual, or remain, sexually active. Although, a SPC may not decrease the incidence of catheter-associated urinary tract infections (CAUTIs), it may be preferred to a urethral catheter in terms of patient satisfaction and nursing care due to easier access and a more convenient location to the entry site for cleansing and catheter change activity.4
According to the British Association of Urological Surgeons (BAUS) and Nurses (BAUN) consensus document (2021) “The suprapubic route can prevent the development of urethral erosions, including traumatic hypospadias, especially in patients with impaired sensation (e.g. neuropathic bladders), impaired mobility or impaired cognition.6,7 Gradual dilatation of the bladder outlet is a common problem in women using long-term urethral catheters, and although spontaneous expulsion of SPC is described, this is much less likely than with urethral catheters.”
The placement of a suprapubic cystotomy catheter is a frequent procedure used in urology, especially in patients with neurogenic bladder who require long-term bladder drainage. The procedure is usually performed in the outpatient setting. Suprapubic cystotomy is also indicated in cases of trauma or urethral pathology that prevent the placement of a transurethral catheter
A qualitative study by Chapple, Prinjha and Feneley (2015)2 of 28 male and female patients of which 23 (64%) had a SPC, but had worn a urethral catheter at one time or another, reported a SPC was more hygienic, more comfortable, and better for sexual relationships than a urethral catheter.
Suprapubic catheters are typically changed by skilled professional nurses practicing in a variety of practice settings with a majority of SPC changes occurring in an outpatient urology clinic or practice or in the community setting in a patient's home. Initial insertion of a SPC can be performed in a urology office or outpatient setting. Twenty‐five percent of SPC insertions are performed in an emergency setting, usually when urethral catheterization has failed or is contraindicated.
Locating the catheter above the pubis, on the lower abdomen, away from the genital region, eliminates the risk of urethral erosion and trauma and urethral stricture formation. There is less contamination with genitalia and bowel bacteria (such as E. coli) which may lead to decreased risk of a CAUTI when used short-term (<30 days). But there is very little evidence to support a lower risk of CAUTIs when a SPC is in place long term. Katsumi et al., (2010)9 conducted a retrospective review of male veterans with a spinal cord injury whose long-term bladder management was with a IUC (n=133, 23.4 years) or SPC (n-46, 14.3 years) and found that overall, 93.2% of patients in the IUC group and 97.9% with a SPC had at least one symptomatic UTI during more than 11 years of follow-up. Using data from a previously published prospective targeted infection prevention study conducted between 2010 and 2013, Gibson and colleagues (2019)3 compared CAUTI rates and multi-drug resistant organism colonization between nursing home residents (n=418) with IUC (n=173, 83%) and SPCs (n=35, 17%). The SPC group had a lower incidence of CAUTI (6.6 vs 8.8 per 1000 device-days; P ¼ 0.05), were half as likely to be hospitalized (hazard ratio (HR) ¼ 0.46; P < 0.01) and were 23% less likely to have had antibiotics in the past 30 days (HR ¼ 0.77; P ¼ 0.02) but were more likely to be colonized with multi-drug resistant organisms.
The order for changing of an existing SPC should be obtained from a prescribing provider. The patient should be informed of the reason for the change to an SPC for bladder management and what to expect in terms of discomfort.
Written by: Diane K. Newman, DNP FAAN BCB-PMD, Urologic Nurse Practitioner, Adjunct Professor of Urology in Surgery, Senior Research Investigator, Perelman School of Medicine, University of Pennsylvania
References:
- Bullman, S. (2011) Ins and outs of suprapubic catheters--a clinician's experience. Urol Nurs, 31(5), 259-63.
- Chapple A, Prinjha S, Feneley R.J (2015). Comparing transurethral and suprapubic catheterization for long-term bladder drainage: a qualitative study of the patients' perspective. Wound Ostomy Continence Nurs. 42(2):170-5. doi: 10.1097/WON.0000000000000096
- Cooper, F.P., Alexander, C.E., Sinha, S., & Omar, M.I. (2016). Policies for replacing long-term indwelling urinary catheters in adults. Cochrane Database Syst Rev. 7:CD011115. doi:10.1002/14651858.CD011115.
- Gibson, K.E., Neill, S., Tuma, E., Meddings, J., & Mody, L. (2019). Indwelling urethral versus suprapubic catheters in nursing home residents: determining the safest option for long-term use. J Hosp Infect. 02(2):219-225. doi: 10.1016/j.jhin.2018.07.027
- Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, HICPAC. (2010) Guideline for prevention of catheter associated urinary tract infections 2009. Infect Control Hosp Epidemiol, 31,319-26. https://doi: 10.1086/651091.
- Hall, S.J., Harrison, S., Harding, C., Reid, S., & Parkinson, R. (2020). British Association of Urological Surgeons’ suprapubic catheter practice guidelines – revised. (2020) BJU International. May. doi: 10.1111/BJU.15123
- Harrison, S.C.W., Lawrence, W.T., Morley, R., Pearce, I., & Taylor, J. (2011). British Association of Urological Surgeons’ suprapubic catheter practice guidelines. BJU Int, 107(1),77-85. https://doi: 10.1111/j.1464-410X.2010.09762.x.
- Hunter, K.F, Bharmal, A., & Moore, K.N. (2013) Long-term bladder drainage: Suprapubic catheter versus other methods: a scoping review. Neurourology Urodynamics, 32(7),944-51. https://doi: 10.1002/nau.22356.
- Katsumi, H.K., Kalisvaart, J.F., Ronningen, L.D., & Hovey, R.M. (2010). Urethral versus suprapubic catheter: choosing the best bladder management for male spinal cord injury patients with indwelling catheters. Spinal Cord. 48:325-9. doi:10.1038/sc.2009.134;
- Kidd, E.A., Stewart, F., Kassis, N.C., Hom, E., Oma,r M.I. (2015). Urethral (indwelling or intermittent) or suprapubic routes for short-term catheterisation in hospitalised adults. Cochrane Database Syst Rev. Dec 10;(12):CD004203.
- Newman, D.K. (2017). Devices, products, catheters, and catheter-associated urinary tract infections. In: D.K. Newman, J.F. Wyman, V.W.Welch (Eds). Core Curriculum for Urologic Nursing (pp. 429-466). Pitman, New Jersey: Society of Urologic Nurses and Associates, Inc.
- Newman, D.K., Cumbee, R.P., & Rovner, E.S. (2018). Indwelling (transurethral and suprapubic) catheters. In: D.K. Newman, E.S. Rovner, A.J. Wein, (Eds). Clinical Application of Urologic Catheters and Products. (pp. 47-77) Switzerland: Springer International Publishing.
- Orikasa, S., Kanbe, K., Shirai, S., Shintaku, I., & Kurosu, S. (2012). Suprapubic versus transurethral bladder drainage after radical prostatectomy. Impact on patient discomfort. Int J Urol, 19(6),587-90. https://doi: 10.1111/j.1442-2042.2012.02980.x.
- Reid S, Brocksom J, Hamid R et al. (2021) British Association of Urological Surgeons (BAUS) and nurses (BAUN) consensus document: management of the complications of long-term indwelling catheters. BJU Int. 128:667–77. https://doi.org/10.1111/bju.15406
- Romo, P.G.B., Smith, C.P., Cox, A., Averbeck, M.A., Dowling, C., Beckford, C., Manohar, P., Duran, S., Cameron, A.P. (2018) Non-surgical urologic management of neurogenic bladder after spinal cord injury. World J Urol. 36(10):1555-1568
- Sabbuba, N.A., Stickler, D.J., Long, M.J., Dong, Z., Short, T.D., & Feneley, R.J. (2005). Does the valve regulated release of urine from the bladder decrease encrustation and blockage of indwelling catheters by crystalline proteus mirabilis biofilms? J Urol, 73(1),262-6. https://DOI:10.1097/01.ju.0000141139.76350.49
- Sweeney, A. (2017). Suprapubic catheter change methods: A crossover comparison cohort trial. J Wound Ostomy Continence Nurs. 44(4), 368-373. https://doi: 10.1097/WON.0000000000000335.
- Van den Eijkel, E., & Griffiths, P. (2006) Catheter valves for indwelling urinary catheters: a systematic review. British Journal of Community Nursing; 11: 3, 111-114.