A scoping review of bladder drainage by Hunter and colleagues (2013)3 compared SPC with other methods (e.g. indwelling urethral catheter) and showed a clear advantage for anterior urethral protection, fistula, scrotal abscess and epididymitis. However, there is very little research and guidance on the application and complications of long-term SPCs. The following are considerations for use of a SPC:
- Lower risk of urethral trauma, erosion, or strictures because of the SPC placement. but SPC has similar rates of upper tract damage, vesicoureteral reflux, renal or bladder calculi.
- More comfortable for wheelchair bound patients as less risk of sitting on the catheter
- Easier access for cleaning by the patient and/or caregiver and catheter changes by nurses may be easier due to abdominal access.
- Can be clamped allowing easier voiding via the urethra during a trial of voiding
- Postoperative discomfort is lower in patients with a SPC versus urethral catheterization (indwelling or intermittent) in patients undergoing abdominal, prostate, gynecological or vascular surgery.
Indications:
- Acute and chronic urinary retention in a patient with contraindications to or complications from a transurethral catheter.
- To enable patient to remain sexually active
- Patients with spinal cord injury who have failed intermittent catheterization and need long-term bladder management, SPC preferred over IUC.4
- Failed urethral catheterization
- Inability to catheterize urethra (e.g. obesity/body hiatus with a large abdominal girth, obstruction, stricture, trauma, abnormal urethral anatomy).
- Lack of urethral or perineal sensation where the risk of urethral injury or skin breakdown is increased (e, g, spinal cord injury).
- While undergoing pelvic radiation
- Postoperative bladder drainage following: GU or colon surgery (e.g. female stress UI, colorectal surgery, prostate surgery), post pelvic trauma or injury.
- Men with diagnosis of bladder outlet obstruction and transurethral resection is contraindicated.
- To avoid urethral trauma in the long-term
- To decrease risk of contamination from fecal material (e.g. patient with fecal incontinence).
- Palliative use - where the use of an SPC may simplify patient care and increase patient comfort.
- Pregnancy
- Known or suspected carcinoma of the bladder.
- Absolutely contraindicated is the absence of an easily palpable or ultrasonographically localized distended urinary bladder.
- Previous lower abdominal surgery.
- Coagulopathy (until the abnormality is corrected).
- Presence of ascites, hernia mesh or other prosthetic devices in lower abdomen.
- Presence of ovarian cyst
- Neuropathic disorders causing frequent urethral catheter expulsion
References:
- 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