About the Special Report

Suprapubic catheterization (SPC) is a surgical procedure traditionally performed in the operating theater, either under general or local anesthesia, using blind or ultrasound-guided percutaneous trocar puncture. In recent years, suprapubic catheters have become more prevalent than indwelling urethral catheters for those requiring long-term catheterization, such as patients with neurological disorders, intractable incontinence or bladder outlet obstruction who are unfit for transurethral resection. In our experience, SPC is superior to urethral catheterization with regard to patient satisfaction, comfort and nursing care [1,2]. For safe placement of a suprapubic catheter, the bladder must be adequately distended. Distention of the bladder can be very difficult in patients with a small-capacity neurogenic bladder [1,3], and blind percutaneous insertion of conventional wide-bore trocars can result in bowel perforation [4,5]. Until recently, SPC with blind trocar has remained the predominant technique used in UK. However, recently a new SPC introducing kit, based on the Seldinger technique, has been developed (MediPlus Ltd, High Wycombe, Bucks UK) that allows controlled entry of the trocar into the bladder over a guidewire and is designed to reduce the potential hazards of the blind technique. The new kit uses the Seldinger technique for safe insertion of the SPC. With the patient supine and the suprapubic area thoroughly cleaned, local anesthetic is infiltrated 2 cm above the pubic symphysis in the midline. In the elective setting, the bladder is filled with a target volume of greater than 350 ml sterile water either using the flexible cystoscope or a urethral catheter. Clearly, the bladder will be palpable or pecussable in an emergency scenario. A small incision about 1 cm in length is made in the skin to allow easier insertion of the trocar later on. The bladder is then punctured using the 18 gauge needle, with the knowledge that inadvertent bowel injury by the needle may still occur, in rare cases. After confirming the position of needle in the bladder by aspiration or flexible cystoscopy, the floppy end of the three-stage 0.035 inch guidewire is introduced through the needle. The needle is then removed leaving the guidewire in the bladder. The trocar and sheath are introduced over the guidewire through the incision until safely in position in the bladder. The guidewire and trocar are then removed from the outer sheath and a 14 Fr silicon catheter (a 16 Fr catheter is also available if required), which is part of the kit, is inserted into the bladder through the peel-away sheath.