What is Supra Pubic Catheterization? How is it performed? What are the Indications?

What is Supra Pubic Catheterization? How is it performed? What are the Indications? : Supra pubic catheterization (SPC) is a medical procedure where a catheter is inserted into the bladder through the lower abdominal wall, bypassing the urethra. This technique is used in patients who are unable to void urine normally due to various urological or neurological conditions. SPC is considered a safe and effective alternative to urethral catheterization, especially in cases of chronic urinary retention, bladder outlet obstruction, or long-term catheterization needs.

With advances in minimally invasive techniques and improved catheter designs, supra pubic catheterization has become an essential part of urological practice. This article provides a detailed understanding of the procedure, its indications, and the latest medical trends related to its use.

What is Supra Pubic Catheterization?

Supra pubic catheterization involves the placement of a catheter directly into the bladder through a small incision made in the suprapubic region (just above the pubic bone). This catheter allows urine to drain from the bladder when normal voiding is not possible. The procedure can be performed in an emergency, as a temporary solution, or as a long-term management option for urinary retention and bladder dysfunction.

Compared to urethral catheterization, SPC offers several advantages, such as reduced risk of urinary tract infections (UTIs), fewer complications related to urethral trauma, and improved patient comfort.

How is Supra Pubic Catheterization Performed?

Supra pubic catheterization can be performed in two main ways:

1. Percutaneous (Trocar) Method

This is the most common method, often performed under local anesthesia with ultrasound guidance to ensure safe placement.

Steps:

• The patient is placed in a supine position, and the suprapubic area is cleaned and sterilized.
• Local anesthesia is administered to numb the area.
• A trocar or needle is used to puncture the abdominal wall and bladder.
• A guidewire is introduced through the trocar to assist in catheter placement.
• The catheter is then inserted over the guidewire, allowing urine to drain freely.

2. Open Surgical Method

This method is used when percutaneous insertion is not feasible or in cases requiring a more controlled approach.

Steps:

• The patient is given local or general anesthesia.
• A small incision is made above the pubic bone.
• The bladder is accessed and the catheter is placed directly.
• The incision is sutured, and the catheter is secured in place.

Indications for Supra Pubic Catheterization

Supra pubic catheterization is recommended for various medical conditions, including:

1. Urinary Retention

• Chronic urinary retention due to conditions like benign prostatic hyperplasia (BPH) or bladder outlet obstruction.
• Acute urinary retention when urethral catheterization is not possible.

2. Neurogenic Bladder Dysfunction

• Patients with spinal cord injuries, multiple sclerosis, or Parkinson’s disease who cannot control bladder function.

3. Urethral Strictures and Trauma

• Severe urethral stricture disease where urethral catheterization is contraindicated.
• Urethral trauma following accidents or surgical procedures.

4. Post-Surgical and Long-Term Catheterization

• Patients requiring long-term catheterization due to chronic conditions.
• Postoperative patients recovering from urological surgeries such as radical prostatectomy or bladder surgeries.

5. Urinary Diversion in Cancer Patients

• Patients with advanced pelvic malignancies affecting the bladder.

Benefits of Supra Pubic Catheterization

Compared to urethral catheterization, SPC provides several advantages:

• Reduced Risk of Infections: Lower incidence of catheter-associated urinary tract infections (CAUTIs).
• Less Urethral Trauma: Avoids complications like urethral strictures and discomfort.
• Better Comfort and Mobility: More convenient for long-term catheter users.
• Improved Bladder Management: Allows for intermittent catheterization in patients with neurogenic bladder dysfunction.

Complications and Risks

Despite its benefits, SPC carries potential risks, including:

• Infection: Although SPC reduces the risk of UTIs, infections can still occur at the insertion site.
• Bladder Perforation: Rare but possible if the procedure is not performed correctly.
• Catheter Blockage: Long-term use can lead to encrustation and blockage.
• Skin Irritation or Granulation Tissue Formation: The catheter site may develop irritation or excessive tissue growth.

Current Medical Trends and Studies

Several advancements and ongoing research studies are shaping the future of SPC:

1. Minimally Invasive Techniques: Newer ultrasound-guided and trocar-free methods are improving the safety and efficacy of SPC placement.
2. Antimicrobial-Coated Catheters: Research is focusing on reducing catheter-associated infections through antimicrobial technology.
3. Biodegradable Catheters: Emerging technologies aim to reduce long-term complications associated with catheter use.
4. Enhanced Patient Care Protocols: Studies are exploring ways to improve patient education and self-care for SPC users, reducing hospital visits and complications.

Conclusion

Supra pubic catheterization is a valuable procedure in urology, offering an effective alternative to urethral catheterization in patients with urinary retention, neurogenic bladder dysfunction, and other conditions. Advances in minimally invasive techniques and catheter technology continue to improve patient outcomes and reduce complications. Awareness and proper management of SPC can significantly enhance the quality of life for patients requiring long-term bladder drainage.

For more information on SPC and related urological procedures, consult with expert urologists at the Institute of Urology, Jaipur.

References

1. Abrams, P., et al. (2021). “The Role of Supra Pubic Catheterization in Long-Term Bladder Management.” Journal of Urology.
2. Herschorn, S. (2022). “Advances in Catheter Technology: The Future of Bladder Drainage.” Urological Research.
3. European Association of Urology (EAU) Guidelines on Urological Catheterization (2023).
4. Smith, C. P., et al. (2023). “Comparative Study on Supra Pubic vs. Urethral Catheterization Outcomes.” International Journal of Urology.