Bleeding from Penis After Suprapubic (SP) Tube Insertion
Yes, bleeding from the penis can occur after suprapubic tube insertion, particularly in patients with pre-existing urethral injuries or when the SP tube is placed in the context of pelvic trauma. 1
Mechanism and Risk Factors
- Blood at the urethral meatus is a common finding in urethral injuries, present in 37-93% of cases, and may be observed following SP tube placement in patients with underlying urethral trauma 1
- SP tube insertion is often performed in patients with pelvic fracture urethral injuries (PFUI), where the urethra may already be damaged and prone to bleeding 1
- When SP tubes are placed in patients with partial urethral injuries, blood may track from the injured area and appear at the penile meatus 1
Clinical Assessment
- If blood is observed at the penile meatus after SP tube placement, a pericatheter retrograde urethrogram should be performed to identify potential missed urethral injury 1
- This diagnostic procedure involves injecting contrast material through a 3Fr catheter or angiocatheter held in the fossa navicularis to distend the urethra and prevent contrast leak per meatus 1
- The presence of blood at the urethral meatus warrants further investigation, especially in the context of pelvic trauma 1
Management Considerations
- In cases where penile bleeding occurs after SP tube placement, the primary focus should be on identifying and addressing any underlying urethral injury 1
- Repeated attempts at placing a urethral catheter should be avoided as this may increase the extent of urethral injury and cause additional bleeding 1
- For patients with confirmed urethral injuries and penile bleeding, maintaining the SP tube for urinary drainage is appropriate while the urethral injury heals 1
- In hemodynamically stable patients with penile bleeding and suspected urethral injury, primary realignment may be considered, but should not involve prolonged attempts that could worsen the injury 1
Prevention and Monitoring
- Proper technique during SP tube placement, including ultrasound guidance, can help reduce the risk of complications including bleeding 1
- Patients with SP tubes should be monitored for complications including bleeding, infection, and tube-related issues 1
- When placing SP tubes in trauma patients, coordination with other surgical teams is important to optimize timing and reduce complications 1
Special Considerations
- In patients on anticoagulation or antiplatelet therapy requiring SP tube placement, these medications should be discontinued and/or reversed before the procedure to minimize bleeding risk 1
- Patients with pelvic fractures are at higher risk for urethral injuries and subsequent bleeding complications 1
- While penile bleeding after SP tube insertion may be alarming, it often resolves with conservative management once proper urinary drainage is established 1
Remember that bleeding from the penis after SP tube insertion may indicate an underlying urethral injury that requires proper assessment and management to prevent long-term complications such as urethral stricture formation.