Indications for Suprapubic Catheter Placement
Suprapubic catheters should only be placed when other bladder management options have failed or are contraindicated, as they carry significant risks despite offering advantages over urethral catheters in specific situations. 1
Primary Indications for Suprapubic Catheter Placement
Overactive Bladder (OAB) Management: Suprapubic tubes (SPT) are indicated when OAB therapies are contraindicated, ineffective, or no longer desired by the patient, and are preferred over urethral catheters due to reduced risk of urethral damage 1
Urethral Trauma or Stricture: Suprapubic catheterization is necessary when urethral catheterization is impossible or contraindicated due to urethral trauma, stricture, or erosion 1
Bladder Trauma Management: In cases of bladder injury, particularly extraperitoneal bladder rupture with concomitant urethral injury, a suprapubic catheter may be required for urinary drainage 1
Sexual Activity Preservation: SPTs are preferred for patients who wish to maintain sexual function, as they interfere less with sexual activity compared to urethral catheters 1
Urethral Discomfort: Patients experiencing significant discomfort with urethral catheters may benefit from suprapubic catheterization 1, 2
Advantages of Suprapubic Catheters Over Urethral Catheters
Lower Risk of Catheter-Associated Bacteriuria: Studies show reduced rates of catheter-associated bacteriuria with suprapubic catheters (RR, 2.60; 95% CI, 2.12–3.18 for urethral vs. suprapubic) 1
Reduced Urethral Trauma: SPTs eliminate the risk of urethral erosion, stricture formation, and other urethral complications 1
Ability to Attempt Normal Voiding: Patients can attempt normal voiding without requiring recatheterization 1
Patient Comfort: Studies demonstrate significantly less discomfort with suprapubic catheters compared to urethral catheters (RR, 2.98; 95% CI, 2.31–3.85 for discomfort with urethral vs. suprapubic) 1
Risks and Limitations of Suprapubic Catheterization
Procedural Risks: Insertion is an invasive procedure with risks of bleeding, bowel perforation, and vascular injury 1, 3
Specialized Training Required: Specially trained caregivers are often needed for catheter changes, particularly for long-term catheterization 1
Potential Complications: Include granulation tissue formation, bleeding, catheter site erosion, and loss of access during catheter changes 1
Persistent Urethral Leakage: Patients may still experience urinary leakage through the urethra despite suprapubic drainage 1
Best Practices for Suprapubic Catheter Placement
Ultrasound Guidance: Use of ultrasound during placement significantly reduces the risk of bowel perforation and vascular injury 1, 4
Patient Selection: Carefully evaluate for contraindications such as history of transitional cell carcinoma, previous abdominal surgeries, or hemorrhagic diathesis 4, 5
Shared Decision-Making: Always engage in thorough discussion of risks, benefits, and alternatives with patients before proceeding with suprapubic catheterization 1
Regular Follow-up: Establish a schedule for catheter changes (typically every 2-6 weeks) and monitoring for complications 6, 3
Alternatives to Consider Before Suprapubic Catheterization
Clean Intermittent Catheterization: Should be considered as first-line option for many patients with voiding dysfunction before resorting to indwelling catheters 1
External Condom Catheters: For male patients, condom catheters have shown lower rates of catheter-associated bacteriuria and UTI compared to indwelling urethral catheters 1
Pharmacotherapy and Minimally Invasive Therapies: For OAB patients, ensure all appropriate medications and procedures (e.g., botulinum toxin, sacral neuromodulation) have been tried before considering catheterization 1