Can a suprapubic catheter (urinary catheter inserted through the abdomen) insertion site be closed in a patient with a history of urinary tract issues?

Closure of Suprapubic Catheter Insertion Site

Yes, suprapubic catheter insertion sites can be closed after catheter removal, but the timing and method depend on tract maturity—mature tracts (typically >4 weeks old) often close spontaneously within 24-48 hours, while newer tracts may require surgical closure if they fail to close spontaneously.

Understanding Tract Maturation and Closure

The suprapubic catheter creates a fistulous tract between the skin and bladder that matures over time. The evidence does not provide specific closure protocols, but clinical practice recognizes two scenarios:

Mature Tracts (>4 weeks)

• Most mature tracts close spontaneously within 24-48 hours after catheter removal through natural wound healing mechanisms
• The tract epithelializes over time, creating a stable channel that paradoxically facilitates easier closure once the catheter is removed
• Patients should be monitored for complete cessation of drainage and ability to void normally

Immature Tracts (<4 weeks)

• Newer tracts may require primary surgical closure if spontaneous closure fails
• These tracts have not fully epithelialized and may be more prone to persistent drainage or infection

When Catheter Removal is Appropriate

Remove the suprapubic catheter as soon as clinically appropriate after definitive treatment to minimize infection risk and catheter-related complications 1. This applies when:

• The underlying urological condition has been definitively treated (e.g., urethral stricture repair completed)
• The patient has regained adequate bladder function and can void spontaneously
• Alternative bladder management strategies are no longer needed

Monitoring After Catheter Removal

After removing the suprapubic catheter, assess for:

• Complete cessation of urinary drainage from the site within 24-48 hours
• Ability to void normally through the urethra with adequate volumes and minimal post-void residuals
• Signs of infection at the closure site (erythema, purulent drainage, fever)
• Persistent leakage beyond 48-72 hours, which may indicate need for surgical intervention

Common Pitfalls to Avoid

• Do not attempt premature closure in patients who still require bladder drainage—ensure the underlying indication for catheterization has been resolved
• Do not ignore persistent drainage beyond 72 hours, as this may indicate a non-healing fistula requiring surgical closure
• Avoid closing the site if the patient may need recatheterization in the near future, as the mature tract facilitates easier reinsertion 2

Special Considerations for Long-Term Catheterization

For patients who have had suprapubic catheters for extended periods:

• Long-term catheterization (>10 years) increases risk of bladder cancer and renal complications, requiring periodic renal scans, urine cytology, and cystoscopy 3
• These patients may have more established tracts that still typically close spontaneously, though healing may take slightly longer
• The British Association of Urological Surgeons emphasizes that while suprapubic catheterization is generally safe, the risk of serious morbidity must always be considered 4

Alternative Management if Closure Fails

If the tract fails to close spontaneously after 72 hours:

• Surgical closure with layered suturing of the bladder wall and abdominal fascia may be required
• Ensure adequate bladder drainage through alternative means (urethral catheter or clean intermittent catheterization) during the healing period
• Rule out distal obstruction that may be preventing normal voiding and maintaining the fistula