Suprapubic catheter insertion using an ultrasound‐guided technique and literature review

Abstract

What's known on the subject? and What does the study add? The conventional ‘blind’ technique for suprapubic catheter (SPC) insertion relies on adequate filling of the bladder to displace bowel away from the site of needle puncture. However, in a small percentage of patients this fails to happen, which can occasionally lead to life‐threatening bowel injury. Recently published British Association of Urological Surgeons (BAUS) guidelines have recommended that ultrasonography (US) may be helpful to identify bowel loops and recommends its usage whenever possible. This paper describes the technique of US‐guided needle puncture and SPC insertion to reduce the likelihood of bowel injury. The paper addresses training, equipment and logistical issues associated with this advice. We have reviewed the available publications on the outcomes from this technique and also present our experience. Suprapubic catheter (SPC) insertion is a common method of bladder drainage in contemporary urological practice. The procedure involves insertion of a sharp trocar into the bladder percutaneously, usually by palpation, percussion or cystoscopy for guidance. Although generally considered a safe procedure, the risk of bowel injury is estimated at up to 2.4% with a mortality rate of 1.8%. Recently published British Association of Urological Surgeons (BAUS) guidelines have recommended that ultrasonography (US) may be helpful to identify bowel loops and recommends its usage whenever possible. The present paper describes the use of US for SPC insertion and discusses the implications of this advice. This paper is designed to support and supplement practical techniques learnt on a course and in clinical practice.

Quality of life after suprapubic catheter placement in patients with neurogenic bladder conditions

“…Overall, SPC placement is associated with an acceptably low complication rate when performed in a monitored setting under cystoscopic guidance. Ultrasound guided placement is another method which could be employed in any patient, and is endorsed by a British Association of Urological Surgeons guideline . However, serious bowel complications in patients with prior abdominal and pelvic procedures can be avoided with a formal open approach to placement, which does not add significant operative time or difficulty.…”

Comparative study of perioperative morbidities of the conventional and ultrasound-guided suprapubic catheterization in the patients of urinary retention during emergency

“…7 Complications rate of 10-25% and mortality of about 1.8% have been reported by several authors for C-SPC procedures. 8 Aguilera et al, performed real-time ultrasound guided SPC insertion in 17 patients of acute urinary retention with no complication. 9 Even, the British Association of Urological Surgeon (BAUS) recommends USG guided SPC in the management of urinary retention to prevent complications and mortality.…”

Small bowel injury after suprapubic catheter insertion presenting 3 years after initial insertion

“…The National Patient Safety Agency (NSPA) goes one step further and recommends that all SPCs be inserted under ultrasound guidance 4. Recent publication has emphasised that the use of ultrasound guided SPC insertion is critically dependent on operator training and experience 5. This poses major issues for training, equipment availability and transfer of patients to centres with the facilities and expertise available.…”