Suprapubic Catheterization


INDICATIONS
  • Men with urethral stricture or complex prostatic disease.
  • Trauma patient with evidence of urethral injury including blood at the meatus, a high-riding prostate, or scrotal or perineal hematoma: Traditionally, in these patients no attempt at urethral catheterization should be made until a retrograde urethrogram is performed to evaluate the integrity of the urethra.
CONTRAINDICATIONS
  • Avoid placing in patients whose bladder is not full enough to visualize or is not definable due to previous surgery or radiation. Ultrasound is useful in determining bladder position.
TECHNIQUE
  • Use sterile technique and local anesthesia. If necessary, conscious sedation should be provided.
  • The needle is placed approximately 2-3 cm above the pubic symphysis directed toward the pelvis and advanced slowly while aspirating until urine is easily aspirated.
  • Once the bladder is located, the Foley is placed over a idewire and sheath.
COMPLICATIONS
  • Bowel perforation, intraperitoneal/extraperitoneal extravasation, infection, obstruction of tubing, tubing comes out, ureteral catheterization
INTERPRETATION OF RESULTS
  •  Aspiration of urine from the catheter confirms placement.
NOTE
  • Patients with pelvic fractures and either a high-riding prostate or blood at the urethral meatus should have a retrograde urethrogram (RUG) for evaluation of urethral injury. If present, place a suprapubic catheter.


 


Insertion site of catheter during suprapubic catheterization.