Suprapubic Catheter Placement
Suprapubic catheters are commonly placed after surgeries that may delay the return of normal, efficient voiding, such as anti-incontinence procedures and procedures for pelvic organ prolapse. Suprapubic catheters are thought to improve patient comfort and ease of nursing care; however, the real advantage is that they allow patients to control voiding trials, thus obviating repeated transurethral catheterizations to check postvoid residual volumes.
The major catheter types available are listed in Table 87–1 and shown in Fig. 87–1. Suprapubic catheters can be inserted using an open or a closed technique. Open techniques are commonly utilized at the time of abdominal surgeries, such as a retropubic urethropexy. Any of the catheter types listed in Table 87–1, as well as a Foley catheter, can be used. To perform the open technique of suprapubic catheter placement, the bladder is filled in a retrograde fashion with saline or water, usually through a three-way Foley catheter. A stab incision is made through the skin above or below a transverse skin incision or off to one side of the lower end of a vertical incision. If a Foley catheter is going to be used, a curved clamp is passed from the undersurface of the rectus muscle and fascia and then out the stab wound (Fig. 87–2A). The Foley catheter is then pulled into the field and is brought into close proximity to the extraperitoneal portion of the dome of the bladder (Fig. 87–2B). If a high extraperitoneal cystotomy has already been made to assess bladder integrity or ureteral patency, the Foley catheter is placed into the same incision of the bladder and the cystotomy is closed in two layers around the catheter (Fig. 87–3) (see description of opening and closing the bladder in Chapter 88). If suprapubic teloscopy has been performed (see Chapter 123), the catheter is placed through the same stab wound in which teloscopy is performed (Fig. 87–4). Otherwise, a stab wound is placed in the extraperitoneal dome of the bladder, the catheter is placed directly into the bladder, and a purse string suture is placed and tied around the catheter (Fig. 87–5). If a commercially available suprapubic catheter is used, the catheter and an introducer are placed into the previously made stab wound in the skin and inserted through the skin muscle and fascia. The bladder is then punctured through the dome, taking care to avoid large vessels. The catheter is advanced through the sheath or over the needle guide, which is simultaneously withdrawn. Efflux of urine or saline should be ensured. If the catheter has a balloon, it is inflated and the catheter is sutured in place on the skin.
