BERKELEY, CA (UroToday.com) - The indications for suprapubic catheter (SPC) insertion include urinary retention after urethral trauma and in patients needing long-term catheterisation for bladder dysfunction in neurological conditions, e.g. multiple sclerosis, spinal cord injury etc.
In most cases, the distended bladder pushes the peritoneal reflection superiorly and prevents bowel loops passing between the anterior abdominal wall and the bladder, therefore allowing safe insertion of a SPC ‘blindly.' However, one study reported the incidence of bowel injury from ‘blind’ SPC insertion to be as high as 2.4% with resultant mortality in 1.8%. Obesity, abdominal adhesions from previous surgery and inadequate bladder distension further increases the risk of bowel injury during ‘blind’ SPC insertion. Cystoscopic-guided or open surgical insertions are alternative methods of SPC insertion. However, cystoscopic guidance does not completely exclude bowel injury. Open surgical SPC insertions need a general anaesthetic and have a higher morbidity. Image-guided suprapubic catheterisation offers a safer, less invasive method obviating the need for a general anaesthetic. ..View or save the full text Mini Review as a .pdf file
|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.
Preman Jacob, Bhavan Prasad Rai,* and Alistair W. Todd
Department of Radiology, *Department of Urology, Raigmore Hospital, Inverness, UK