What does this procedure involve?
Usually a supraubic catheter is inserted during a cystoscopy (telescopic inspection of the bladder). The cystoscopy allows any bladder abnormalities to be identified and often corrected prior to the insertion of the catheter. It also provides a technique by which the procedure can be closely monitored and the exact position of the suprapubic catheter determined and controlled.
Who needs a suprapubic catheter?
There are many different reasons for insertion of a suprapubic catheter (SPC). The reason you are having this procedure will have been discussed with you in detail prior to the operation.
The SPC is a method for draining urine from the bladder that avoids the need for a catheter in the urethra. It is usually offered to people in chronic urinary retention – that is unable to pass urine spontaneously. Occasionally people with incontinence find that a SPC is the best way to remain dry.
There is some evidence that it has less chance of becoming infected than the urethral indwelling catheter (IDC). Women, in particular, cannot tolerate an IDC for an extended period of time as it causes damage to the urethra – making it “patulous” and thereafter permanently altered.
What are the alternatives to the procedure?
Alternatives to this procedure include:
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Learning to perform self-catheterisation.
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A catheter through the urethra (IDC).
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Permanent urinary diversion.
What happens during the procedure?
Usually you will be given a full general anaesthetic (where you will be asleep) or a spinal anaesthetic (where you are unable to feel anything from the waist down). The anaesthetist will explain the pros and cons of each type of anaesthetic to you.
You will usually be given injectable antibiotics before the procedure, after checking for any allergies.
The surgeon will first perform a cystoscopy to inspect the bladder and on completion fill your bladder with fluid. A small incision will be made in your lower abdomen, just above the pubic hairline. A special inserted trocar allows insertion of the suprapubic catheter. In patients with small bladders, the incision often needs to be larger so that the bladder can be seen clearly to allow the catheter to be inserted. Correct positioning within the bladder is checked throughout the procedure utilizing the cystoscope.
What happens after the procedure?
You will usually be discharged the same day as your surgery.
There will be a light dressing around the SPC that can be removed whenever desired. The catheter is held in place by an inflated balloon (integral within the catheter) inside the bladder.
You will be shown how to care for the catheter. Most SPC need to be changed every six weeks (a simple, painless, five minute procedure done in outpatients), and we like to perform the first change under supervision in the clinic/hospital.
Are there any possible side effects?
All procedures have the potential for side-effects. Although these complications are well recognised, the majority of patients do not have problems after a procedure. Risks of the anaesthetic need to be discussed with the anaesthetist who will be looking after you during the operation, and who will visit you beforehand.
There are specific risks with this surgical procedure, and these will be discussed with you before your procedure.
Relatively Common
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Temporary mild burning or bleeding during urination.
Occasional
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Infection of the bladder needing antibiotics (occasionally, recurrent infections).
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Blocking of the catheter needing unblocking.
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Bladder discomfort and pain.
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Persistent leakage from the water pipe (urethra), which may need a further operation to close the bladder neck.
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Development of stones and debris in the bladder, causing catheter blockage, and requiring removal or crushing by a further procedure.
Rare
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Bleeding requiring irrigation, or additional catheterisation, to remove blood clot.
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Rarely, damage to surrounding structures, such as bowel or blood vessels with serious consequences, possibly needing additional surgery.
What should I expect and do afterwards?
It is common to experience some burning as well as a feeling of need to pass urine more often than normal. There may also be some light bloodstaining in the urine.
To help minimize any discomfort, you should:
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Drink plenty of fluid – at least one glass an hour.
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Take 2 Panadol tablets every 4 hours.
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Take a sachet of Ural® or its equivalent every 4 hours. (HINT: take it with the Panadol).
The catheter will need to be changed, for the first time, after approximately six weeks – this will be arranged for you. Thereafter, further catheter changes can be performed by your GP or community nurse.
Anything else?
If you develop a fever, redness in the wound, any pus from the catheter site or worsening bleeding, you should contact your Surgeon immediately.
In the event of the catheter falling out, it must be replaced as a matter of urgency or the track will close up (often in less than an hour) and it may not be possible to re-insert the catheter. Contact your GP for immediate advice or go directly to your local hospital Emergency Department to have a new catheter put back in before the track closes.
Some discharge from the catheter site is not unusual in the longer term. If the catheter blocks within the first four weeks, the channel between the skin and the bladder will not have healed completely so it is not possible to change the catheter easily. In this event, it is important that the catheter is not taken out in an attempt to change it. It should simply be left in place and a urethral catheter inserted as well, followed by immediate notification of your Urologist.