Suprapubic Catheters: What Are The Benefits And Risks Of Getting A Suprapubic Catheter?

Many people with certain medical conditions need to use urinary catheters. A urinary catheter is a hollow and flexible tube that is used for collecting urine directly from the bladders. Urinary catheters are required when a person is unable to empty their bladder. If the bladder does not get drained in a timely manner, then urine will start to build up. This increases the pressure in the kidneys. This increased pressure can cause kidney failure if left untreated, which can result in permanent damage to the kidneys and can be a dangerous medical condition.1

The catheter is connected to a drainage bag. There are many types of urinary catheters, and they can be made of plastic (PVC), silicone, or rubber. They are also available in different sizes as required.2

Most urinary catheters will remain in place until you are able to urinate on your own, which is typically not for very long. Older adults and people who have some type of permanent injury or even certain severe illnesses might have to use urinary catheters for a longer time, or sometimes even permanently.3,4

The most commonly used catheter is known as the urethral catheter, and it is directly inserted into the urethra, from where the urine comes out naturally. Another type of urinary catheter that is used in known as the suprapubic catheter. A suprapubic catheter is a type of urinary catheter that helps empty out the bladder through an incision made in the abdomen instead of having to insert the tube into the urethra. A suprapubic catheter is considered for those who do not want or cannot have a urethral catheter.5

A suprapubic catheter is known to have several advantages over a urethral catheter, but at the same time, it needs more care to avoid infections and other associated problems. Here’s everything you need to know about suprapubic catheters, when it is used, special care that needs to be taken, and general information about what you can expect if you need a suprapubic catheter.

What are Suprapubic Catheters?

A suprapubic catheter also referred to as an SPC, is a type of urinary catheter that is inserted into the bladder for draining urine when you are unable to urinate on your own. Under normal conditions, if you require a urinary catheter, then the catheter gets inserted into the bladder through your urethra. The urethra is the tube through which the body naturally passes our urine. When a suprapubic catheter is used, it is inserted a few inches below the belly button directly into the bladder. This prevents the need to have a tube going directly to your genitals.6

Many people prefer to use a suprapubic catheter as they are more comfortable than the regular urethral catheters since they are not inserted directly into the urethra. The urethra is a highly sensitive tissue, due to which having a catheter placed there can cause a lot of discomforts. Your doctor might also recommend the use of a suprapubic catheter if they feel that the urethra will not be able to hold a catheter safely.

What Are The Uses Of A Suprapubic Catheter?

A suprapubic catheter is an alternate type of urinary catheter that does not get inserted into the urethra. Some of the common uses of suprapubic catheters include:7

  • The inability to use the urethra for inserting the urinary catheter due to damage or injury to the part.
  • A weakening of the pelvic floor muscles, which causes the urethral catheter to fall out.
  • If a surgical procedure involving the uterus, bladder, prostate, or other nearby organs has been carried out.
  • If a person has urinary retention, meaning they are incapable of urinating on their own.
  • In people with urinary incontinence or leakage
  • In cases of lower body paralysis
  • In cases of spinal trauma or injuries
  • In cases of pelvic organ prolapse
  • In Parkinson’s disease
  • In multiple sclerosis (MS)
  • If the person is sexually active and requires a catheter for a longer time.
  • For patients who need to use a catheter for a longer period of time since a suprapubic catheter is more comfortable and also easier to change than the commonly used urethral catheter
  • In cases of bladder cancer or benign prostatic hyperplasia (BPH)

Here are some conditions that might require you to need a suprapubic catheter for a longer time:

  • If there is a bladder blockage that cannot be corrected with surgery or medications
  • If a person has urine incontinence that has led to skin rashes and skin irritation
  • If a person is severely impaired or terminally ill, which makes it difficult or painful to carry out bed changes or to keep changing the urethral catheter.

Why is a Suprapubic Catheter Used?

Your doctor may choose to administer a suprapubic catheter instead of a standard urethral catheter for a number of reasons.8 These may include:

  • You are at a low risk of catching an infection.
  • The tissues around the genital area are unlikely to get damaged.
  • The urethra might be too sensitive or damaged to hold a urethral catheter.
  • You are otherwise in good health and can remain sexually active even with a catheter.
  • You have just undergone a surgical procedure on the urethra, bladder, uterus, penis, rectum, or any other organ that is close to the urethra.
  • You are confined to a wheelchair for long periods of time, in which case it may be challenging to take care of a urethral catheter.

How Does The Suprapubic Catheter Work?

Your doctor might take some X-ray, or you may have to undergo an ultrasound. This is to check the bladder area for any abnormalities.

A suprapubic catheter can only be inserted during a minor surgery. You will be given anesthesia, usually localized anesthesia, but some patients may require general anesthesia as well. This is just for managing the pain from the insertion procedure.9

After administering the anesthesia, a surgeon will make a tiny cut in your abdomen, typically located just a couple of inches below your belly button or the navel. The surgeon will then insert the catheter into the abdomen. The suprapubic catheter will not be in contact with your genital area or the urethra.

There is a small balloon at the end of the catheter, and once your surgeon puts the catheter in place in your bladder, they will inflate the balloon to prevent the catheter tube from falling back out.

In case if you have a distended bladder, then your doctor is likely to use the Stamey procedure for inserting the suprapubic catheter. A distended bladder means that it is overfilled with urine. This is how the suprapubic catheter is inserted in this procedure:10

  • Your doctor prepares the bladder area by using iodine and a cleaning solution.
  • Locates the bladder by gently pressing and feeling around the area.
  • Local anesthesia is administered to numb the bladder area.

The urinary catheter is inserted with the use of a Stamey device. This device helps guide the catheter with the use of a metal piece known as an obturator. The obturator is removed once the catheter is in place in the bladder.

  • The balloon present at the end of the catheter is inflated with water to prevent it from coming out.
  • The incision area around the catheter is cleaned, and the opening is stitched up.

Your doctor is also likely to provide you a bag that will be attached to your leg. The urine from the catheter drains into this bag. In some cases, a bag is not needed, and the catheter itself has a valve on it. This allows you to drain the urine into the toilet as and when needed.

Complications With Using A Suprapubic Catheter

While the insertion of a suprapubic catheter is generally a safe procedure, but there can be some complications. It is necessary to let your doctor know if you are on blood thinners or have undergone a heart valve replacement. In such cases, you will be prescribed a course of antibiotics at least a week before the procedure.

Here are some minor complications of getting a suprapubic catheter:11

  • Urine starts to leak out of the catheter.
  • Urine does not drain properly.
  • There is a small amount of blood present in your urine.

If any such complications are there, you need to let your doctor know at the earliest. If you notice any of the following complications, you might be required to remain in the hospital under your doctor’s supervision:

  • Infection
  • High fever
  • Abnormal pain in the bladder area or the abdominal region
  • Discharge from the insertion area or the urethra
  • Hole in the bowel area (known as a perforation)
  • Internal bleeding (indicated by visible blood in the urine)
  • Pieces of tissue or stones present in your urine

Such cases can prove to be dangerous, which is why you must inform your doctor at once if you notice any of these symptoms. If your catheter falls out at home, then it will be to be reinserted, so it is essential to see your doctor as soon as possible.

What Are The Benefits And Risks Of Getting A Suprapubic Catheter?

There are risks associated with both urethral and suprapubic catheters. The biggest risk is of getting an infection if bacteria enter the catheter and travel up to the bladder. The infection can also affect the bladder and urinary tract, eventually spreading to the kidneys if left untreated.12

This type of infection caused by catheter use is known as catheter-associated urinary tract infection, or CAUTI.13 CAUTIs have the potential to become severe, especially in people who have underlying medical conditions such as diabetes or heart disease, or in those with a weakened immune system. The chances of developing an infection increase the longer the catheter is being used.14

This is why most medical experts are against the use of catheters for a long time. Some of the common complications of long-term suprapubic catheter use may include:

  • Chronic kidney infections
  • Bladder or kidney stones
  • Kidney inflammation
  • Sepsis – a life-threatening condition that develops as a response to CAUTI15

However, the rate of infection for a urethral catheter and a suprapubic catheter is more or less the same itself.16

The major advantage of using a suprapubic catheter is that it is more comfortable and easier to manage by the person, especially if the catheter needs to be used for a more extended period. It is also easier to clean than a urethral catheter. Many people have also claimed that they feel that a cut in the abdomen is more comfortable and easier to manage than to have a catheter placed in the urethra. This is especially true if a person is in a wheelchair. Having a catheter placed in the belly area instead of the genital area also increases a person’s confidence.9

There is also no risk of urethral trauma, catheter-induced urethritis, urethral strictures, and necrosis of the genital skin when using a suprapubic catheter. At the same time, there is a lower risk of catheter contamination with microbes that are commonly found in the bowel. It also allows for easier access to the catheter entry site for cleansing and changing of the catheter. The biggest advantage is that there is a lot of evidence that shows there are greater satisfaction and a better quality of life associated with a suprapubic catheter as compared to urethral catheter.17

How To Care For The Suprapubic Catheter?

Here are some tips to properly care for your catheter:

  • Always wash your hands with soap and water before and after handling the catheter.
  • Place the urine collection bag below the level of your bladder.
  • Ensure that the catheter tube is not kinked or twister.
  • Make sure that urine is flowing correctly out of the catheter tube and into the urine collection bag.
  • Clean the bag every day after separating it from the catheter.
  • Put in another container while you are cleaning the bag. Your doctor or a nurse will give you instructions on how to clean it.
  • Make sure that the urine bag is not dragging or pulling down the catheter.

Summing Up

A suprapubic catheter is preferred by many people over the regular urethral catheter. This comfortable catheter is more suited for people who need to continue wearing a catheter for a longer time. There are less discomfort and pain associated with a suprapubic catheter, and it can easily be covered up with clothing to allow you to keep it private. If you prefer to use a suprapubic catheter over a urethral one, then it is a good idea to bring up discussion with your doctor about how to take care of such a catheter and what you can do to keep it in a good condition, thus avoiding infections for a longer time.

References:

  1. Cravens, D.D. and Zweig, S., 2000. Urinary catheter management. American family physician, 61(2), pp.369-376.
  2. Hamill, T.M., Gilmore, B.F., Jones, D.S. and Gorman, S.P., 2007. Strategies for the development of the urinary catheter. Expert review of medical devices, 4(2), pp.215-225.
  3. Niël‐Weise, B.S., van den Broek, P.J., da Silva, E.M. and Silva, L.A., 2012. Urinary catheter policies for long‐term bladder drainage.
  4. Cochrane Database of Systematic Reviews, (8).
  5. Wilde, M.H., McDonald, M.V., Brasch, J., McMahon, J.M., Fairbanks, E., Shah, S., Tang, W. and Scheid, E., 2013. Long‐term urinary catheter users self‐care practices and problems. Journal of Clinical Nursing, 22(3-4), pp.356-367.
  6. Katsumi, H.K., Kalisvaart, J.F., Ronningen, L.D. and Hovey, R.M., 2010. Urethral versus suprapubic catheter: choosing the best bladder management for male spinal cord injury patients with indwelling catheters. Spinal cord, 48(4), pp.325-329.
  7. Hunter, K.F., Bharmal, A. and Moore, K.N., 2013. Long‐term bladder drainage: Suprapubic catheter versus other methods: A scoping review. Neurourology and urodynamics, 32(7), pp.944-951.
  8. Horgan, A.F., Prasad, B., Waldron, D.J. and O’sullivan, D.C., 1992. Acute urinary retention. Comparison of suprapubic and urethral catheterisation. British journal of urology, 70(2), pp.149-151.
  9. Harrison, S.C., Lawrence, W.T., Morley, R., Pearce, I. and Taylor, J., 2011. British Association of Urological Surgeons’ suprapubic catheter practice guidelines. BJU international, 107(1), pp.77-85.
  10. Ahluwalia, R.S., Johal, N., Kouriefs, C., Kooiman, G., Montgomery, B.S. and Plail, R.O., 2006. The surgical risk of suprapubic catheter insertion and long-term sequelae. The Annals of The Royal College of Surgeons of England, 88(2), pp.210-213.
  11. Walker, G.T. and Texter Jr, J.H., 1992. Success and patient satisfaction following the Stamey procedure for stress urinary incontinence. The Journal of urology, 147(6), pp.1521-1523.
  12. Kumar, P. and Pati, J., 2005. Suprapubic catheters: indications and complications. British Journal of Hospital Medicine (2005), 66(8), pp.466-468. Baan, A.H., Vermeulen, H., Van Der Meulen, J., Bossuyt, P., Olszyna, D. and Gouma, D.J., 2003. The effect of suprapubic catheterization versus transurethral catheterization after abdominal surgery on urinary tract infection: A randomized controlled trial. Digestive surgery, 20(4), pp.290-295.
  13. Nicolle, L.E., 2014. Catheter associated urinary tract infections. Antimicrobial resistance and infection control, 3(1), pp.1-8.
  14. Tambyah, P.A. and Maki, D.G., 2000. Catheter-associated urinary tract infection is rarely symptomatic: a prospective study of 1497 catheterized patients. Archives of internal medicine, 160(5), pp.678-682.
  15. Stamm, W.E., 1991. Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention. The American journal of medicine, 91(3), pp.S65-S71.
  16. English, S.F., 2017. Update on voiding dysfunction managed with suprapubic catheterization. Translational Andrology and Urology, 6(Suppl 2), p.S180.
  17. Lavelle, R.S., Coskun, B., Bacsu, C.D., Gliga, L.A., Christie, A.L. and Lemack, G.E., 2016. Quality of life after suprapubic catheter placement in patients with neurogenic bladder conditions. Neurourology and Urodynamics, 35(7), pp.831-835.

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