Name of the Procedure:

Catheter, suprapubic/cystoscopic (C2627)

Summary

Inserting a suprapubic catheter involves placing a tube directly into the bladder through the abdomen to drain urine. This is done using a cystoscope, a specialized instrument for visualizing the bladder.

Purpose

This procedure addresses urinary retention or blockages, often due to conditions such as prostate enlargement, spinal injuries, or certain pelvic surgeries. It aims to bypass obstructed urine flow, reduce infection risk, and provide an alternative to urethral catheterization.

Indications

• Chronic urinary retention
• Neurogenic bladder
• Severe urethral stricture
• Patients requiring long-term catheterization
• Failed urethral catheterization attempts

Preparation

• Patients may need to fast for a few hours before the procedure.
• Medication adjustments might be necessary, particularly blood thinners.
• Pre-procedure assessments may include urine tests, ultrasound, or other imaging studies of the bladder.

Procedure Description

1. The patient is positioned, usually lying flat on their back.
2. Anesthesia (local, regional, or general) is administered to numb the area or sedate the patient.
3. The bladder is visualized using a cystoscope inserted through the urethra.
4. A small incision is made in the lower abdomen.
5. A catheter is inserted through the incision into the bladder.
6. The catheter is secured in place, and urine flow is confirmed.

Duration

The procedure typically takes about 30 minutes to an hour.

Setting

It is usually performed in a hospital operating room or an outpatient surgical center.

Personnel

• Urologist or trained surgeon
• Surgical nurses or assistants
• Anesthesiologist or nurse anesthetist (if sedation or anesthesia is used)

Risks and Complications

• Infection at the insertion site or in the bladder
• Bleeding
• Injury to surrounding organs
• Dislodgement or blockage of the catheter
• Pain or discomfort

Benefits

• Immediate relief from urinary retention
• Reduced infection risk compared to long-term urethral catheterization
• Improved quality of life
• Lower incidence of urethral damage

Recovery

• Post-procedure care includes monitoring for signs of infection and ensuring the catheter is draining properly.
• The patient may need to avoid strenuous activities for a few days.
• Follow-up appointments are necessary to monitor recovery and check catheter function.
• Recovery time varies but usually takes a few days to a week.

Alternatives

• Urethral catheterization
• Intermittent self-catheterization
• Medication to relieve urinary retention
• Surgical interventions like prostatectomy or urethral dilation

Patient Experience

• During the procedure, the patient may feel pressure but generally no pain with proper anesthesia.
• Post-procedure discomfort at the insertion site is common but manageable with pain medication.
• Adjusting to the catheter may take a few days, with initial sensations of urgency or bladder fullness.
• Proper care and hygiene are essential to prevent infection and ensure successful recovery.