Permanent suprapubic catheterisation in men

Q 1. What determines whether a suprapubic or urethral catheter is chosen?

A. When an indwelling or long-term catheter to drain the bladder is advised, the question of whether this is best placed in the urethra (water pipe) or supra-pubically (directly into the bladder through the skin over the bladder) arises.

A number of issues are considered in this question and these are set out below.

Some problems related to catheters probably occur equally often with urethral or suprapubic catheters.

These include the risk of:

• Infection (or persistent carriage of bacteria in the urine)
• Catheter blockages
• Bladder spasms causing leakage of urine either around the catheter or via the urethra (water pipe) with suprapubic catheters.

In other words, neither sort of catheter has any advantage in respect of these problems.

Q 2. What are the advantages of a suprapubic catheter?

A.

• The first obvious advantage of suprapubic catheters is that it is usually, but not always, significantly easier to change a suprapubic catheter than a urethral catheter. This is because the pathway from the skin to the bladder is usually straight, readily accessible, and short.
• Over a period of years, a urethral catheter can put pressure on the exit point of the water pipe from the penis, and produce a split (which can sometimes be very lengthy) in the end of the penis.
• What is more serious is that a similar split can sometimes occur in the valve which holds urine in the bladder (the sphincter). If this occurs, leakage around the catheter may occur and this can be extremely difficult to treat.
• In men who are sexually active a suprapubic catheter leaves the male genitalia free for this purpose.

Q 3. How are suprapubic catheters inserted?

A. Suprapubic catheters are probably usually inserted under local anaesthesia.

Q 4. What do I do if the catheter falls out?

A. If your catheter falls out, it must be re-inserted as soon as possible or the track into your bladder will close off rapidly.

You should contact your urologist immediately.