Permanent suprapubic catheterisation in women

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 suprapubically (directly into the bladder through the skin over the bladder) arises.

A number of issues are considered in this question and are discussed 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 and most obvious advantage of suprapubic catheters is that they are usually, but not always, significantly easier to change than urethral catheters. This is because the pathway from the skin to the bladder is usually straight, readily accessible, and short.
• A further advantage of suprapubic catheters for women is that the area round the urethra and the adjacent genitalia is not continually irritated by the presence of a catheter. This reduces soreness and discomfort.
• In women who are sexually active, the absence of a urethral catheter is an obvious advantage.

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.