What determines whether a suprapubic or urethral catheter is chosen?
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 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.
What are the advantages of a suprapubic catheter?
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.
Urethral catheters usually need to be changed by a district nurse or a doctor whilst it is much more likely that a carer, or possibly the patient himself, can change a suprapubic catheter.
Are there any other advantages?
There are two further advantages of suprapubic catheters over urethral catheters.
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. This can be a nuisance, but not more serious.
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.
How are suprapubic catheters inserted?
Suprapubic catheters are probably best inserted under a brief general anaesthetic and this usually requires an overnight stay in hospital.
What do I do if the catheter falls out?
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 GP or district nurse immediately and, if they are unable to help you, come without delay to the Accident and Emergency department where the catheter can be replaced promptly.
If you have a supply of catheters yourself, it is reasonable to try and insert a new catheter; if you fail to do this, you should seek medical help without delay.
This patient information leaflet provides input from specialists, the British Association of Urological Surgeons, the Department of Health and evidence based sources as a supplement to any advice you may already have been given by your GP. Alternative treatments can be discussed in more detail with your Urologist or Specialist Nurse.
Who can I contact for more help or information?
Uro-oncology nurse specialist
Bladder cancer nurse practitioner (haematuria, chemotherapy and BCG)
Prostate cancer nurse practitioner
01223 274608 or 216897 or bleep 154-548
Surgical care practitioner
01223 348590 or 256157 or bleep 154-351
Urology nurse practitioner (incontinence, urodynamics, catheter patients)
01223 274608 or bleep 154-594
Urology nurse practitioner (stoma care)
Urology nurse practitioner (stone disease)
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