Introduction

There are two main types of percutaneous suprapubic catheters used in practice: the Bonanno suprapubic catheter system and Stamey-type suprapubic catheter. These catheters differ in their methods of insertion as described below; however the indications and contraindications are the same.

Indications

1. ▪ Failure to pass urethral catheter

2. ▪ Urethral stricture

3. ▪ False passage

4. ▪ Surgeon choice

5. ▪ Acute prostatitis

6. ▪ Traumatic urethral disruption

7. ▪ Peri-urethral abscess

8. ▪ Long-termcatheterization.

Contraindications

1. ▪ Previous lowermidline incision

2. ▪ Non-distended bladder

3. ▪ Coagulopathy

4. ▪ Pregnancy

5. ▪ Carcinoma of the bladder

6. ▪ Pelvic irradiation.

Equipment

1. ▪ Suprapubic catheter set of choice

2. ▪ Urine drainage bag

3. ▪ Sterile preparation

4. ▪ Local anaesthetic

5. ▪ Suture material.

Clinical examination

Confirmthe presence of a bladder.

Inspect for scars.

If there is concern about the presence of a bladder an ultrasound scan can be performed or indeed used to guide the insertion.

Site of insertion of the suprapubic catheter is finger breadths above the symphysis pubis. If there is a previous midline scar, it is advocated that insertion should proceed under ultrasound guidance with the insertion site being 2–3 cm lateral to the incision (see Figure 124).

Technique: Bonanno

After fully informing the patient of the procedure and confirming the bladder on palpation, the patient is prepared and draped. Local anaesthetic is infiltrated into the skin and into the abdominal wall, and a small incision made in the skin.

The Bonanno catheter is prepared by straightening the catheter with the stylette in situ using a plastic sleeve.