Patients who suffer urinary retention (inability to empty their bladder) must have their bladder emptied for them until their own ability to void to completion (empty their bladder) returns. There are three common methods used to empty the bladder:
Foley catheter - an indwelling catheter through the urethra
Suprapubic tube (SP tube) - a catheter through the abdominal wall into the bladder
CIC (Clean Intermittent catheterization) - placing a catheter through the urethra long enough to empty the bladder then removing the catheter. This is repeated daily or several times a day.
Clean Intermittent Catherization (CIC) provides the lowest risk of urinary tract infection, indwelling Foley has the highest risk of urinary tract infection, and an SP tube falls in between. CIC and SP tubes (when plugged or capped intermittently) allow your own bladder to cycle through filling and emptying. Using CIC or by plugging an SP tube the bladder can be allowed to fill and then the patient can void as completely as possible. After voiding as completely as possible CIC can then be performed (or the SP tube opened to drain the bladder). The amount of urine emptied from the bladder after voiding is called Post Void Residual (PVR). Measuring the PVR and allowing the bladder to cycle through filling and emptying are important advantages of CIC and an SP tube over using an indwelling Foley catheter. Another potential advantage of CIC or an SP tube over an indwelling Foley is decreased irritation to the urethra.
Antibiotic Prophylaxis and Sterile Catherization
When the urethra is instrumented antibiotic prophylaxis should be considered. We routinely use antibiotic prophylaxis when we have to instrument the urethra for cystoscopy (special telescope inspection of the bladder) or catheter placement. This prophylaxis reduces but does not eliminate the risk of urinary tract infection. This is no longer advantageous when catheterizing daily or when an SP tube or indwelling catheter has been in place for several days. Staying on antibiotics for prolonged periods can lead to infection with more dangerous bacteria resistant to common antibiotics.
Suprapubic Tube
A suprapubic catheter or SP tube is basically an indwelling catheter that is placed directly into the bladder through the abdomen. The catheter is inserted above the pubic bone. This catheter must initially be placed by an Urologist during an outpatient surgery. The insertion site (opening on the abdomen) and the tube should be cleansed daily with soap and water.
These catheters usually are changed by qualified medical personnel such as a nurse, a medical technician, a physician’s assistant or a doctor. The catheter may be attached to the drainage bags. A suprapubic catheter may be recommended in people who require long term catheterization, after some bladder or prostate surgeries, and in people with urethral injury or obstruction.
A suprapubic catheter is a catheter which is inserted through a small incision made in the wall of your lower abdomen just above your pubic bone and below your belly button. A doctor inserts the catheter during a short surgical procedure. It is used for a short time after surgery on the bladder, prostate or for some gynecologic procedures.
A suprapubic may be used in persons who need to have a catheter placed for a long period of time because it has less risk of infection than an indwelling urethral catheter. It may be more comfortable, less prone to infection and it is a less likely to fall out or leak. An SP tube needs to be changed just like an indwelling Foley catheter approximately every four weeks.
Changing a suprapubic tube that has been in place for over a week is as simple or even easier than changing an indwelling Foley catheter. However, for the first week after placement if the tube falls out a new SP tube may be difficult to place. For that reason a suture is usually used to hold the catheter in place during the first week. If the catheter becomes displaced during the first week despite placement of a temporary suture then you should notify your urologist immediately. The more quickly a replacement catheter can be put into the SP tube site the less likely we are to have difficulties placing the new catheter. The temporary holding suture usually can be removed one month after placement at the time of your first sp tube change in the office.
Supplies for Suprapubic tubes, Foley Catheters, and CIC supplies can be obtained from:
180° Medical
(877) 688-2729 - phone
(888) 718-0633 - fax
180medical.com - web
SupraPubic Tube Placement Post-Op Instructions
Diet:
You may return to your normal diet immediately. Alcohol, spicy foods, acidy foods and drinks with caffeine may cause irritation or frequency and should be used in moderation. To keep your urine flowing freely and to avoid constipation, drink plenty of fluids during the day (8-10 glasses).
Activity:
During the first two weeks following SP tube placement do not engage in strenuous activity. If you are active, you may see more blood in the urine. We would suggest cutting down your activity under these circumstances until the bleeding has stopped.
Bowels:
It is important to keep your bowels regular during the postoperative period. Straining with bowel movements can cause bleeding. A bowel movement every other day is reasonable. Use a mild laxative if needed, such as Milk of Magnesia 2-3 tablespoons, or 1-2 Dulcolax tablets. Call if you continue to have problems. Narcotics can worsen constipation; if you had been taking narcotics for pain, before, during or after your surgery, you may be constipated. Ditropan for bladder spasms may also cause constipation.
- Fevers over 101.5 degrees Fahrenheit.
- Inability to urinate.
- Drug reactions (hives, rash, nausea, vomiting, diarrhea).
- Severe burning or pain with urination that is not improving.
Follow Up:
You will need to call our office at 302-836-5500 or 302-571-8958 for a follow-up appointment to change to have your suprapubic catheter changed 4 weeks following placement.
POST OP MEDICATIONS:
You will need three medications for this procedure:
- An antibiotic: One of the following (unless allergic)
Septra DS taken by mouth twice a day for three days
Cipro 250mg taken by mouth twice a day for three days
Keflex 250mg taken by mouth four times a day for three days
- An anticholinergic:
Ditropan 5 mg by mouth every 6-8 hours for the first few days, Then as needed for bladder spasms
- A pain pill: One of the following will be prescribed for pain control
Vicodin (Hydrocodone/APAP) 5/500mg. 1-2 tabs by mouth every 6 hours as needed for pain
Percocet 5/325mg. 1-2 tabs by mouth every 6 hours as needed for pain.
Dilaudid 2mg. 1-2 tabs by mouth every 6 hours as needed for pain.
