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Suprapubic catheterization is the insertion of a flexible catheter tube through the abdominal wall into the bladder. The catheter allows for the continuous drainage of urine from the bladder. A suprapubic catheter may be necessary for people that have urinary incontinence from muscle weakness or a congenital defect that prevents the person from feeling the sensation of having to urinate. Many people need a catheter during the recovery period after a complex surgical procedure.
Not everyone is a candidate for catheterization through the abdomen. A suprapubic catheterization is not usually recommended for people with bladder cancer or other cancers in the pelvic region. Inserting a catheter through the abdominal wall is also not suggested if a person has had prior abdominal surgery, due to the possible weakness of the abdominal wall and the risk of developing adhesions in the area. If the bladder is enlarged and can be felt by the physician on a physical exam, a catheter will likely be inserted through the urethra.
A local anesthetic will be injected into the abdominal wall before a suprapubic catheterization. Lidocaine and saline is used most often to numb the area. The surgeon will make a small incision into the abdominal wall above the pubic area. A catheter is then inserted through the opening and a tiny amount of air is added to the tubing to create a balloon effect that will hold the catheter in place inside the bladder.
The suprapubic catheter is not surgically attached to the exterior of the abdomen. Typically, the inflated tip of the catheter will keep the tubing in place. A bandage will be used to cover the abdominal opening and keep the area free of contamination. The catheter can be left in place until normal urination can be resumed.
After the procedure to insert the suprapubic catheter, the external tubing is connected to a urine collection bag. Following the catheter insertion, the abdominal area will need to be cleaned daily with a mild antiseptic. The wound dressing will need to be replaced after each washing of the abdominal opening. Some urine collection bags are designed to be washed out and reused, but disposable collection bags may be available for use.
Complications of the suprapubic catheterization are not uncommon. There may be noticeable blood in the urine caused by bladder wall irritation from the tubing. The bladder muscle may begin to spasm uncomfortably after the catheter is inserted. Medications may be prescribed to relieve the spasms of the bladder muscles, or the spasms may become less of an issue over time.