For many years the routine was to use urethral catheterization for bladder drainage in patients with spinal injuries. Lately however, suprapubic cystostomy or vesicostomy, has been adopted by more doctors in caring for patients with cervical spinal cord injuries. It has proved ideal for these patients and those with hand coordination problems unable to do self-catheterization. Suprapubic catheterization is done after a simple incision (under a local anesthetic) is made 4-5 cm above the pubic symphysis (between the pubic bone and lower abdomen) to reach into the bladder. A catheter is inserted through the incision and stitched to hold it in place.
Once in place and draining urine, the suprabic catheter can be left in place for a number of weeks before changing. With such a catheter, patients can avoid the 4-6 hourly intermittent catheterizations. All that is needed is daily catheter irrigation.
Suprapubic catheterization vs chronic intermittent catheterization in patients with spinal cord injuries
Overall suprapubic catheterization has proved more convenient for patients who suffer complications from spinal cord injury. For patients suffering from spinal injuries, self-catheterization is very difficult unless assisted by another person. While men may find it relatively easier, women have more problems doing it and maintaining the required sterility during the catheterization process. This difficulty is easily overcome with suprapubic cystostomy. A few advantages of a suprapubic cystostomy over urethral catheterization are:
- The catheter insertion point is easily accessible enabling patients with limited hand dexterity to accomplish the process.
- Comfort and ease of use.
- There is no associated connection with bladder cancer
- Suprapubic catheterization is reversible.
- The ability decrease the likely-hood of catheter blockage by opting for a larger catheter lumen.
However, there are drawbacks to suprapubic catheterization compared to urethral:
- There is more of a tendency to develop bladder stones (crystallized minerals such as calcium or magnesium).
- Presence of bladder spasms and the need for medication to minimize its effects.
- Leakage from the catheter site
Aseptic catheterization is crucial to prevent introduction of harmful microorganisms that can cause UTIs.
A study done in 2000 compared a group of patients under suprapubic cystostomy and intermittent catheterization. No patient in the groups had any renal issues. A UTI infection rate revealed a 12% rate in suprapubic catheterized patients and a 26% for those doing intermittent catheterization. The incidence of kidney stones was higher for suprapubic cysostostomy patients at 9% while intermittent catheterization patients had a 4% occurrence. The prevalence of bladder stones was also higher at 65% in the suprapubic catheterization group compared to 30% in the intermittent catheterization group. The conclusion was that suprapubic catheterization has a higher incidence of both bladder and renal stones than intermittent catheterization. This and other studies however, indicate that the incidence of urinary tract infections is significantly lower for patients with suprapubic catheterization than those with chronic Foley catheters or those who do intermittent catheterization.
Bladder cancer incidence
Continued use of intermittent catheters is suspected to contribute to bladder cancer. This may be due to repeated or chronic urinary tract infections or due to chronic tissue irritation or a combination of the two. Many studies have been done to see whether suprapubic catheters cause cancer of the bladder. One such study revealed that out of 130 patients with cancer of the bladder, the risk of cancer associated with suprapubic and intermittent catheterization was the same. The rate for cancer in these two methods was however, lower than in those patients who had chronic Foley catheterization.
Suprapubic catheterization is not only convenient and comfortable for many patients with spinal injuries, but it also offers benefits of a lower incidence of long-term complications like infections and cancer of the bladder.