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Suprapubic Catheterization After Bladder Surgery

What is a Suprapubic Catheter?

It is a standard urinary catheter that instead of draining urine through the urethra, it does it via a “supra pubic” incision. The catheter is inserted into the bladder after making a mini-incision on the lower abdomen – the supra pubic entry gives it its name. Catheters are placed in the supra-pubic mode when it is not possible nor recommended to drain urine through the more common urethral insertion.

Why would you need a suprapubic catheter?

Following bladder or urethral surgery involving the bladder, a suprapubic catheter is the only option enabling continuous urine draining without causing further stress on the bladder.  It hastens the healing process and enables full urine evacuation until bladder functionality is regained. Since the catheter must remain affixed for days, it is stitched around the point of entry (on the exterior part of the abdominal wall). The tip is then connected to a urine collection bag. Sterile dressings are used to keep the catheter incision site clean and to minimize the risk of infection.

Considerations when using a Urine Collection Bag:

  • The urine bag must at all times be below your bladder level. This is important because it prevents the urine in the bag from flowing back into the bladder. Should this happen, the risk of infection is very high.
  • The urine bag should never be placed on the floor.
  • The catheter and urine bag tubing must not kink at any point for urine to flow smoothly.
  • The urine bag should be emptied when half full. If a record of urine output is needed, the amount should be noted before emptying.
  • The urine outlet valve must not touch any surface during emptying.
  • It is normal for urine to be pinkish or blood-stained immediately after surgery. Clear urine will come out with time.

Bladder Training:

On the second morning post-operatively at around 6 am a nurse will clamp the catheter to cut-off the draining and force the bladder to fill-out naturally by itself. Because of its reduced size post-surgery, you may note your bladder not working as before. Try passing urine in about 3 or 4 hours. Do not strain or worry as it might not happen automatically. Inform your nurse of any difficulties. Letting the taps run in the sink can sometimes trigger micturition reflexes which can help you urinate easily. Ask for a urine measuring container before attempting urination so that the amount of urine collected is measured.

After passing urine through the urethra, the catheter is unclamped to release any urine remaining in the bladder. This amount is called ‘the residual urine’ and it must be measured. It is a good way to assess how well the bladder is doing. If the urine residual is less than 100 ml in two subsequent measures and there is good volume output through the urethra, then the catheter can be removed. If residual urine is more than 400 ml, the urine bag is reconnected and the catheter is clamped again for another one day.

To promote good catheter drainage, an intake of 6-8 cups of fluid per day is recommended.

Cleaning the catheter:

Wash gently around the catheter while showering. Dry with a clean towel and please do not use talcum powder or creams. Your health professional should examine the catheter insertion site and check for any signs of infection. If need be, a dressing may be applied.

What if unable to urinate?

Do not be overly worried and anxious about this. As soon as the bladder regains its normal muscle tone, this problem will be over. It is important not to rush the healing process. Attempting to dislodge the catheter before regaining the ability to urinate normally, will strain the bladder, cause considerable pain and delay healing. Having the catheter for a few more days is safer.

When discharged home, you will do so with your catheter in place. Your nurse will show you how to care for the catheter and how to maintain proper hygiene. A home visiting nurse might be recommended to help you with any issues you may have including help you determine when to permanently remove the catheter.