EVIDENCE BASED RESEARCH RELATED TO THE DISEASE

Suprapubic Bladder Catheterization

Inserting a drainage tube into the bladder just above the symphysis is called
suprapubic catheterization. Suprapubic catheterization is an option to empty the bladder
if other procedures are clinically unrealistic, inconvenient, or impossible. Urethral
catheterization, intermittent catheterization, urinary drainage, and percutaneous
nephrostomy drainage are all alternatives to suprapubic catheterization. Percutaneous
or open placement of these specialized drainage catheters is common. Cystoscopy is
routinely used to visualize percutaneous access.
A urologist, a surgeon specializing in the genitourinary system, performs
suprapubic catheterization. General surgeons, gynecologists, genitourinary physicians,
and emergency physicians such as emergency physicians and trauma surgeons can
perform this treatment. Suprapubic catheterization can be performed under local or
general anesthesia, depending on the situation. Shave the lower abdomen and prepare
for surgery as usual. If the procedure involves penetration into the urethra, the genitals
are properly prepared and covered. If rigid cystoscopy is required, the patient should
undergo a dorsal lithotomy. In most cases, flexible cystoscopy can be done in the
supine position. Patients should always be in the Trendelenburg position to reduce the
risk of bowel damage. To ensure that there is no bowel loop between the inflated
bladder and the abdominal wall, which can occur accidentally when the suprapubic tube
is attached, especially in patients who have previously undergone abdominal surgery.
Technique
Several techniques for placing a suprapubic catheter are well documented. The
bladder is identified and soluble sutures are placed on both sides of the proposed
bladder incision. The tube is attached to the bladder with a meltable handkerchief stitch.
This can be done physiologically (urinary retention) or with the help of a cystoscope.
Cystoscopy allows direct visualization of the puncture needle, but it is not required.
Next, the guide wire is advanced through the needle into the bladder. The suprapubic
catheter is inserted into the bladder through the access sheath and the bladder is
removed after the catheter balloon is inflated. The Lowsley Curved Prostate Retractor
can be used for a modified open approach. This technique requires urethral access to
the bladder. The urethral catheter is then connected to the Lowsley prostate opener and
pulled into the bladder at the tip of the catheter. Inflate the balloon on the suprapubic
tube and untie the jaw to release the catheter from the Lowsley. The tip of the catheter
may be inside the bladder, but the balloon is inflated just outside. For this reason,
cystoscopy is recommended after placement to ensure complete placement. The Trocar
Kit can also be used to puncture the bladder directly. Several off-the-shelf kits are
available for percutaneous techniques, which is usually the most common method.
Complications
Early complications of surgery include accidental bowel damage, bleeding, blood
vessel damage, tube obstruction, and failure to invade the bladder during initial
treatment. Intestinal damage can be limited by both preoperative diagnostic imaging
and intraoperative ultrasonography. Other late complications are refractory hematuria,
urinary sepsis, wound infection, bladder stones, calcification or dysfunction of the duct,
and loss of the bladder incision. In patients with chronic obstruction such as BPH,
decompression of the bladder can lead to post-occlusion diuresis. This is defined as a
urine output of over 200 ml per hour over 2 hours. This vigorous diuresis is the
physiological response to volume expansion that occurs when chronic obstruction is
relieved. Another late complication is chronic inflammation of the bladder secondary to
the probe. It is considered a risk factor for squamous cell carcinoma of the bladder.
After all, changes in body image are not really surgical complications, but can later
become a patient problem.

Clinical Significance

Suprapubic catheters provide another way to empty the bladder. Urethral

catheters have obvious limitations in the patient's sexual function, making the pubic
tubule potentially more attractive to sexually active individuals. A common consideration
when choosing a bladder drainage system is catheter replacement access. Urinary
incontinence is often considered when considering urinary catheterization. It should be
noted that urinary incontinence through the urethra can occur despite suprapubic
drainage. These can ensure stable bladder drainage before and after complex urethral
reconstruction. The inflow of irrigation can be injected through a suprapubic catheter,
the outflow can be injected through a urethral catheter, and vice versa. For patients
undergoing bladder, prostate, or urethral surgery, these tubes are a valuable tool for
maintaining proper urination.

Approach to Suprapubic Catheters

Patients should also be monitored for signs and symptoms of urinary tract
infections. Finally, a common problem with Suprapubic Catheterization is leakage from
the skin area, so nurses should monitor this area for signs of incontinence.
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