Suprapubic Catheterization in Neurogenic Bladder by Distending Bladder with Air-A Novel Technique

Suprapubic catheterization (SPC) in patients with neurogenic bladder (NGB) is difficult and high risk. Our aim is to provide a novel SPC method in patients with NGB by distending the bladder with air. A total of 26 patients with NGB underwent SPC using this new method. The bladder was first filled with air based on its volume of urine or liquids. Then, a reusable trocar was advanced into the bladder as per the general method. Preoperative demographics of patients and operative details were recorded. SPC was performed under local anaesthesia in 26 patients with NGB, including 18 men and 8 women. The mean age of the patients was 36 years (range, 28-77). An 18F Foley catheter was used for all patients. Blood loss was minimal, and the procedure was performed successfully in all patients without any complication. By distending the bladder with air, the SPC method is presented as an effective and safe method suited for patients with NGB. To our knowledge, this is the first report of this novel procedure.

Septic Shock Immediately following Percutaneous Suprapubic Catheterization

Suprapubic catheterization (SPC) is considered a safe and effective procedure for long-term bladder decompression. With proper technique and appropriate patient selection, significant complications of SPC are rare. Immediate postoperative septic shock (i.e., within the first 24 hours of surgery) is rarely reported. We report a case of an 83-year-old patient who developed septic shock within one hour of suprapubic catheterization for a chronic hypotonic bladder, highlighting the importance of early recognition of complications from SPC and prompt management to ensure positive outcomes.

Transurethral versus suprapubic catheterization to test urethral function in rats

Transurethral and suprapubic catheterization have both been used to test urethral function in rats; however, it is unknown whether these methods affect urethral function or if the order of catheterization affects the results. The aim of this cross-over designed experiment was to compare the effects of catheterization methods and order on leak point pressure (LPP) testing. LPP and simultaneous external urethral sphincter electromyography (EUS EMG) were recorded in anesthetized female virgin Sprague-Dawley rats in a cross-over design to test the effects of transurethral and suprapubic catheterization. There was no significant difference in peak bladder pressure during LPP testing whether measured with a transurethral or suprapubic catheter. There was no significant difference in peak bladder pressure between the first and second catheter insertions. However, peak EMG firing rate, as well as peak EMG amplitude and EMG amplitude difference between peak and baseline were significantly higher after the first catheter insertion compared to the second insertion, regardless of the catheter method. Our results suggest that route of catheterization does not alter urethral function, e.g. create a functional partial outlet obstruction. Either catheterization method could be used for LPP and/or EUS EMG testing in rats.

Clinical evaluation of cases of lower genitourinary tract trauma with special reference to primary realignment in cases of posterior urethral distraction defect

Background: The exact management strategy for lower genitourinary tract trauma remains controversial. Primary realignment with/without suprapubic catheterization provides definitive procedure with low complications and avoids the need for further open surgeries.Methods: This was a prospective longitudinal study done on 31 cases with different complaints related to lower tract genitourinary trauma. All patients underwent suprapubic catheterization and/or primary realignment. The outcome was measured in the terms of time for discharge, urinary incontinence, stricture formation, erectile dysfunction and impotence.Results: Maximum proportion of patients with lower genitourinary injuries in the study was in 10-20 years age group (48.4%). Blunt trauma was accounted for 93.6% of lower genitourinary injuries. Road traffic accidents were the most common cause (90.32%) of lower genitourinary injuries. Urinary bladder injuries accounted for 41.9% of all lower genitourinary injuries. Blood at meatus is present in only about half of the significant urethral injuries. Primary realignment of urethral injury results in lesser duration of hospital stay (9.24±2.44 days), shorter length of suprapubic catheterization (11.67±4.78 days) and early spontaneous voiding (40.93±15.79 days). The stricture rate following primary realignment is low (31.25%). Erectile dysfunction was noted only in two patients (16.6%).Conclusions: Management of traumatic urethral disruption by primary realignment serves as ultimate therapy in majority of patients.

Basic urological surgical skills and equipment

This chapter covers techniques, indications, and useful guides for common urological skills and equipment. It has topics on catheters, including techniques for urethral and suprapubic catheterization, and how to deal with complications, stents, lasers and diathermy, sterilization, urological incisions, and small bowel surgery. Highly illustrated, it serves as a useful primer.