Clinic review to discuss findings and further treatment plan.
This procedure involves the surgical insertion of a suprapubic catheter (SPC) into the bladder through the lower abdominal wall to establish urinary drainage. It is typically performed under general anaesthetic, using both ultrasound and endoscopic guidance.
Where indicated, a diagnostic cystoscopy ± urethral dilatation is first performed to assess the urethra and bladder, and to confirm safe intravesical access. A cystostomy tract is then created percutaneously under direct vision and ultrasound guidance, and the SPC is inserted and secured in place.
Bladder outlet obstruction unsuitable for urethral catheterisation
Definitive management of BPH or urethral stricture disease
The suprapubic approach avoids the urethra and is often preferred for long-term bladder drainage, particularly in patients at risk of urethral trauma or with poor tolerance of transurethral catheters.
Follow-up considerations:
Routine catheter care, with SPC changes every 2 months, or monthly in cases of recurrent urinary tract infections (UTIs)
Monitoring for complications such as infection, encrustation, and catheter dislodgement
Assessment of long-term bladder function as appropriate. Daytime use of a flip-flow valve is advisable to preserve bladder capacity.
UTI prophylaxis may include:
D-mannose 1g twice daily
Adequate fluid intake (minimum 2 litres/day)
Timely catheter changes based on individual risk
Further investigation (e.g., ultrasound, cystoscopy) to exclude bladder stones if UTIs persist
Uromune® immunotherapy may be considered for selected patients with recurrent UTIs
