SAQ 382 – Urology – urinary retention and suprapubic catheter

Urology – urinary retention and suprapubic catheter.

a. Diagnosis

• Urinary retention.

b. Causes

• Infective, such as UTI.
• Medication-related, such as anticholinergics.
• Neurological, such as cauda equina syndrome.
• Structural, such as BPH, haematuria, or phimosis.
• Inefficient detrusor muscle, often with another precipitant or fluid challenge.

c. Diagnosis

• Voiding difficulty with or without lower abdominal pain.
• Post-void residual volume greater than 300 mL.

d. Suprapubic catheter steps

• Confirm bladder position with bedside ultrasound.
• Position supine, prep and drape, and use sterile gloves.
• Infiltrate local anaesthetic 2 cm above the pubic symphysis; insert needle until urine is aspirated, with direction approximately perpendicular, more cephalad in children and more caudal in adults.
• Needle to bladder, introduce wire, make skin incision, dilate, insert catheter, and split away sheath; or use trocar technique with scalpel incision, firm pressure into bladder, remove trocar, insert catheter, and split away sheath.
• Attach collection bag, dress the skin, and organise catheter care and follow-up.