S-Cath System for suprapubic catheterisation

Introduction

A suprapubic catheter (SPC) is a hollow flexible tube, which is inserted into the bladder through an abdominal incision just above the pubic hairline. It is used to drain urine from the bladder in people who are unable to pass urine normally and in whom placement of a urethral catheter is not possible or desirable. The procedure to insert the SPC is called asuprapubic cystostomy (also known as a vesicostomy or epicystostomy). SPCs are often used for long‑term catheterisation, for example, in people with spinal cord injuries and conditions such as multiple sclerosis (Jacob et al. 2012). They can also be used in people who only need them for short periods, for example, in people with a traumatic injury to the lower urinary tract (National Patient Safety Agency 2009), and in people with an enlargement of the prostate or a urethral stricture (Lamont et al. 2011). It has been suggested that a typical district general hospital in England or Wales will do over 100 suprapubic catheterisations each year (National Patient Safety Agency 2009).

The conventional technique used to insert SPCs is ultrasound-guided or blind (without ultrasound guidance) percutaneous trocar puncture. In this procedure, a trochar comprising an obturator and a catheter is inserted through the abdominal wall into the bladder through a track made with a needle. The risks of SPC insertion include haemorrhage, infection, pain and injury to the abdominal organs (Harrison et al. 2010). For example, blind insertion can cause bowel injury (Mohammed et al. 2008), although a full bladder usually prevents loops of bowel passing between the bladder and the anterior abdominal wall allowing safe SPC insertion (Jacob et al. 2012). An unpublished survey of British urologists, cited in a Rapid Response Report by the National Patient Safety Agency (2009), found the estimated risk of an individual SPC procedure resulting in bowel perforation to be 0.15% with a 0.05% risk of death. The survey concluded that although reported bowel complications were 'very rare', the true incidence may be higher. A 2006 UK study reported that SPC insertion has a 2.4% risk of bowel injury and a 30‑day mortality of 1.8% (Ahluwalia et al. 2006). The Rapid Response Report recommends that ultrasound is used wherever possible to visualise the bladder and guide the insertion of suprapubic catheters (National Patient Safety Agency 2009).

The Seldinger technique is a method of accessing blood vessels and hollow organs using a guidewire and is an alternative technique to conventional trochar puncture for inserting SPCs. Using a guidewire could minimise some of the risks associated with SPC insertion by reducing the risk of track loss (the path between the abdomen and the bladder) and catheter misplacement (Goyal et al. 2012).