Percutaneous Balloon-Assisted Suprapubic Cystostomy Tube Placement: A Novel Technique

Suprapubic catheters are commonly used in patients with urinary retention requiring bladder decompression if placement of a Foley catheter is not possible or not desirable.[1] [2] Often times, patients with chronic bladder outlet obstruction due to neurogenic bladder, chronic urethral strictures, or benign prostatic hypertrophy (BPH) requiring Foley catheterization may opt to have a long-term suprapubic catheter placed instead. While these were traditionally placed in the operating room, they are now commonly placed percutaneously using ultrasound and fluoroscopic guidance.[3] [4] [5] In a study of 549 patients, percutaneous suprapubic catheter placement has been shown to be a safe procedure with a very high technical (99.6%) and clinical success rate (98.1%) for primary tube placement.[6] In the acute setting, a smaller bore pigtail-type catheter can suffice. However, in the long term, larger bore balloon-tipped catheters (16 Fr or larger; Dover Medtronic [formerly Covidien], Minneapolis, MN) are preferred for as they provide reliable drainage and demonstrate lower incidences of catheter clogging and dislodgement.[4] [7]

At our institution, the typical patient requiring a long-term suprapubic catheter is commonly referred to vascular interventional radiology by the urologist. Traditionally, we would place a 12-Fr locking pigtail catheter (Skater; Argon Medical Devices, Inc, Frisco, TX) in the bladder percutaneously using Seldinger technique under ultrasound and fluoroscopic guidance. This type of catheter is easy to place initially but is not durable. The patient would then return in 4 to 6 weeks to allow for tract maturation, at which point they undergo an additional image-guided procedure to upsize the catheter to a larger bore 16-Fr Council tip suprapubic catheter using stepwise dilators and a peel away sheath. Depending on the technical challenges, placement of the larger bore Council tip catheter may also take an additional upsizing procedure.

The typical two- or three-step approach to placing a large bore catheter has been successful and relatively safe, but is inconvenient for the patient. More importantly, this stepwise approach requires additional image-guided procedures scheduled in an angiography suite using moderate sedation requiring constant monitoring. In addition, there is a higher risk of catheter blockage and accidental dislodgement with the smaller bore pigtail catheters used in the initial placement. A one-step technique for initially placing the larger bore 16-Fr suprapubic catheter precludes the need for upsizing and can save time and money.

Publication History

Article published online:
24 November 2021

• References

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