Lowsley Retractor – why surgeons are now considering an alternative technique

The Lowsley Retractor

The Lowsley retractor is a surgical instrument that elevates the bladder during suprapubic catheterisation (SPC). This has been used for many years to help create a suprapubic tract from “the inside out” so avoids some of the issues using blind trocars, such as damaging the posterior wall of the bladder. It is passed through the urethra and pressed against the inner bladder wall, guiding the surgeon to make an incision from the outside.

Limitations of SPC using the Lowsley retractor:

• Requires urethral access: In cases of urethral trauma, strictures, false passages, urethral obliteration, or pelvic fracture urethral injury, the retractor cannot be passed, making the method unusable.
• Higher risk of complications: The Lowsley method traditionally involves blind suprapubic entry, increasing risk of bowel injury and bladder perforation
• Requires operating theatre: As this method involves passing a transurethral instrument and making a suprapubic puncture, it usually needs to be performed under general anaesthetic and in operating theatre conditions which has the subsequent effect of increased costs
• Increased discomfort and invasiveness: The approach can be more traumatic than other techniques leading to increased patient discomfort
• Not suitable for certain patient group: It can be difficult or unsafe in obese patients due to the difficulty in suprapubic access and patient who have undergone lower abdominal surgery previously

The Evolution of the Seldinger Technique

The Seldinger technique is a guidewire-assisted approach used to gain controlled access to the bladder prior to inserting a sheath dilator and catheter suprapubically. It is recognised as a highly precise, safer, and less traumatic method of catheter insertion compared to blind insertion.

Key Features:

• Controlled Entry: Involves needle access, guidewire placement, dilation, and catheter insertion [2].

• Highly Adaptable: Suitable for bedside or in the operating theatre and can be used in conjunction with imaging guidance [3].

Advantages:

• Supports elective and emergency use [1].

• Lower Complication Rates: One study found catheter occlusion was more frequent in the blind trocar group (41.7%) versus the Seldinger group (16.9%) [4].

• Enhanced Safety Profile: Guidewire-assisted placement minimises trauma to surrounding tissues [5].

• Versatility: Can be combined with ultrasound for increased precision across various clinical settings [6].

Financial Advantages:

• Reduced Operating Theatre Utilisation: The guided, stepwise technique allows for bedside, eliminating the need for operating theatre time and associated staff overheads [7].

• Shorter Lengths of Stay: When performed in theatre settings, patients can often be discharged the same day. This reduces hospital bed occupancy and improves throughput [8].

• Fewer Complications: The precision of the Seldinger technique results in fewer adverse events such as bowel perforation, hematuria, and catheter misplacement. This reduces the cost of managing complications and prevents unnecessary readmissions [9].

The adoption of the Seldinger technique signifies a vital evolution in urology care. Offering enhanced safety, greater accuracy, and improved patient comfort, this approach effectively addresses the limitations of traditional blind methods.

Mediplus S-Cath™ System Featuring the Seldinger Technique

A more recent development is the S-Cath™ System. This features a patented design that employs the Seldinger technique to deliver a comprehensive, user-friendly solution to enhance the safety of suprapubic catheterisation. This system reduces the need for general anaesthetic, making the procedure safer and more accessible. The use of a 3-stage guidewire ensures accurate catheter placement, significantly reducing the risks associated with blind insertion. Supplied as a sterile, complete kit – including a needle, guidewire, sheath dilator, silicone Foley catheter, scalpel, and syringes—the system supports both inpatient and outpatient use across adult and children’s populations. As healthcare providers work to reduce complications and improve efficiency, advanced devices like the S-Cath™ System offer a precise, low-risk, minimally invasive SPC solution that elevates patient care.