How to Insert a Suprapubic Catheter

What is a Suprapubic Catheter?

Suprapubic catheters (SPCs) provide bladder drainage via a tract created through the lower abdominal wall directly into the bladder. This type of catheter is typically inserted by a trained healthcare professional using a minor surgical procedure, often under local or general anaesthesia.

When is a Suprapubic Catheter Used?

• Failed or contra‑indicated urethral catheterisation
• Unable to pass urethral catheter due to strictures, false passages, severe BPH, urethral obstruction, or phimosis, despite appropriate attempts. [1,2]
• Suspected or confirmed urethral injury (e.g., pelvic fracture with blood at the meatus). [2]
• Long‑term bladder drainage
• Chronic urinary retention (e.g., neurogenic bladder from spinal cord injury, MS, diabetic neuropathy) where intermittent catheterisation is not feasible or has failed. [1]
• Intolerant of long‑term urethral catheters (urethral erosion, trauma, recurrent catheter‑associated infections). [1]
• Specific clinical scenarios
• Patients with limited hip/thigh mobility or wheelchair users where urethral catheter care is difficult. [1]
• Patients requiring frequent catheter changes (easier with SPC). [3]
• When sexual activity or perineal wound care is relevant to patient quality of life. [1]
• Short‑term postoperative drainage where urethral catheterisation is undesirable (e.g., complex urethral or prostate surgery). [4]

How to insert a Suprapubic Catheter:

Having injected local anaesthetic at the entry site, using an 18g needle, make a 1cm subcutaneous incision and follow the 8 steps below:

1. Inject local anaesthetic along a track from the skin incision down to the bladder
2. Remove syringe of anaesthetic from needle
3. Insert guidewire through needle, floppy end first, up to first black mark; remove needle while holding guidewire in place
4. Insert sheath dilator into bladder along guidewire to second black mark
5. Remove dilator and guidewire from outer sheath. Occlude outlet of sheath with thumb to avoid excessive release of fluid from bladder
6. Insert Foley catheter down sheath to mid point of catheter length
7. Inflate balloon with 10ml sterile water
8. Slide outer sheath back along catheter shaft until external to abdomen. Pull sheath apart and remove from catheter

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References:

1. Poulton, T. and Leslie, S.W. (2025) Suprapubic Bladder Catheterization. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available at: NCBI Bookshelf article

2. Shlamovitz, G.Z. and Kim, E.D. (2024) Suprapubic Catheterization: Overview, Indications, Contraindications. Medscape. Available at: https://emedicine.medscape.com/article/145909-overview

3. British Association of Urological Surgeons (2023) Suprapubic catheter care (male patients). Available at: https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Suprapubic%20care%20male.pdf

4. UroToday (2024) Suprapubic urinary catheter indications. Available at:https://www.urotoday.com/library-resources/suprapubic-catheter/144194-suprapubic-urinary-catheter-indications.html