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Suprapubic Catheter (SPT)

A suprapubic catheter (SPT) is a bladder drainage catheter placed through the anterior abdominal wall directly into the bladder, bypassing the urethra entirely. Standard long-term drainage option when urethral catheterization is contraindicated or impractical.

Devices​

  • Cystofix (Braun) — trocar-placed, smaller-caliber (10–12 Fr typical)
  • Bonanno catheter — trocar-placed, pigtail tip
  • Stamey SP catheter — Malecot-tip self-retaining
  • Any Foley catheter can be placed through a surgically or percutaneously created tract and secured with its balloon

Placement​

Percutaneous (Trocar)​

  • Performed when the bladder is full and palpable
  • Local anesthesia, small suprapubic stab
  • Trocar advanced into the bladder; catheter fed through
  • Cystoscopic or ultrasound guidance preferred to avoid bowel injury

Open Cystotomy​

  • Preferred in patients with prior abdominal surgery, pelvic radiation, or small non-palpable bladder
  • Controlled placement through a small incision
  • Direct visualization eliminates bowel-injury risk

Indications​

  • Urethral stricture precluding catheter passage
  • Post-urethral reconstruction — urine diversion during healing
  • Neurogenic bladder with inability to catheterize per urethra
  • Severe urethral trauma (pelvic fracture) — primary suprapubic diversion before posterior urethroplasty
  • Chronic retention where long-term drainage is needed and CIC is not feasible
  • Failed urethral Foley in a non-surgical setting
  • Comfort — long-term SPT is widely considered more comfortable than long-term urethral Foley

Maintenance​

  • Exchange every 2–4 weeks (latex) or 8–12 weeks (silicone)
  • First exchange at 4–6 weeks after placement — allows tract to mature
  • Early dislodgement before tract maturation requires open replacement or cystoscopic repositioning

Complications​

  • Bowel injury during trocar placement — the feared complication
  • Tube dislodgement — particularly before tract maturation
  • Persistent urine leak around the tube
  • Encrustation
  • UTI — although lower rates than urethral catheter in most long-term studies
  • Tract contracture during prolonged use — can be managed with gentle dilation during exchange

See also: Foley Catheter, Self-Retaining Catheter, Intermittent Catheter.