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Thread: What is the difference between indwelling suprapubic and urethral catheters?

  1. #1

    What is the difference between indwelling suprapubic and urethral catheters?

    What is the difference between indwelling suprapubic and urethral catheters?
    Wise Young PhD MD

    A person recently wrote an email to me asking about the difference between suprapublic and indwelling urethral catheters. Foley catheters are commonly used for both urethral and suprapubic catheters. Invented by Frederic Foley in 1929 and initially manufactured by C. R. Bard Inc of Murray Hill New Jersey for trans-urethral drainage of the bladder, foley catheters are classified by diameter, tip type, number of lumens, material, and coating. Size is in "French units" (1 F is 0.33 mm = 0.13 inch diameter) from 10 F to 28 F. The tips can be straight or "coudé", which means "elbow" in French and has a 45˚ bend at the tip to allow easier passage in a urethra with an enlarged prostate. Foley catheters can have two or three lumens, the latter allowing fluid to be injected into the bladder for flushing or assessing bladder response to infused fluids. The catheter can be made from rubber, silicone, poly-urethane, or other materials. The surface may be coated with antibacterial chemicals or teflon to reduce friction.


    A suprapubic catheter is inserted into the bladder through the abdomenal wall above the pubis, hence the name suprapubic catheter. Traditionally, three procedures are used to introduce suprapubic catheters into distended bladders.
    • Stamey procedure. One of my teachers at Stanford was Thomas Stamey who developed this procedure to drain the bladders of people with severe bladder distension due to prostate enlargement. The procedure uses a Stamey-Malecot catheter with an obturator (a hollow needle with a sharp point) inside. The catheter is inserted through the abdomenal wall above the pubis into the distended bladder. The obturator is then withdrawn, expanding the cage at the tip to keep the catheter in the bladder.

    • Seldinger technique [1]. The insertion site is first injected with local anesthetics and a 1-2 cm incision is made in the abdomenal wall 1-2 fingerwidth above the pubic bone. A long needle is inserted into the bladder and urine is aspirated. A guidewire is placed in the bladder through the needle and the needle is withdrawn, leaving the guide in place. A trocar with an outer sheath is inserted into the bladder using the guide wire. The trocar is removed, leaving the outer sheath. A 14-French foley catheter is inserted into the bladder and the balloon is inflated.
    • Lowsley tractor. People with spinal cord injury often have small spastic bladders that cannot be readily distended. In such cases, urologists may use a Lowsley tractor, a bent metal instrument that can be inserted through the urethra into the bladder and pushed to tent the bladder dome against the abdomenal wall. A scalpel is used to cut through the abdomen wall to the Lowsley tractor, which can be extended through the skin and use to grasp and pull a catheter into the bladder [2]. The Swan Valley Medical T-SPeC device is a device designed to simplify this procedure.

    Suprapubic catheters have evolved from standard urethral "foley" catheters in several respects.
    • Flange to hold the catheter in place and to prevent stoma leakage. Fluid-filled balloons “fall” away from the bladder wall and may no longer seal the channel, allowing leakage. To keep tension on the catheters so that the balloons can occlude the channel, most suprapubic catheter kits include a circular flange that abuts against skin and holds the catheter in place. A more modern design is a concave flange that looks like a suction cup and contacts skin only on the edges of the flange, leaving the skin around the stoma untouched and ventilated [3].
    • Newer retention mechanisms exert less pressure on the bladder wall than balloons [4]. Soft cage-like expansions of the catheter tip can be designed to collapse with excessive tension and prevent bladder damage. A popular approach is to use “pig-tailed” catheters that have a trochar to straighten the catheter tip so that it can be inserted. When the trochar is withdrawn, the catheter tip curls up to hold the catheter in place. If the catheter is pulled hard, the pig-tail curl will “give” and can be withdrawn without putting excessive pressure on the bladder wall.

    • Concentric double lumen catheters allow one lumen to deliver fluids while the other lumen can be used to drain or monitor pressure in the bladder. The center lumen can hold the trocar that provides stiffness to the catheter during insertion and activates the catheter retention mechanisms when withdrawn. Many catheters now have valves that can be used to control inflow and outflow of each lumen. The central lumen can also be capped (plugged). With the newer retention mechanisms, there is no need for a third lumen to fill the balloon with fluids.


    References Cited

    1. http://www.google.com/url?sa=t&rct=j...XAzjqYw6oNFaHw

    2. http://www.suna.org/education/2013/a...3105259263.pdf

    3. http://www.supra-cath.com/

    4. http://www.suna.org/education/2013/a...3105259263.pdf
    Last edited by Wise Young; 10-15-2012 at 05:43 PM.

  2. #2
    Thank you for posting this information, Dr. Young.

    I would guess that hardly any of us who use suprapubic catheters know about catheters that are specifically designed for the suprapubic stoma. I've done a lot of reading and research about management of the bladder with suprapubics, and I have not run across the kind of information you have provided.

    At the time of my suprapubic surgery, my urologist placed a Bardex Lubricious Coated Foley Catheter and that is what I have been using for over 30 months. I questioned him about other materials for the catheter, silicone and poly vinyl choride (PVC) etc., but he prefers the latex because they are softer than other materials. He is of the opinion that issues with latex allergies are overblown and says he prefers to use latex unless he is forced (by allergy problems) to use other catheters, he will stay with latex.

    Recently, Poiesis Medical (http://poiesismedical.com/) posted a reference to their approach to an indwelling catheter on Care Cure Community. Their catheter, called the Duette is an all silicone dual-balloon catheter. This catheter has two balloon ports to fill two different 5cc balloons inside the bladder. According to material on their website, the Duette Catheter "is designed to protect the mucosal lining and the integrity of the bladder wall from trauma. An intact bladder wall maintains the body’s natural host defenses. The cushioning effect of the tip balloon its designed to reduce or eliminate the widely-observed clinical adverse effects of Foley catheterization, including bladder spasms, catheter-associated urinary tract infections (CAUTI), sepsis, and in chronic users, cancer." I requested a sample of the product, but have not had a convenient chance to try it.

    Do you think the "made for suprapubic catheters" are better for the suprapubic application than "made for urethral foley catheters?"

    Do you have brand names for the catheters that use a pigtail and the "suction cup" type flange as retention devices?

    Note about references: Regarding the references, the first one is not loading correctly and the second and fourth references are the same.

    All the best,
    GJ
    Last edited by gjnl; 10-15-2012 at 07:41 PM.

  3. #3
    Senior Member lynnifer's Avatar
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    There has to be something better for women ... I had an unfortunate 'tug' on the foley this weekend and have been leaking since, despite replacing the catheter.

    It's with renewed interest that I figure out how to deal with flaccid bladder and a 27yr paralyzed sphincter muscle. This puts a 'damper' on everything ... not to mention that I'm tired of doing laundry!
    Make America Sane Again. lol

    T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

  4. #4
    Senior Member Fragile's Avatar
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    Does anybody have any experience with the Supra-Cath (link above)? How would you keep the catheter sterile?

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