Overview

SPC insertion provides urinary drainage when urethral catheterisation is not possible or contraindicated. It can be done emergently for urinary retention or electively.

Indications

• Acute urinary retention with failed urethral catheterisation
• Urethral trauma
• Long-term bladder drainage
• Post-urological surgery

Contraindications

• Distended bladder not palpable or visualised on ultrasound
• Suspected bladder carcinoma
• Pelvic trauma with possible bladder rupture
• Coagulopathy

Equipment

• Sterile gloves and gown
• Chlorhexidine and sterile drapes
• Local anaesthetic (e.g., lignocaine 1%)
• SPC kit or 14–16F catheter and trocar
• Scalpel
• and dressing or suture set to secure to the skin
• Syringe with sterile water for balloon inflation
• Ultrasound (if available)

Procedure

• Confirm bladder position: Palpable above pubic symphysis or visible on US.
• Sterilize and drape lower abdomen.
• Infiltrate local anesthetic at puncture site (2–3cm above pubic symphysis) and in area surrounding expected flange placement if suturing in place. Usually 20ml of 1% Lignocaine is used
• Small incision: 0.5–1cm (2–3cm above pubic symphysis).
• Trocar insertion or blunt dissection: Advance catheter into bladder.
• Urine return: Confirm entry, collect sample, connect to drainage.
• Secure SPC: Inflate balloon, Secure catheter/flange to skin using dressing/sutures

Complications 

• Bowel injury
• Hematuria
• Infection
• Catheter misplacement