Suprapubic Aspiration

The urinary bladder is frequently the site of bacterial infection which can cause urinary urgency, frequency, even fever and pain if the infection extends to the kidneys. In order to make a diagnosis of urinary tract infection, especially one that involves multiple parts of the excretory system, it is often necessary for doctors to check the bladder for the presence of bacteria and certain inflammatory cells. The most common way that this is achieved is by analyzing a urine sample that has been obtained by the clean catch method; the patient urinates into a sterile cup. However, certain diseases like cancer of the bladder, trauma to the urethra, or a stricture of the urethra can cause significant problems with or even prevent urination. In cases where a urine sample is essential a suprapubic aspiration is performed. When normal urination is not possible, suprapubic aspiration is combined with urinary catheterization to provide a way for urine to be expelled from the body.

 

 

A suprapubic aspiration is a procedure in which a needle is inserted into the bladder above (supra) the symphysis pubis (pubic) to remove fluid (aspiration). After sterilizing the belly with an iodine-containing antiseptic, the area is numbed with a local anesthetic. Once the area is sterile and numb, a needle is introduced through the wall of the abdomen, down into the bladder. Most physicians will use a portable ultrasound device to identify the structures in the abdomen so they the needle is not placed in bowel or other organ. Successful placement of the suprapubic aspiration needle is often quite obvious—the urine begins to flow into the connected syringe.

 

In terms of a method for urinalysis, suprapubic aspiration is among the cleanest and most accurate. Since the abdomen is sterilized and the sterile needle only passes through un-infected regions of the body, any bacteria that are detected in the suprapubic aspirate can be considered as having come from the bladder and nowhere else. The cleanliness and accuracy of suprapubic aspiration makes it the diagnostic approach of choice in patients where a “clean catch” urine sample is unlikely to occur (such as the very young, very old, the infirm or incapacitated). The risks associated with a suprapubic aspiration are quite uncommon and include possible damage to structures within the abdomen. When a ultrasound device is used to guide a suprapubic aspiration, the complication rate is quite low.

 

Suprapubic aspiration is not only a superior technique for obtaining an accurate, uncontaminated urine sample, but it also provides the opportunity to place a catheter. Suprapubic aspiration gives patients that cannot otherwise pass urine the chance to excrete urine without the need for immediate surgery. Urinary catheter placement through a suprapubic aspiration injection can be done at the beside under local anesthesia. In fact, emergency department physicians are usually able to perform this maneuver in urgent or emergent situations.

 

While the complication rate for suprapubic aspiration is low, when a catheter is placed, the chance for infection increases dramatically. This approach to catheterization may be associated with higher rates of infection than normal urinary catheterization as well. If one has a suprapubic aspiration with urinary catheterization, it is important to seek a long term treatment for urinary problems; however suprapubic aspiration is a safe and effective bridge to subsequent treatment.