I am adding this note to help any others who have this intervention after prostatectomy as there seems to be little information. We received one leaflet which gave general information but no indication of the actual plan following surgery.
A suprapubic catheter is a tube inserted under general anaesthetic through a hole (punched by trochar) in the lower abdominal wall and into the bladder. It has two openings, one for the passage of urine and a smaller one for inflating the catheter balloon (and for flushing the bladder should it become necessary).
Most of the available information online relates to the permanent use of such catheters for various problems where the open end is attached to a longer tube and urine bag.
This was the situation in the immediate post-operative period and overnight, with the bag hanging on the side of the bed.
The advice was that the suprapubic catheter is more comfortable than a urethral (penile) catheter and that it allows a quicker return to normal urination, because it is possible to urinate via the urethra rather than using the catheter ouflow – what we had not understood is that there would be no urine bag attached at discharge and none provided for overnight.
The catheter opening is fitted with a flip-flo valve which when closed allows the bladder to fill normally and when opened allows urine to be released – into the toilet. What is intended for prostatectomy patients is that the valve be closed for much of the time, they urinate normally via the urethra and then any residual urine is released via the flip-flo valve. Before catheter removal, the volume of residual urine after normal urination is checked and if below a certain volume then the catheter is removed.
Hubby’s experience was that it was extremely painful to urinate for the first few days, there was blood in the urine (expected) including occasional (worrying) clots and that sleep was disrupted by the frequent urge to urinate through the night – at this point we wondered if a penile (urethral) catheter would have been easier!
Things did gradually improve with decreased pain and less frequent urges overnight although occasional painful bladder spasms were an issue. Our next surprise was when the catheter removal was scheduled for day 6. Hubby had found the catheter a ‘fiddle’ and a ‘nuisance’ and was pleased to have it removed.
Removal took place at an outpatient appointment but on a hospital ward. He had to drink as much as possible during the first hour then collect two lots of urine to measure normal output and residual volume. Results were 350ml and 5ml respectively, so the catheter was removed and a dressing applied over the wound. No sutures required – apparently the muscles of the bladder and the abdominal wall contract sufficiently to close the holes and any leakage is minimal!
Is suprapubic preferable to a penile catheter, difficult to say when Hubby has no experience of the latter. Certainly, being able to urinate normally one week after prostatectomy seems a bonus compared to having to relearn the process after 10 days or more with a urethral catheter in place and, despite our anxiety, not having to deal with urine bags was probably a bonus.