BACKGROUND
Suprapubic catheter (SPC) changes are generally managed in the community by district nurses. Failed reinsertion of SPCs is frequently encountered and usually dealt with by junior doctors in hospital in an emergency setting. An extensive literature review revealed only two related publications, both describing the use of an Otis urethrotome to dilate the old tract.1,2 There have been anecdotal references on the use of progressive dilatation.
TECHNIQUE
We present a technique using single use hydrophilic-coated female Nelaton catheters to progressively dilate the stenosed tract. Ultrasonography is performed to ensure a full bladder. After analgesia and local anaesthetic infiltration, starting with a well lubricated 8Fr catheter, the tract is dilated up to 18Fr. Successful insertion into the bladder each time is confirmed by efflux of urine. After dilatation, an 18Fr silicone long-term Foley catheter is inserted.
DISCUSSION
This is a simple procedure that can be carried out safely in an emergency setting by junior doctors. It allows early discharge of the patient and saves additional invasive procedures. It is less traumatic compared to other methods as well as being cost effective. A silicone catheter is preferable to a latex catheter as it is more rigid and therefore easier to reinsert via the dilated tract. We have dilated five tracts in the last two months without any complications.
Figure 1.
Hydrophilic-coated female Nelaton catheters
References
- 1.Thrasher JB, Kreder KJ. Suprapubic tube tract dilation using the Otis urethrotome. Urology. 1993;41:247–248. doi: 10.1016/0090-4295(93)90567-t. [DOI] [PubMed] [Google Scholar]
- 2.McInnes BK. Use of Otis urethrotome to reopen stenotic suprapubic tract. Urology. 1981;17:373. doi: 10.1016/0090-4295(81)90272-7. [DOI] [PubMed] [Google Scholar]