Decreasing suprapubic tube-related injuries: results of case series and comprehensive literature review.
Key Words: Suprapubic tube, percutaneous, complications, bowel injury.
Suprapubic tube catheterization (SPT) is a commonly performed technique for urinary diversion in select patient populations (see Table 1). However, an unusually high mortality rate (1.8%) for such a minor procedure has been reported (Ahluwalia et al., 2006). Suprapubic catheterization is superior to urethral catheterization with regards to patient satisfaction, comfort, incidence of urethral irritation and erosion, assessment of voiding, and ease of nursing care (Niel-Weise & Van den Broek, 2005; Sheriff et al., 1998).
Open placement of an SPT is considered the gold standard because it provides for direct vision, placement of a large catheter, and tacking of the bladder to the anterior abdominal wall to facilitate future catheter changes. Open placement, how ever, likely increases the cost of the procedure due to the surgical morbidity associated with general and spinal anesthesia.
Although infrequent, bowel perforation and obstruction are known complications of percutaneous SPT, occurring in approximately 0.3% to 2.7% of cases (Ahluwalia et al., 2006; Cronin et al., 2011; Flock, Litvak, & McRoberts, 1978; Sheriff et al., 1998). As a result of five recent cases of bowel injury related to percutaneous SPT placement at our institution, the literature was reviewed in an effort to provide physicians with guidance regarding risk-stratifying patients for open as opposed to percutaneous SPT placement.
Materials and Methods
A review of the literature was performed using PubMed. All available English language articles were identified using the search terms percutaneous, suprapubic tube, bowel injury, and complication of suprapubic tube. Articles reporting percutaneous SPT placement-related bowel injury were selected. Five bowel injury cases that recently occurred at our institution were added to the data analysis.
Data were obtained regarding the technique of SPT placement utilized, incurred bowel complications, timing of presentation of the complication, and underlying patient risk factors. Percutaneous SPT-related bowel injuries were stratified according to the Clavian classification of surgical complications (see Figure 1) (Dindo, Demartines, & Clavien, 2004).
A comprehensive review of the literature demonstrated that after SPT placement, the most common complications in the peri-procedure setting were urosepsis, surgical site infection, surgical site bleeding, and catheter obstruction. Common post-procedure complications included catheter obstruction, urinary tract infection (UTI), catheter malposition, difficult catheter change, and SPT site infection/bleeding, some of which may be technique-related.
In addition to our five cases, 28 patients incurring bowel injury as a complication of percutaneous SPT placement were identified in a total of 18 articles or case reports (see Table 2). Two articles involving eight patients identified in the literature were excluded due to insufficient information (Ahluwalia et al., 2006; Sheriff et al., 1998), leaving 25 patients for review. Bowel injury complications presented both acutely after SPT placement (14/25, 56%) and later at the time of initial SPT change (11/25, 44%). Prior abdominal surgery (13/25, 52%), external beam radiation therapy (EBRT) (6/25, 24%), and a small/thick walled non-distensible bladder (4/25, 16%) were common factors noted in patients with SPT-associated bowel injury (see Figure 2). Only 8% of bowel injuries occurred in patients without risk factors. Of these 25 patients, three had Clavien Class II complications, 20 had Clavien Class IIIb complications, and two had a Clavien Class V complication.
SPT placement is a commonly performed technique for urinary diversion in select patients. Indications for placement include acute urinary retention and inability to place a urethral catheter, urethral stricture disease, poor detrusor contractility, neurogenic bladder dysfunction, elderly patients with lower urinary tract symptoms in whom an indwelling urethral catheter is not a suitable alternative, and chronic bladder outlet obstruction (Niel-Weise & Van den Broek, 2005; Sheriff et al., 1998).
Minimally invasive alternatives have been developed, such as the Lowsley retractor, percutaneus punch, and Bonnano, Rutner, Stamey, and Sofflex devices. Two of the more commonly performed minimally invasive techniques, the Staney procedure and use of the Lowsley tractor, were recently highlighted (Bullman, 2011). These percutaneous devices can be utilized under local anesthesia/intravenous sedation in a cost-effective and safe manner in patients with significant co-morbid medical conditions. Despite the low risk associated with this procedure, the use of ultrasound or fluoroscopy to guide catheter placement, as well as Trendelenburg positioning, has been proposed to decrease the risk of organ injury (Aguilera, Choi, & Durham, 2004; Ahluwalia et al., 2006; Bonanno, Landers, & Rock, 1970; Cromie & Lake, 1978; Cronin et al., 2011; Flock et al., 1978; Lingard & Foote, 2005; Mond & Lee, 1994).
A variety of complications have been reported after percutaneous SPT placement. In 1978, Flock and colleagues published their initial experience with SPT placement in 250 individuals. They noted a low minor complication rate of 1.6% and a bowel injury rate of 0.4% (Flock et al., 1978). Ahluwalia et al. (2006) described a 10% intra-operative complication rate, 2.4% risk of bowel injury, and a mortality rate of 1.8% in 219 patients. An additional review by Sheriff et al. (1998) reported a 10% intraoperative complication rate, 2.7% rate of bowel injury, and a 0.8% mortality rate in patients with neurogenic bladders. The difference in mortality rates between the Ahluwalia and Sheriff's series may reflect that the latter patient population was significantly younger (mean age 73 years vs. 37.5 years) and had less co-morbid conditions.
Additional complications have been reported after percutaneous SPT placement, including intraperitoneal extravasation, extraperitoneal extravasation, infection, ureteral obstruction, catheter obstruction or dislodgement, hematuria, hernia, bowel obstruction, subcutaneous emphysema, urosepsis, and bladder penetration with associated rectal, vaginal, or uterine injury (Dangle, Tycast, Vasquez, Geary, & Chehval, 2010; Heit, 1997; Lobel & Sand, 1997; Vaidyanathan, Soni, Singh, & Hughes, 2006). Such complications may result in significant morbidity, even mortality, and thus, efforts have been made to improve the safety of SPT placement.
Modifications in technique, such as patient positioning, bladder distention, image-guidance with ultrasound, and fluoroscopy, have been reported as methods to decrease the risk of complication (Ahluwalia et al., 2006; Cronin et al., 2011; Flock et al., 1978; Sheriff et al., 1998). Placing the patient into a Trendelenburg position uses gravity to displace bowel away from the bladder. In patients with prior abdominal/pelvic surgery or EBRT, this may not be possible secondary to adhesions and scarring. Distention of the bladder is limited in many patients as well. Only those patients with a patent urethra and a non-contracted bladder are amenable to this approach.
Efforts to successfully place larger catheters to prevent obstruction and dislodgment have focused on the placement of urethral sounds to juxtapose the anterior bladder wall against the anterior abdominal wall (Bonanno et al., 1970; Cromie & Lake, 1978; Lingard & Foote, 2005). This approach requires a patent urethra and is not advisable in individuals with small capacity, contracted bladders, and in whom bladder distention is not possible. Despite the advantages offered by this technique, it still has limitations of a percutaneous approach, and trapping of the bowel can still occur.
Cho, Doo, Yang, Song, and Lee (2010) evaluated the impact of bladder distension on bowel displacement. In their study, computerized tomography (CT) scans of 226 patients with bladder distension greater than 6 cm above the symphysis pubis were reviewed to assess the proximity of bowel loops to the potential SPT tract. Bowel was identified in the path of the proposed SPT tract in 40.9% of those patients with and only 8.3% of those without a history of prior pelvic surgery. Obesity, history of pelvic surgery, and a short distance (< 11 cm) between the symphysis pubis and umbilicus correlated significantly with bowel presence within the proposed SPT tract (Cho et al., 2010).
The use of ultrasound and fluoroscopy guidance has been advocated as methods to evaluate bladder distention, assess for overlying loops of bowel, and visualize catheter placement (Aguilera et al., 2004; Cronin et al., 2011; Mond & Lee, 1994). Ultrasound-assisted percutaneous SPT placement in the emergency room by knowledgeable emergency room physicians has been demonstrated to be a safe and effective method for emergent bladder decompression. A study out of UCLA (Aguilera et al., 2004) demonstrated no complications following ultrasound-guided placement of Stamey percutaneous cystostomy catheters in 17 consecutive patients requiring emergent bladder decompression. The authors noted that obesity creates an acoustic barrier that can limit visualization (Aguilera et al., 2004). In addition, pressure on the ultrasound probe over the lower abdominal wall may interfere with visualization of bowel loops, and individuals with contracted bladders may not achieve sufficient bladder distention for adequate visualization.
Fluoroscopic guidance has been shown to be useful in percutaneous SPT placement in the interventional radiology literature. In a series of 549 percutaneous SPT placements under fluoroscopic guidance, the authors noted a minor complication rate of 7.2% at insertion and 4.8% on catheter exchange with a major complication rate of 0.3%. The minor complications included hemorrhage (3.3%), pain (1%), urinary tract infection (UTI) (1%), and urine leak (1.8%). Only one patient experienced a small bowel injury for a small bowel perforation rate of 0.3%. No mortalities were reported in their series (Cronin et al., 2011).
A variety of techniques have been employed for placement of suprapubic tubes. Each technique has advantages, disadvantages, as well as different complication rates, which may be pertinent to patient selection (see Table 3). Analysis of the literature revealed that risk factors for the complications of bowel injury during percutaneous SPT placement include a small capacity or thickwalled neurogenic bladder, patients with a bladder that cannot be adequately distended, history of prior abdominal/pelvic EBRT, and/or surgery. Thickwalled, small-capacity bladders can be diagnosed through history, physical, cystoscopy, ultrasound, and urodynamics. Percutaneous SPT-related bowel injury has a bimodal presentation, and may manifest symptoms and signs of bowel injury at either the time of SPT catheter insertion or following the initial catheter change.
History, physical examination, laboratory data, and radiologic imaging are useful adjuncts for diagnosis of bowel injury (see Figure 3). Based on the literature and our institutional experience, consideration of open SPT placement is proposed for high-risk patients. Additionally, the use of ultrasound and/or fluoroscopy, the Trendelenburg position, and bladder distension during percutaneous SPT placement may help to decrease the incidence of bowel injury in this population (see Figure 4).
As part of a quality assurance project in our division, a decision-making algorithm was developed in an attempt to identify patient risk factors and methods to decrease the risk of SPT-related bowel injury in our institution. The algorithm was presented to members of our division of urology and adopted into practice (see Figure 4).
Nursing awareness regarding potential complications of suprapubic tube placement and the presenting signs and symptoms is critical. Nurses have an important role in caring for patients who undergo placement of suprapubic tubes. This not only involves strict attention to post-operative complications but also patient education to facilitate the transition to management at home. Post-operatively, the patient should be monitored for fever; changes in the location and nahtre of pain; lack of urinary drainage, which could represent catheter obstruction or dislodgement; urinary tract infection; and changes in color, consistency, or presence of particulate matter in the urine, which may be indicative of stool, stone debris, urinary tract infection, and dehydration (Ahluwalia et al., 2006). Proper care of suprapubic tubes, wound care, securing the catheter to prevent dislodgement, and monitoring of urine output are all key elements of patient education by nursing (Bullman, 2011). The urologist often does the first suprapubic tube change approximately four to six weeks after placement. Subsequent changes can be delegated to trained nursing staff. Although the majority of SPT-related bowel injuries present early after placement or at the time of the first SPT change, some present later, and nurses will often be the recipients of phone calls regarding the presence of feculent material in the urine or from the SPT site. Thus, awareness of this complication will help nursing staff prompt patients to seek immediate evaluation. In addition to the short-term issues related to SPT placement, there are long-term risks, including bladder stones and development of bladder cancer. Therefore, it is important for patients to understand the need for follow-up cystoscopic examinations and renal ultrasound every five years post-placement (Vaidyanathan, Soni, Hughes, Singh, & Oo, 2011)
Prior abdominal surgery, abdominal/pelvic EBRT, and a small/thick-walled non-distensible bladder are risk factors for percutaneous SPT-associated bowel injury and are present in 92% of bowel injury cases. Consideration of open or image-guided percutaneous SPT placement in patients with small capacity or thick-walled neurogenic bladders, those in whom the bladder cannot be distended adequately, prior abdominal/pelvic EBRT, and/or surgery is advocated (see Figure 4). If the patient's ASA score is greater than or equal to 3, percutaneous image-guided approaches should be used. If percutaneous SPT is planned, Trendelenburg positioning and the use of ultrasound and/or fluoroscopy at the time of SPT placement is supported by the literature review.
1. Describe indications for suprapubic tube catheterization (SPT) placement.
2. Discuss the prevalence of injuries resulting from SPT as discovered in dais literature review.
3. Identify alternatives for catheter placement that may alleviate or reduce suprapubic tubing injuries.
Aguilera, P.A., Choi, T., & Durham, B. A. (2004). Ultrasound-guided suprapubic cystostomy catheter placement in the emergency department. The Journal of Emergency Medicine, 26(3), 319-321.
Ahluwalia, R.S., Johal, N., Kouriefs, C., Kooiman, G., Montgomery, B.S., & Plail, R.O. (2006). The surgical risk of suprapubic catheter insertion and long-term sequelae. Annals of the Royal College of Surgeons of England, 88(2), 210-213.
Ahmed, S.J., Mehta, A., & Rimington, P. (2004). Delayed bowel perforation following suprapubic catheter insertion. BMC Urology, 4(1), 16.
Bonanno, P.J., Landers, D.E., & Rock, D.E. (1970). Bladder drainage with the suprapubic catheter needle. Obstetrics & Gynecology. 35(5), 807-813.
Bullman, S. (2011). Ins and outs of suprapubic catheters--A clinician's experience. Urologic Nursing, 31(5), 259-263.
Cho, K.H., Doo, S.W., Yang, W.J., Song, Y.S., & Lee, K.H. (2010). Suprapubic cystostomy: Risk analysis of possible bowel interposition through the percutaneous tract by computed tomography. Korean Journal of Urology, 51(10), 709-712.
Cromie, W.J., & Lake, M.H. (1978). The Lowsley cystotomy. Urology, 11(1), 78.
Cronin, C.G., Prakash, P., Gervais, D.A., Hahn, P.F., Arellano, R., Guimares, A., & Mueller, P.R. (2011). Imaging-guided suprapubic bladder tube insertion: Experience in the care of 549 patients. American Journal of Roentgenology, 196(1), 182-188.
Cundiff, G., & Bent, A.E. (1995). Suprapubic catheterization complicated by bowel perforation. International Urogynecology journal, 6(2), 110-113.
Dangle, P.P., Tycast, J., Vasquez, E., Geary, B., & Chehval, M. (2010). Suprapubic cystostomy: A bizarre complication of catheter migration causing ureteric obstruction. Canadian Urological Association Journal, 4(5), E127-E128.
Dindo, D., Demartines, N., & Clavien, P.A. (2004). Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of Surgery, 240(2), 205.
Flock, W.D., Litvak, A.S., & McRoberts, W.J. (1978). Evaluation of closed suprapubic cystostomy. Urology, 11(1), 40-42.
Goldblum, D., & Brugger, J.J. (1999). Bowel obstruction caused by dislocation of a suprapubic catheter. Surgical endoscopy, 13(3), 283-284.
Hebert, D.B., & Mitchell, G.W. (1983). Perforation of the ileum as a complication of suprapubic catheterization. Obstetrics & Gynecology, 62(5), 662-664.
Heit, M. (1997). Infectious peritonitis complicating suprapubic catheter removal. International Urogynecology Journal, 8(1), 47-49.
Liau, S.S., & Shabeer, U.A. (2005). Laparoscopic management of cecal injury from a misplaced percutaneous suprapubic cystostomy. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 15(6), 378-379.
Lingard, C., & Foote, A.J. (2005). Suprapubic catheterisation: A retrospective comparison of two insertion systems. Australian and New Zealand Journal of Obstetrics and Gynaecology, 45(1), 74-76.
Lobel, R.W., & Sand, P.K. (1997). Incisional hernia after suprapubic catheterization. Obstetrics & Gynecology, 89(5), 844-846.
Mond, D.J., & Lee, W.J. (1994). Fluoroscopically guided suprapnbic cystostomy in complex urologic cases. Journal of Vascular and Interventional Radiology, 5(6), 911-914.
Mongiu, A.K., Helfand, B.T., & Kielb, S.J. (2009). Small bowel perforation during suprapubic tube exchange. Canadian Journal of Urology, 16(1), 4519-4521.
Moody, T.E., Howards, S.S., Schneider, J.A., & Rudolf, L.E. (1977). Intestinal obstruction: A complication of percutaneous cystostomy. A case report. The Journal of Urology, 118(4), 680.
Morse, R.M., Spirnak, J.P., & Resnick, M.I. (1988). Iatrogenic colon and rectal injuries associated with urological intervention: report of 14 patients. Journal of Urology, 140(1), 101-103.
Niel-Weise, B.S., & Van den Broek, P.J. (2005). Urinary catheter policies for short-term bladder drainage in adults. Cochrane Database System Review, 3, CD004203.
Noller, K.L., Pratt, J.H., & Symmonds, R.E. (1976). Bowel perforation with suprapubic cystostomy Report of two cases. Obstetrics and Gynecology, 48(1, Suppl.), 67S-69S.
Parikh, A., Chapple, C.R., & Hampson, S.J. (2008). Suprapubic catheterisation and bowel injury. British Journal of Urology, 70(2), 212-213.
Pieretti, R.V., & Pieretti-Vanmarcke, R.V. (1995). Combined abdominal and posterior sagittal transrectal approach for the repair of rectourinary fistula resulting from a shotgun wound. Urology, 46(2), 254-256.
Sheriff, M.K., Foley, S., McFarlane, J., Nauth-Misir, R., Craggs, M., & Shah, P.J. (1998). Long-term suprapubic catheterisation: Clinical outcome and satisfaction survey. Spinal Cord, 36(3), 171-176.
Simpson, R.R. (2001). An unusual cause of small bowel obstruction: The misplaced suprapubic catheter. The Journal of Urology, 165(6), 1998-1998.
Tompkins, A.J., Travis, M., Watne, R.E., Lasser, M., & Ellsworth, P. (2014). Decreasing suprapubic tube-related injuries: Results of case series and comprehensive literature review. Urologic Nursing, 34(1), 9-17. doi: 10.7257/1053-816X.2014.34.1.9
Vaidyanathan S., Soni B., Hughes P., Singh G., & Oo T. (2011). Preventable long-term complications of suprapubic cystostomy after spinal cord injury: Root cause analysis in a representative case report. Patient Safety in Surgery, 5, 27-34.
Vaidyanathan, S., Soni, B.M., Singh, G., & Hughes, P.L. (2006). Fatality due to septicemia and hemorrhage in a patient with spinal cord injury and ischemic heart disease with the need for long-term catheter drainage. Advances in Therapy, 23(2), 354-358.
Witham, M.D., & Martindale, A.D. (2002). Occult transfixation of the sigmoid colon by suprapubic catheter. Age and Ageing, 31(5), 407-408.
Wu, C.C., Su, C.T., & Lin, A.C. (2007). Terminal ileum perforation from a misplaced percutaneous suprapubic cystostomy. European Journal of Emergency Medicine, 14(2), 92-93.
Andrew J. Tompkins, MD, is a Urologic Resident Surgeon, Rhode Island Hospital, Providence, RI.
Michelle Travis, NP, is a Nurse Practitioner, VA Medical Center, Providence, RI.
Reed E. Watne, is a Student, Brown University, Providence, RI.
Michael Lasser, MD, is Medical Director of Robotic Surgery, Atlantic Coast Urology, Neptune, NJ.
Pamela Ellsworth, MD, FAAP, FACS, is a Urologist, University Urological Association, Providence, RI.
Tompkins, A.J., Travis, M., Watne, R.E., Lasser, M., & Ellsworth, P. (2014). Decreasing suprapubic tube-related injuries: Results of case series and comprehensive literature review. Urologic Nursing, 34(1), 9-17. doi:10.7257/ 1053-816X.2014.34.1.9
Table 1. Common Indications for Suprapubic Tube Symptomatic elevated post-void residual and inability to perform clean intermittent catheterization (CIC) Urethral erosion with chronic indwelling urethral catheter Traumatic urethral disruption Temporary diversion following certain urologic/gynecologic procedures Table 2. Literature Review of Suprapubic Tube-Related Bowel Complications Patient Age, Gender, Authors and Risk Factors Technique Ahluwalia et al., Not reported Cystoscopic bladder 2006" distention with visual guidance Ahmed, Mehta, & 86m, pelvic surgery Lawrence Add-a-Cath Rimington, 2004 and EBRT trocar with ultrasound guidance Cronin et al., 2011 History midline Fluoroscopic and laparotomy US guided SPT in interventional radiology Cundiff & Bent, 1995 62f, TAH-BSO, pelvic Trendelenburg, prolapse, and SUI bladder filled to procedures 400cc, Rutner catheter through stab incision with cystoscopy Flock, Litvak, & History of prior Lowsley tractor in McRoberts, 1978 lower abdominal bladder and cut down surgery onto tip and Foley delivered into bladder Flock, Litvak, & Neurogenic bladder Lowsley tractor in McRoberts, 1978 bladder and cut down onto tip and Foley delivered into bladder Goldblum & Brugger, 78m, retention Cystofix SPT with 1999 cystoscopic guidance Hebert & Mitchell, 37f, open CCY'and Following total 1983 Marshall-Marchetti- abdominal Krantz procedure hysterectomy, bladder filled to 400cc and Argyle Ingram SPT placed percutaneously Hebert & Mitchell, 57f, G5P3 and Cysto-Trocath placed 1983 uterine prolapse through urethra, into bladder and out SP incision following total vaginal hysterectomy Liau & Shabeer, 2005 72f, MS Percutaneous SPT Mongiu, Helfand, & 88f, PV sling, AUS Cystoscopic assisted Kielb, 2009 SP approach SPT Moody, Howards, 69m, Bilroth II Percutaneous Bonanno Schneider, & Rudolf, gastrojejunostomy, SPT 1977 s/p TURP with retention Morse, Spimak, & 65m, urinary Punch SPT Resnick, 1988 retention Noller, Pratt, & 35f, G10P5 Transurethral Davis Symmonds, 1976 sound, 16 French foley Noller, Pratt, & 72f, cystocele, Bladder filled to Symmonds, 1976 enterocele, 400 cc, chest tube perineorrhhaphy trocar SPT with 14 French foley Parikh, Chapple, & 82f, pelvic surgery SPT placed with Hampson, 2008 and EBRT Nottingham introducer under general anesthesia Parikh, Chapple, & 92f, pelvic EBRT SPT placed with Hampson, 2008 Nottingham introducer under general anesthesia Pieretti & Pieretti- 7mos m, bladder Percutaneous Stamey Vanmarcke, 1995 exstrophy, retention SPT Sheriff et al., Most patients with Cystoscopic bladder 1998 * neurogenic bladder distention with visual guidance using "Add-a Cath" or Nottingham introducer Simpson, 2001 76m, acute retention Percutaneous SPT Tompkins, Travis, 86f, PV sling and Percutaneous SPT Watne, Lasser, & cystocele Ellsworth, 2014 (current article) Tompkins, Travis, 63f, neurogenic Van Buren sound and Watne, Lasser, & bladder, abdominal cut down onto sound Ellsworth, 2014 surgery and catheter pulled (current article) into bladder with cystoscopy Tompkins, Travis, 70m, APR, EBRT Bladder distention, Watne, Lasser, & posterior urethral- trocar SPT and 16 Ellsworth, 2014 pelvic fistula French Foley placed (current article) using peel away sheath--cystoscopy-- posterior cystotomy noted Tompkins, Travis, 85m, EBRT for Van Buren sound and Watne, Lasser, & prostate cancer cut down onto sound Ellsworth, 2014 and catheter pulled (current article) into bladder with cystoscopy Tompkins, Travis, 85m, EBRT for Bladder distention, Watne, Lasser, & prostate cancer, trocar SPT and 16 Ellsworth, 2014 APR, AAA French Foley placed (current article) using peel away sheath--cystoscopy Witham & Martndale, 75m, hx CVA Percutaneous SPT 2002 under general with cystoscopy Wu, Su, & Lin, 2007 71 m, neurogenic Percutaneous SPT bladder Authors Diagnosis and Outcome Ahluwalia et al., 3 out of 219 patients had bowel injury (2.4%) 2006" Ahmed, Mehta, & 10 days post-SPT--peritonitis, feculent Rimington, 2004 drainage--exploratory laparotomy--small bowel penetration--small bowel resection Cronin et al., 2011 Small bowel injury (0.3%) Cundiff & Bent, 1995 POD 3--abdominal distention and loss bowel sounds--SPT pierced muscularis of ileum Flock, Litvak, & Enterovesical fistula 3.5 weeks postop with McRoberts, 1978 1 st catheter change--healed with Foley and removal of SPT Flock, Litvak, & Intraperitoneal extravasation of irrigation fluid McRoberts, 1978 16 days post-procedure--exploratory laparo tomy demonstrated peritoneum violation and antimesonteric perforations in the ileum Goldblum & Brugger, 6 days post-SPT, peritonitis--exploratory 1999 laparoscopy--catheter wrapped around jejunum--no bowel resection Hebert & Mitchell, 19 days post-SPT--peritonitis--exploratory 1983 laparotomy--ileum perforation--small bowel resection Hebert & Mitchell, 3 days post-SPT--feculent drainage-- 1983 cystogram--exploratory laparotomy--ileum perforation--primary repair Liau & Shabeer, 2005 3 months post-SPT--feculent drainage-- exploratory laparoscopy--catheter in cecum --primary repair Mongiu, Helfand, & 8 months post-SPT--feculent drainage-- Kielb, 2009 catheter in ileum Moody, Howards, 10 days post-SPT- signs of bowel Schneider, & Rudolf, obstruction--exploratory laparotomy--atretic 1977 segment of ileum and mesentery punctured by SPT--small bowel resection Morse, Spimak, & Peritonitis--exploratory laparotomy--rectal Resnick, 1988 perforation--diverting colostomy Noller, Pratt, & 5 days postop drainage around SPT c/w Symmonds, 1976 bowel contents--exploratory laparotomy-- small bowel penetration--small bowel resection Noller, Pratt, & 2 weeks postop brown discharge-- Symmonds, 1976 ileocutaneous fistula--conservative management Parikh, Chapple, & 9 months post-SPT--drainage of stool-- Hampson, 2008 cystogram--enterovesical fistula to small bowel -exploratory laparotomy--small bowel resection Parikh, Chapple, & 12 hours post-SPT drainage of intestinal con Hampson, 2008 tents--exploratory laparotomy SPT passed through small bowel--small bowel resection Pieretti & Pieretti- 2 months post-SPT - - abdominal pain/ Vanmarcke, 1995 distention--posterior bladder wall perforation, distal ileal obstruction Sheriff et al., 5 out of 185 patients had bowel injury (2.7%) 1998 * Simpson, 2001 10 days post-SPT--abdominal pain/ distention--exploratory laparotomy--incar cerated loop small bowel beneath intraperi toneally exposed SPT--no bowel resection Tompkins, Travis, 8 months post-SPT, catheter change required Watne, Lasser, & cysto, dilation, and manipulation--abdominal Ellsworth, 2014 distention--exploratory laparotomy catheter (current article) penetrated bowel--patient died post operatively Tompkins, Travis, 2 months post-SPT--abdominal pain, N/V-- Watne, Lasser, & CT demonstrated SPT through small bowel-- Ellsworth, 2014 exploratory laparotomy--small bowel (current article) resection Tompkins, Travis, Peritonitis postoperatively--exploratory Watne, Lasser, & laparotomy--SPT traversed a portion of small Ellsworth, 2014 bowel that was adherent to anterior bladder (current article) wall--small bowel resection Tompkins, Travis, 2 weeks after SPT change--feculent Watne, Lasser, & drainage--exploratory laparotomy--SPT in Ellsworth, 2014 loop of small bowel--small bowel resection (current article) Tompkins, Travis, 1 year post-SPT and 20 days following SPT Watne, Lasser, & change--feculent drainage--CT Ellsworth, 2014 demonstrated Foley in bladder with tip eroded (current article) through posterior bladder into loop of bowel-- patient comfort measures only Witham & Martndale, First catheter change 3 months postop-- 2002 feculent drainage--exploratory laparotomy-- tip of catheter in sigmoid--primary repair Wu, Su, & Lin, 2007 2 months post-SPT first change, feculent material--exploratory laparotomy--SPT in terminal ileum--small bowel resection * Excluded from data analysis secondary to no individual patient medical/surgical history reported. Notes: m = Male, f = Female, y = year old, G10P5 = gravida 10 para 5, SPT = suprapubic tube, US = ultrasound, UTI = urinary tract infection, CT = computerized tomography, XRT = external beam radiation therapy, CCY = laparoscopic cholecystectomy, MS = multiple sclerosis, TURP = transurethral resection of prostate, TAH-BSO = total abdominal hysterectomy bilateral salpin-go oophorectomy, SUI = stress urinary incontinence, CVA = cerebral vascular accident, PV = pubovaginal, AUS = artificial uri-nary sphincter, APR = abdominal perineal resection, AAA = abdominal aortic aneurism. Table 3. Advantages/Disadvantages of Suprapubic Tube Placement Tecniques Technique Advantages Disadvantages Percutaneous Bedside procedure, Small catheter prone to (i.e., Stamey) smaller catheter may obstruction, dislodged improve comfort. easily, blind procedure, difficult to place in thick walled bladder. Lowsley Bladder tented up to Requires patient urethra, Tractor abdominal wall, larger requires sedation/ catheter size possible, anesthesia, often less risk of obstruction. performed blind. Open Direct vision, bladder Requires anesthesia. sutured to abdominal wall assisting with straight tract formation, does not require patent urethra. Figure 1. Clavian Classification of Surgical Complications Grade I: Any deviation from the normal post-operative course without the need for pharmacological treatment or surgical, endoscopic, and radiological intervention. * Allowed therapeutic regimens are drugs as antiemetics, antipyretics, analgesics, diuretics, electrolytes, and physiotherapy. * Wound infections opened at bedside. Grade II: Requiring pharmacological treatment with drugs other than for class I complications, including blood, and total parenteral nutrition are also included. Grade III: Requiring surgical, endoscopic, or radiological intervention. * Grade IIIa: Intervention not under general anesthesia. * Grade IIIb: Intervention under general anesthesia. Grade IV: Life-threatening complication, including central nervous system (CNS) complications, requiring IC/ICU management. * Grade IVa: Single-organ dysfunction (including dialysis). * Grade IVb: Multi-organ dysfunction. Grade V: Death of a patient. Source: Dindo, Demartines, & Clavien, 2004. Figure 2. Bowel Injury Following Percutaneous Suprapubic Tube Catheterization (SPT) Prior Abdominal Surgery 54% External Beam Radiation Therapy (EBRT) 21% Small/Thick-Walled Bladder 17% No Risk Factor 8% Note: EBRT = external beam radiation therapy Note: Table made from pie chart.
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|Title Annotation:||CNE SERIES/ADVANCED CLINICAL PRACTICE|
|Author:||Tompkins, Andrew J.; Travis, Michelle; Watne, Reed E.; Lasser, Michael; Ellsworth, Pamela|
|Article Type:||Clinical report|
|Date:||Jan 1, 2014|
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