Physics, Techniques and Procedures

Suprapubic bladder puncture

percutaneous puncture of the urinary bladder performed in the mid-line above the pubic symphysis. The procedure is most commonly performed when drainage of the bladder is needed in patients where transurethral catheterization is impossible or undesirable. It is also an alternative means of performing cystography and micturating cystourethrography without use of a urethral catheter. The procedure is performed under sterile conditions with local anaesthesia. A full bladder will lift intestinal loops away from the puncture site and ensure an extraperitoneal puncture. The position of the bladder can be confirmed with ultrasonography, and even though usually not necessary, the puncture itself may be guided by ultrasonography. In adults, the needle puncture is performed 2-3 cm above the symphysis in a vertical direction with the patient supine. A 5-7 French catheter with end-hole and side-holes may be introduced with the Seldinger technique, or large-bore catheters (10-15 F), for long-lasting drainage, may be introduced with special trocar systems. When the procedure is done only for cystourethrography in infants, no catheter is usually needed, and the contrast medium is instillated through a thin (21-23 gauge) needle introduced in the mid-line 1 cm above the symphysis.

HJS