Urethral trauma (e.g., partial or full transection)

 Urethral stricture

 Chronic urethral infection

 Urinary retention in which a urethral catheter cannot be passed (e.g., prostate obstruction, gynecologic malignancy or other pelvic mass, neurogenic bladder)

 Patients requiring a long-term indwelling urethral catheter

 Phimosis

CONTRAINDICATIONS

 An empty or nonpalpable urinary bladder

 History of previous lower abdominal surgery

 Lower abdominal wound or cellulitis

 Previous pelvic radiation with resultant scarring

 Presence of a femoral–femoral bypass graft in the suprapubic subcutaneous tissue

 Significant uncorrected coagulopathy

 Known bladder cancer

LANDMARKS

 In the adult, the urinary bladder is a pelvic organ located immediately posterior to and extending slightly above the symphysis pubis (FIGURE 38.1)

 In the child, the urinary bladder is still an abdominal organ, located in the midline, slightly superior to the symphysis pubis

SUPPLIES

 Povidone–iodine antiseptic solution

 Sterile gloves and drapes

 Suprapubic catheterization kit (e.g., Cook cystostomy kit), which typically includes:

    Local anesthetic (1% lidocaine), 10-mL syringe, 25-gauge needle

    22-gauge, 1.5-inch (for children) or 3-inch (for adults) spinal needle

    4- × 4-cm gauze pads

    J-tip guidewire

    Scalpel (no. 11 blade)

    Dilator

    Introducer sheath

 Foley catheter (size should be 1 French smaller than the diameter of the introducer sheath)

 Sterile, closed system urinary drainage bag

 Sterile dressing

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