Preventable long-term complications of suprapubic cystostomy after spinal cord injury: Root cause analysis in a representative case report

A 23-year-old female patient with tetraplegia underwent suprapubic cystostomy. During the next decade, this patient developed several catheter-related complications, as listed below: (1) Suprapubic catheter came out requiring reoperation. (2) The suprapubic catheter migrated to urethra through a patulous bladder neck, which led to leakage of urine per urethra. (3) Following change of catheter, the balloon of suprapubic catheter was found to be lying under the skin on two separate occasions. (4) Subsequently, this patient developed persistent, seropurulent discharge from suprapubic cystostomy site as well as from under-surface of pubis. (5) Repeated misplacement of catheter outside the bladder led to chronic leakage of urine along suprapubic tract, which in turn predisposed to inflammation and infection of suprapubic tract, abdominal wall fat, osteomyelitis of pubis, and abscess at the insertion of adductor longus muscleSuprapubic catheter should be anchored securely to prevent migration of the tip of catheter into urethra and accidental dislodgment of catheter. While changing the suprapubic catheter, correct placement of Foley catheter inside the urinary bladder must be ensured. In case of difficulty, it is advisable to perform exchange of catheter over a guide wire. Ultrasound examination of urinary bladder is useful to check the position of the balloon of Foley catheter.Early studies on suprapubic cystostomy in patients with neuropathic bladder reported accelerated renal deterioration and lower urinary tract complications, including stones, recurrent infections and blocked catheters. Hackler [1] showed that suprapubic cystostomy maintained for more than five years caused as much renal damage as the intraurethral catheter retained for more than twenty years. Therefore, Hackler recommended that in spinal cord injury patients, suprapubic cystostomy should be used only temporarily after urethral, ureteric or bladder surgery. In contrast, recent investigations in which