Suprapubic Catheter Drainage for the Definitive, Long-term Management of Lower Urinary Tract Dysfunction: Utilization...

To determine the utilization patterns and long-term outcomes of suprapubic catheterization for the definitive management of refractory lower urinary tract dysfunction (LUTD).

All patients undergoing suprapubic catheterization (SPC) placement by either a urologist or an interventional radiologist for the definitive (long-term) management of LUTD with a minimum of 2years of clinical follow-up were included in the study. The primary outcome of interest of SPC discontinuation. Secondary outcomes were both short-term (<30 days) and long-term SPC complications (Clavian-Dindo classification), and the use of ancillary LUTD treatments. Patient, SPC, and urinary tract variables were assessed to determine their relationship to SPC discontinuation.

There were 222 patients that met study criteria. Short (30.2%) and long-term (59.9%) complication rates were high, though Clavian-Dindo Grade III or greater were uncommon (4.5% and 23%, respectively). Ancillary LUTD treatments were used in 46%. The SPC discontinuation rate was 13.9% at a median of 12 months. Univariate predictors of discontinuation were the absence of ancillary LUTD treatments (OR 56.8; P<.0001) and initial SPC placement by interventional radiology (IR, vs urology) (OR 2.03; P<.01).

SPC placement was demonstrated to be safe with no procedurally related bowel injuries or deaths. However, short- and long-term complications rates were high, though mostly minor. Discontinuation rates were low and associated with the absence of ancillary LUTD treatments and initial SPC placement by IR. Initial placement of a larger SPC in a strategic location and the anticipated and proactive use of ancillary LUTD management strategies (eg, anti-cholinergics, Botox) may increase SPC longevity.