Pigtail Suprapubic Catheter Placement in a Patient With Acute Urinary Retention and Abdominal Mesh

Acute urinary retention (AUR) is a urological emergency that requires immediate bladder decompression. When urethral catheterization is not feasible, suprapubic catheterization can be performed as an alternative. An 86-year-old male patient with a history of benign prostatic hyperplasia and prior hernia repair with surgical mesh presented to the emergency department (ED) with AUR for 16 hours. Due to multiple false passages, a completely blind-ended bladder neck, and a 6 mm urethral stone, urethral catheterization was unsuccessful, prompting an attempt at suprapubic catheterization. However, suprapubic catheter placement was also unsuccessful due to the presence of surgical mesh from the previous hernia repair. Instead, an 8.5 Fr pigtail catheter was successfully placed using ultrasound guidance and the Seldinger technique, draining over 1 L of urine from the patient's bladder. The use of a smaller-diameter pigtail catheter offers multiple benefits when standard suprapubic catheter placement is not feasible due to anatomical or structural difficulties. It allows for urgent and effective bladder decompression, minimal training is required, and pigtail catheters are readily accessible. However, because smaller-diameter catheters are used, they may not effectively drain blood clots. Despite this limitation, their availability and effectiveness make them a viable alternative in the ED.