Bedside Flexible Cystoscopy-Guided First Suprapubic Catheter Exchange in a High-Risk Patient

Suprapubic catheter (SPC) exchange carries the risk of catheter malposition and tissue injury, particularly during the first exchange when the tract may not be fully matured. We report the case of a 56-year-old man with hypoxic-ischemic encephalopathy who was managed with mechanical ventilation and gastrostomy, had substantial suprapubic subcutaneous tissue (30 mm), and was receiving warfarin therapy. After initial 14-Fr SPC placement under ultrasonographic and flexible cystoscopic guidance, the first exchange on day 28 was performed at the bedside using flexible cystoscopy because transfer to the fluoroscopy suite was unfeasible. Direct visualization of the guidewire, catheter tip, and balloon confirmed intravesical positioning and allowed immediate monitoring for bleeding. The exchange was completed without significant bleeding or other complications. Bedside flexible cystoscopy may represent a practical and feasible option for the first SPC exchange in selected high-risk patients when fluoroscopic exchange is difficult, though further study is needed.