Suprapubic catheterisation (SPC) is a surgical procedure traditionally performed in the operating theatre and is routinely used in urology to decompress the bladder in patients who present as an emergency with bladder outlet obstruction (BOO) and where a urethral catheterisation is unsuccessful, or undesirable, because of an enlarged prostate or urethral stricture. It is also electively indicated in patients unable to tolerate a long-term urethral catheter due to bladder spasm, discomfort, bypassing, and in patients with neurological diseases such as multiple sclerosis and spina bifida.

Although generally regarded as a safe procedure, initial insertion can carry a small but significant risk of bowel puncture, particularly in patients with a contracted bladder. Traditional methods are often daunting for both the surgeon and patient, due to the potential risks involved.

Mediplus Ltd and The BioMed Centre, Bristol have developed a new catheter insertion kit using the Seldinger technique - a well-established clinical procedure - to increase safety and reduce the number of insertions performed under general anaesthetic. S-Cath^TM

The Seldinger Suprapubic Catheter Kit, S-Cath^TM consists of a long needle (16G), a guide wire, a trocar with an outer sheath and a choice of 8, 12, 14 or 16 French silicone catheters.  The catheters are available in either open tip or closed tip. (8 and 12Fr are only available in closed tip)

The anaesthetised tract is created in the normal way, but the needle is left in the patient. The guide wire is then inserted through the needle into the bladder. It will curl upon the posterior wall preventing the trocar from being pushed in too far. The needle can then be removed. The trocar is then inserted in a controlled manner, helping to reduce user anxiety and ensuring it enters the bladder.

S-Cath^TM offers a number of advantages to both the clinician and the patient:

• Less pressure needed to insert the trocar, so more comfortable under local anaesthetic and less stressful for the surgeon; high degree of control for accurate placement.
  

• Minimum trauma for the patient and minimum tissue damage.
  

• Locates the bladder with 18g hypodermic needle, so more confidence of inserting the trocar into the bladder, as the track has already been secured by the guide wire.  - No more guessing the angle the anaesthetic needle is pointing in!
  

• Three-stage guide wire improves insertion and removal and guarantees insertion of the trocar along the anaesthetised track. The variable stiffness of the guide wire allows secure and comfortable curling up in the bladder while reliably guiding the trocar and preventing damage to the posterior wall.
  

• The soft, uniformly inflated balloon is flush to the catheter shaft to improve insertion and removal, and sits well against the bladder.  Many people report less 'cuffing' of the balloon when compared to other Foley catheter designs.
  

• Radiopaque tip on the catheter allows x-ray confirmation of placement.
  

• Procedures can now easily be performed in an outpatient setting using local anaesthetic.