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 System

The Seldinger Suprapubic Catheter Kit, S-Cath^TM System consists of a long needle (16G), a guide wire, a trocar with an outer sheath and a choice of 8, 12, 14 or 16 Fr 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 System offers a number of advantages to both the clinical staff and the patient:

1. Greater control and accuracy.  A high degree of control allows accurate placement.
   

2. Reduced risk.  Low risk of trauma and tissue damage for the patient.  The catheter rarely needs to be inserted under general anaesthetic - reducing the associated risks in an elderly at risk group of patients.
   

3. Greater confidence.  The bladder may be located with an 18g hypodermic needle, giving more confidence in inserting the trocar into the bladder, as the track has already been secured by the guide wire.
   

4. Improved insertion and removal.  The safety guide wire improves insertion and removal, guaranteeing insertion of the trocar along the anesthetised track.
   

5. Reduces costs and hospital stay.  The procedure rarely needs to be undertaken as an inpatient, under general anaesthetic or in an operating theatre - reducing hospital stay, as well as reducing overall costs.  Evidence shows the length of stay can be reduced from 2.3 days to a procedure time of 29 minutes.
   

6. Frees up consultants' time and enhances out of hours services. Enables non-consultant grade clinical staff and suitably trained nurse practitioners to perform the procedure after training, thereby freeing up Consultant time and allowing suitably trained staff to safely insert catheters during out of hours.