Suprapubic percutaneous cystostomy versus urethral catheterisation in abdominal surgery - A prospective randomised controlled study

Background: We conducted a randomised, prospective trial to evaluate the safety and effectiveness of suprapubic percutaneous cystostomy (SPC) in comparison with perurethral catheterisation in patients who needed postoperative bladder drainage. Patients and Method: Between 1992 and 1995, in the course of abdominal surgical procedures, we performed SPC with a custom set (Cystofix) in 85 patients. During the same period we inserted a Foley bladder catheter immediately preoperatively in another 88 patients. The 2 groups were statistically comparable in terms of age, sex and gravity of procedure. Results: Patients with SPC were able to micturate normally from the 2nd postoperative day. The Foley catheter remained in place for 3-11 days (mean 3.4 days), and had to be replaced in 8 patients because of urinary retention. Gross haematuria was observed in 4 patients with SPC and in another 4 with urethral catheter, and microscopic haematuria in 16 (18.8%) and 36 (40.9%) patients, respectively (p<0.01). Urine cultures were negative in all patients with SPC, while Streptococcus faecum was grown in urine cultures from 2 patients with a urethral catheter at a concentration of >10(6). More than 6 white cells per high-power field were observed in 6 patients (7%) with SPC and in 23 (26.1%) with a urethral catheter (p<0.01). Finally, SPC was better tolerated than the urethral catheter. Conclusion: SPC is a simple and safe method for draining the urinary bladder. It allows prompt re-establishment of normal micturition, is better tolerated by the patients and has a lower risk of complications.