Indications for Suprapubic Catheter (SPC)

Primary Indications

1. Impassable urethral stricture - When a urethral catheter cannot traverse a stricture, bladder neck contracture, or urethral obstruction
2. Inability to pass a urethral catheter over an elevated bladder neck or an enlarged median lobe of the prostate (e.g., BPH with obstruction)
3. Urethral trauma - Any injury to the urethra that makes transurethral catheterization unsafe or impossible (e.g., pelvic fracture with urethral disruption)
4. Recent urethral or bladder neck reconstructive surgery - To avoid disturbing the operative site
5. Inability to tolerate a urethral catheter - In patients unwilling or unable to perform intermittent self-catheterization
6. Urethral or prostatic infection - When bladder drainage is needed in the presence of significant urethral or prostate infection, to avoid seeding infection proximally
7. Severe phimosis - Precluding insertion of a urethral catheter

Additional Contexts (from associated ICD codes and clinical scenarios)

• Neurogenic bladder with chronic urinary retention (when intermittent catheterization is not feasible)
• Bladder neck contracture (post-TURP or radiation)
• Long-term bladder drainage needs where a urethral catheter would cause urethral complications (urethral erosion, hypospadias, penoscrotal fistula)
• Acute urinary retention in females with urethral pathology
• Post-operative bladder drainage after certain pelvic, gynaecological, or urological surgeries

Contraindications (for completeness)

• Uncooperative patient
• Anticoagulation or coagulopathy (relative - reverse first or consult urology)
• Cellulitis over the suprapubic insertion site
• Previous pelvic surgery, cancer, or trauma causing anatomic distortion (bowel may be interposed - use ultrasound guidance)