No abstract

IndicationsChanging a suprapubic catheter in patients who have developed a mature cystocutaneous fistula is usually straightforward. Occasionally a catheter requires changing before the fistula tract has developed. Under these circumstances replacing a suprapubic catheter may require cystoscopic guidance under general or spinal anaesthesia. A simple technique, which can be performed as an oBce procedure, is described, using the sheath of a Lawrence Add-a-Cath@ (Femcare Ltd., Nottingham, UK) placed around the existing catheter. The patient is prepared as for the insertion of a suprapubic catheter; the bladder is filled with sterile normal saline. The catheter size is noted and the corresponding its balloon is inflated, and the Add-a-Cath@ sheath Add-a-Cath@ selected. The trocar is removed from the withdrawn and removed from the new catheter. If the sheath and the detachable strip peeled away (Fig. 1).suprapubic catheter has migrated out of the bladder, The sheath is then lubricated with lignocaine gel inside the trocar of the Add-a-Cath@ can be inserted into the and out, encircled around the catheter in situ (Fig. 2) sheath and guided back into the bladder using ultrasonand advanced into the bladder. The balloon of the ography, and the new catheter inserted. catheter is deflated and the catheter withdrawn, ensuring that the Add-a-Cath@ sheath remains static. A new Advantages catheter is fully inserted down the lumen of the sheath, This technique has been very successful and can avoid the need for general or spinal anaesthesia. For example, one patient who had three previous failures of routine change of suprapubic catheter necessitating admission and reinsertion under general anaesthesia, had subsequent replacement as an outpatient procedure. It is simple to perform and makes use of the existing fistulous tract, thus reducing the risk of urinary extravasation with further puncture sites.