A suprapubic catheter (SPC) is a flexible, hollow tube inserted directly into the bladder through a small incision in the lower abdomen, positioned just above the pubic bone. The device serves as a method of urinary diversion, allowing the bladder to drain urine when the normal path through the urethra is blocked or compromised. While often chosen over a traditional urethral catheter for comfort, its long-term use (months or years) introduces significant challenges. The ongoing presence of this foreign body creates a chronic environment leading to long-term effects.
Chronic Urinary Tract and Systemic Infection
The presence of any long-term indwelling catheter means the urinary system is continuously colonized by bacteria, known as asymptomatic bacteriuria. This colonization occurs in nearly all patients after about 30 days because the catheter provides a surface for bacteria to adhere and form a protective biofilm. While this condition often does not cause immediate illness, it can easily progress to a symptomatic Urinary Tract Infection (UTI).
Recurrent symptomatic UTIs are a frequent long-term complication, often requiring repeated courses of antibiotics to manage. This cycle of infection and antibiotic treatment promotes the development of multidrug-resistant organisms (MDROs). The frequent use of antibiotics selects for germs resistant to multiple drug classes. MDRO infections are significantly more difficult to treat and are associated with worse outcomes, especially in long-term care settings. An uncontrolled UTI can rapidly ascend to the kidneys, leading to pyelonephritis, or progress to a life-threatening systemic infection called urosepsis.
Stoma Site and Skin Integrity
The stoma, the small opening in the abdominal wall where the catheter exits, is a chronic wound. Constant friction and moisture at this exit point often lead to chronic inflammation of the surrounding skin. A common physical reaction is the formation of hypergranulation tissue, or granuloma, an overgrowth of inflamed, fragile tissue that can bleed easily and cause discomfort.
Persistent drainage around the catheter is common, leading to skin maceration—the softening and breakdown of the skin due to excessive moisture. This compromised barrier becomes susceptible to localized skin infections like cellulitis or abscesses. Chronic irritation and inflammation of the stoma tract over many years, particularly in patients with long-standing SPCs, has been associated with the rare but serious development of squamous cell carcinoma (SCC) at the insertion site. Clinicians must remain vigilant for long-term changes.
Internal Bladder Changes and Foreign Body Reaction
The catheter is a foreign body inside the bladder, triggering reactions that worsen over time. One of the most frequent long-term complications is encrustation, where mineral deposits form a hard layer on the catheter’s surface. These crystalline deposits, fueled by the bacteria within the biofilm, can severely narrow or completely block the catheter’s drainage eyelets. Blockage is a common complication, often necessitating emergency replacement and leading to painful bladder distension.
The crystalline material that forms on the catheter can also shed into the bladder, acting as a nucleus for the development of bladder stones, or calculi. Bladder stones are a recognized long-term risk of chronic catheterization and can cause severe pain, bleeding, and further blockages. The presence of the catheter also causes chronic irritation to the bladder lining, frequently leading to painful and involuntary muscle contractions known as bladder spasms. Over extended periods, the constant drainage and lack of normal filling and emptying cycles can lead to chronic physiological changes, including a reduction in the bladder’s functional capacity or irreversible tissue changes like bladder wall fibrosis.
Quality of Life Implications
SPCs introduce psycho-social and daily living burdens. Patients often report chronic discomfort or pain related to spasms, stoma irritation, and the constant presence of a drainage bag. Maintaining the device is significant, involving scheduled catheter changes, supply management, and unplanned visits to the emergency department for blockages or infections.
The dependence on the device can affect self-image and limit physical activity, as certain movements or clothing choices must accommodate the tube and collection bag. Intimacy can also become complicated, adding strain to personal relationships. The overall lifestyle impact is notable, and patients may face psychological adaptation challenges, including anxiety or depression, related to device dependency and the fear of recurrent, unpredictable complications.