Suprapubic bladder aspiration is the introduction of a
needle through the anterior abdominal wall and into the bladder
to obtain a urine specimen under strict sterile technique. It is
performed primarily to diagnose urinary tract infections.1–5 It
is most commonly performed in children under the age of 2 years
as part of the septic work-up. The procedure is quick, simple to
perform, safe, and has a low rate of complications. The main advantage
of suprapubic bladder aspiration is that it bypasses the urethra
and minimizes the risk of obtaining a contaminated urine specimen.
Urinary sampling remains the cornerstone for the diagnosis of
many disease processes including metabolic derangements, infectious
processes, catabolic states, and neoplastic conditions. In cases when
the usual means of voided urine collection or bladder drainage is
not possible or preferable, suprapubic bladder aspiration becomes
a viable option both therapeutically and diagnostically. If properly
performed, this technique can yield an uncontaminated urine sample
without urethral or skin flora contamination.
The urinary bladder of the neonate and infant begins as an abdominal
organ (Figure 122-1A). As the child
grows the pelvis enlarges and the bladder migrates down into the
pelvis. The bladder eventually assumes its retropubic position that
is maintained throughout life (Figure 122-1B).
Position of the bladder. A. The
bladder is an abdominal organ in the neonate and infant. B. The bladder is a pelvic organ in
the older child, adolescent, and adult.
The anatomic knowledge required to perform this procedure is
minimal. The pubic symphysis is in the midline and forms the anterior
border of the bony pelvis. The bladder resides posterior and superior
to the pubic symphysis in the young child. The needle will pass
through the skin and subcutaneous tissue of the lower abdominal
wall, the rectus sheath, the peritoneum, and the bladder wall.
The adult urinary bladder resides behind the pubic symphysis
and has both retroperitoneal and intraperitoneal attachments (Figure
122-1B). A working knowledge of this
anatomy makes percutaneous bladder manipulation both safe and possible.
The rectum lies just inferior and posterior to the urinary bladder.
This relationship must be kept in mind when attempting percutaneous
access. The bladder dome has peritoneal attachments and access in
this area carries the potential for bowel injury and intraperitoneal
Multiple major vascular structures, including the common iliac
and hypogastric vessels, reside in the bony pelvis alongside the
bladder. These structures are lateral to the bladder and eccentric
percutaneous access may result in troublesome hemorrhage.
Suprapubic bladder aspiration is the preferred method of urinary
sampling and drainage in instances where voided specimens are undesirable
or unattainable, and when urethral catheterization is not technically
possible or contraindicated.1–5 It offers the
examiner a viable means of obtaining an ...