Chapter 174: Suprapubic Bladder Aspiration

INTRODUCTION

Suprapubic bladder aspiration is the insertion of a needle through the anterior abdominal wall and into the bladder to obtain a urine specimen. It is performed to either temporarily relieve urinary retention when the bladder outlet is obstructed and one is unable to place a transurethral catheter or to obtain a sterile urine sample for urinalysis.^1-10 It is most commonly performed in children under the age of 2 years as part of the septic work-up.⁷ 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. Suprapubic bladder aspiration is a viable option, both therapeutically and diagnostically, when the usual means of urine collection or bladder drainage is not possible or preferable. The technique can yield an uncontaminated urine sample without urethral or skin flora contamination.

ANATOMY AND PATHOPHYSIOLOGY

The urinary bladder of the neonate and infant begins as an abdominal organ (Figure 174-1A). As the child grows, the pelvis enlarges and the bladder migrates down into the bony pelvis. The bladder eventually assumes a retropubic position that is maintained throughout life (Figure 174-1B).

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 174-1B). 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. The bladder is attached to the anterior abdominal wall by the urachus which is a fibrous chord.¹¹ The posterior surface of the bladder is lined with the parietal peritoneum.¹¹ The bladder dome has peritoneal attachments and access in this area carries the potential for bowel injury and intraperitoneal bladder perforation. These relationships must be kept in mind when attempting percutaneous access of the bladder.

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 (i.e., off the midline) ...