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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.19 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 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 143-1A). 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 143-1B).

Figure 143-1.

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 143-1B). 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 bladder perforation.

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.110 It offers a means of obtaining an uncontaminated urine sample from ...

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