Surgical Insertion of Suprapubic Catheters in Patients with Neurogenic Lower Urinary Tract Dysfunction: An Old Method Revisited.

Introduction
Although intermittent catheterization is the gold standard for bladder evacuation in patients with neurogenic lower urinary tract dysfunction (NLUTD), an increasing number of patients are not able to perform this procedure and require indwelling catheters. Insertion of a suprapubic catheter (SPC) is usually done percutaneously. Due to comorbidities, this minimally invasive approach is not possible in all patients. We describe the results of a case series of patients in which the SPC was inserted by laparotomy.Methods
In a retrospective chart analysis, we evaluated the complication rates, clinical course, and urodynamic results in patients with NLUTD undergoing autologous SPC insertion by laparotomy at our institution.Results
The data of 24 patients who underwent this procedure could be analyzed. In 1 patient, SPC placement was not possible with this technique. After a median follow-up of 37 months, all patients were still equipped with an SPC. In 3 patients, surgical re-insertion was required. One patient used an additional transurethral catheter due to incontinence despite SPC. Postoperative complications occurred in 5 patients (20.8%), which required surgical interventions in 3 patients (12.5%) (wound revision and transurethral coagulation).Conclusion
In our case series, SPC insertion by laparotomy is a safe and well-tolerated procedure with satisfying long-term results in patients with NLUTD who otherwise would have been dependent on transurethral catheters. This technique should, thus, be considered in carefully selected patients.