Suprapubic urinary drainage in gynecologic surgery

Abstract

Instrumental drainage of the distended bladder has been practiced since before the days of Hipprocrates, and the suprapubic approach was well known to the earliest physicians [I]. This method of management was applied mainly in situations of acute retention. Its use in routine urologic and gynecologic surgery is a much more recent practice. Suggestions concerning suprapubic drainage, and its subsequent acceptance, are almost totally British in origin. Walker [Z] in 1917 first advocated suprapubic drainage. His report, however, received little attention until Riches’ publication [3] in 1943. This was followed by Scorer’s report [4] in 1953 of experience with 200 male patients; Cameron [5], again reporting on male patients, first recommended the small caliber plastic tube in 1963. Gynecologists throughout the world have practiced transurethral drainage for years, and the introduction of the Foley catheter was enthusiastically received since it greatly simplified retention catheterization. The Foley catheter with its various modifications has been preferred as a method of bladder drainage in pelvic surgery since 1937 [2]. Emphasis on a closed, bacteria-occlusive system and, more recently, the addition of bacteria-filtered air vents has satisfied most gynecologists [6]. Gravity and an open system were used until 1959 when studies by Kass and Sossen [7] demonstrated the benefits of a closed bacteria-free system. They showed that significant bacteriuria, ie, 105, would develop in 98 per cent of patients if a catheter was left in place four days or longer. They further reported a high incidence of bacteriuria after even a single catheterization and therefore recommended midstream clean-catch urine collection