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Suprapubic Aspiration

Overview

Suprapubic aspiration and catheterization is a procedure to obtain uncontaminated urine from the urinary bladder.
It is easy to perform in the emergency department and is associated with minimal complications. Huze and Beeson first published this practice in 1956 as an alternative to more traditional methods of obtaining urine for analysis and culture.
Their findings suggested that suprapubic catheterization and aspiration was superior to clean-catch or transurethral (via catheterization) collection of bladder urine for bacteriologic study. The sensitivity of the aspirated urine for bacteriuria on urinalysis approaches 100% and is rarely associated with contamination.
In a study comparing contamination rates of various urine collection methods for children less than 24 months old, suprapubic catheterization had a contamination rate of 1% compared to 26% for clean-catch and 12% for catheterized specimens.

Relevant Anatomy

The adult bladder is located in the anterior pelvis and is enveloped by extraperitoneal fat and connective tissue. It is separated from the pubic symphysis by an anterior prevesical space known as the retropubic space (of Retzius). The dome of the bladder is covered by peritoneum, and the bladder neck is fixed to neighboring structures by reflections of the pelvic fascia and by the true ligaments of the pelvis. Conversely, the bladder of a child is an abdominal organ and contacts the lower two thirds of the abdominal wall between the symphysis pubis and the umbilicus. The bladder rapidly descends during the first few years of life and then slowly descends until approximately the 9th year of life when it approaches the adult position.

The body of the bladder receives support from the external urethral sphincter muscle and the perineal membrane inferiorly and the obturator internus muscles laterally (see the image below).

Gross anatomy of the bladder.

Gross anatomy of the bladder.

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For more information about the relevant anatomy, see Bladder Anatomy. See also Female Urinary Organ Anatomy and Male Urinary Organ Anatomy.

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