Suprapubic Catheter Drainage for the Definitive, Long-term Management of Lower Urinary Tract Dysfunction: Utilization Patterns and Longitudinal Outcomes.

[OBJECTIVE] To determine the utilization patterns and long-term outcomes of suprapubic catheterization for the definitive management of refractory lower urinary tract dysfunction (LUTD).

[MATERIALS/METHODS] All patients undergoing suprapubic catheterization (SPC) placement by either a urologist or an interventional radiologist for the definitive (long-term) management of LUTD with a minimum of 2years of clinical follow-up were included in the study. The primary outcome of interest of SPC discontinuation. Secondary outcomes were both short-term (<30 days) and long-term SPC complications (Clavian-Dindo classification), and the use of ancillary LUTD treatments. Patient, SPC, and urinary tract variables were assessed to determine their relationship to SPC discontinuation.

[RESULTS] There were 222 patients that met study criteria. Short (30.2%) and long-term (59.9%) complication rates were high, though Clavian-Dindo Grade III or greater were uncommon (4.5% and 23%, respectively). Ancillary LUTD treatments were used in 46%. The SPC discontinuation rate was 13.9% at a median of 12 months. Univariate predictors of discontinuation were the absence of ancillary LUTD treatments (OR 56.8; P<.0001) and initial SPC placement by interventional radiology (IR, vs urology) (OR 2.03; P<.01).

[CONCLUSION] SPC placement was demonstrated to be safe with no procedurally related bowel injuries or deaths. However, short- and long-term complications rates were high, though mostly minor. Discontinuation rates were low and associated with the absence of ancillary LUTD treatments and initial SPC placement by IR. Initial placement of a larger SPC in a strategic location and the anticipated and proactive use of ancillary LUTD management strategies (eg, anti-cholinergics, Botox) may increase SPC longevity.