Limited high quality data exists on the risks of complications associated with suprapubic catheter (SPC) insertion. Bowel injury (BI) is a well-recognised albeit uncommon complication. UK Guidelines on the insertion of SPC have been developed by the Birtish Association of Urolgical Surgeons (BAUS), but there remains little evidence regarding  the incidence of this complication. 

This study uses contemporary UK data to assess the incidence of SPC insertion and the rate of bowel injury. We also perform a systematic review and  meta-analysis of available research worldwide on BI rates from SPC insertion.

National Hospital Episodes Statistics data was searched on all SPC insertions in the UK over an 18 month period for OPCS Code M38.2 (Cystostomy and insertion of suprapubic tube into bladder). Patients age, 30 day readmission rates, 30 day mortality rate and catheter specific complication rate were collected. Cause of death was not collected. 

To estimate bowel injury rate, we searched patients who had undergone any laparotomy or bowel operation within 30 days of SPC insertion. Trusts were contacted directly and directed to ascertain whether there was SPC related bowel injury. 

PubMed search to identify papers reporting on SPC related bowel injury was performed for meta-analysis. We excluded expert opinion, case studues, individual reviews and oncluded only those that reported bowel injury rate.

A total of 11,473 SPC insertions took place in the UK in this 18 month time period. Of all SPC insertions 64% were elctive, 34% emergency and 2% unknown. 141 cases had laparotomy within 30 days accross 80 different NHS trusts (some at sime time as SPC insertion). Responses from 114 of these cases reported one bowel injury related to SPC insertion. The bowel injury rate in this large, comtemporary UK series was therefore 1 in 11,473.

Meta-analysis showed a BI rate of 0-2.7%. Studies published before 2012 had a higher rate of BI (0-2.7%) than those after 2012 (0%). An overall bowel injury rate of 11/1490 (0.7%) was seen.

This is the largest data set reported on SPC insertions showing a lower than previously reported rate of bowel injury from SPC insertion. 

We acknowledge limitations to this study. Data are missing for 27 of the 142 laparotomies performed, and the rate of bowel injury may therefore be understimated. However, even if it was assumed that all these cases had a BI (which is unlikely) the BI rate would still be in line with recent studies at 0.24% (28/11,473).

We recommend clinicians use a risk of bowel injury of less than 0.25% when counselling low-risk patients about SPC insertion.