Bladder Puncture – Definition, Procedure & Use
Bladder puncture is a medical procedure used to collect urine directly from the urinary bladder through the abdominal wall. It is used for both diagnostic and therapeutic purposes.
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Bladder puncture is a medical procedure used to collect urine directly from the urinary bladder through the abdominal wall. It is used for both diagnostic and therapeutic purposes.
What is a Bladder Puncture?
A bladder puncture (also called suprapubic bladder puncture or suprapubic aspiration) is a medical procedure in which urine or fluid is withdrawn directly from the urinary bladder using a hollow needle. Access is gained through the abdominal wall above the pubic bone (suprapubic region). The procedure is performed for both diagnostic and therapeutic purposes.
Indications
A bladder puncture is performed in a variety of medical situations:
- Sterile urine collection: When an uncontaminated urine sample is required for microbiological testing and cannot be obtained by normal voiding -- for example, in suspected urinary tract infections, especially in infants and young children.
- Urinary retention: In cases of acute or chronic urinary retention when the patient is unable to urinate and urethral catheterization is not feasible or appropriate.
- Suprapubic catheter placement: As an alternative urinary drainage method to urethral catheterization in cases of prolonged urinary retention or following pelvic surgery.
- Therapeutic drainage: To relieve pathological fluid accumulation in or around the bladder.
Preparation and Procedure
Before the procedure, the bladder must be sufficiently full to allow safe puncture. Bladder filling is routinely confirmed by ultrasound examination. The procedure typically follows these steps:
- Disinfection of the skin in the lower abdominal area above the pubic bone
- Local anaesthesia of the puncture site using a local anaesthetic
- Insertion of the hollow needle through the abdominal wall into the bladder under ultrasound guidance
- Withdrawal of urine or placement of a suprapubic catheter
- Covering the puncture site with a sterile dressing
The procedure is generally brief and well tolerated. It can be performed on an outpatient or inpatient basis.
Risks and Complications
Bladder puncture is a safe procedure with a low complication rate when performed by experienced clinicians. Possible risks include:
- Bleeding: Minor bleeding at the puncture site or into the bladder may occur.
- Infection: Despite sterile technique, local infection can rarely develop.
- Injury to adjacent structures: In rare cases, bowel loops or blood vessels may be inadvertently injured, particularly if the bladder is not adequately filled.
- Discomfort: Mild pain or pressure at the puncture site following the procedure.
Aftercare
Following a single diagnostic bladder puncture, no special aftercare is usually required. If a suprapubic catheter is inserted, it requires regular care and periodic replacement. Signs of infection such as redness, swelling, or fever should be reported to a healthcare provider promptly.
Bladder Puncture in Infants and Children
In infants and young children, suprapubic bladder puncture is the preferred method for obtaining sterile urine samples, as urethral catheterization in this age group is technically more challenging and distressing. The procedure in this population is also performed under ultrasound guidance and is generally well tolerated.
References
- Deutsche Gesellschaft fuer Urologie (DGU): Guidelines on the Diagnosis and Treatment of Urinary Tract Infections. AWMF Registration No. 043-044, 2017.
- Hautmann R., Gschwend J.E.: Urologie. 5th edition. Springer Medizin Verlag, Heidelberg, 2014.
- Larcombe J.: Urinary tract infection in children. BMJ Clinical Evidence. 2015;2015:0306.
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