[Bladder catheter or suprapubic fistula? Indications and contraindications].

Even in closed sterile transurethral catheter drainage, infections of the lower urinary tract are documented in 50% of cases after 1 week of indwelling catheter. Not all of these cases develop symptomatic catheter-associated urinary tract infection. Suprapubic catheter drainage of the bladder results in markedly later urinary tract infection, presenting 50% of patients infected on day 40. The markedly later onset of catheter-associated urinary tract infection makes the suprapubic approach to bladder drainage suitable for all those patients, who may need catheters for more than 3 days postoperatively. Transfusion-dependent bleeding after puncture in 2-4% of cases and perforation of adjacent organs in 0.3% are the main complications. Suprapubic insertion of a catheter is contraindicted in patients with bleeding disorders and in those with bladder cancer in their history.