Case report: Suprapubic bladder aspiration - an Innovative approach to manage urinary retention in the dying patient

Abstract

Suprapubic Bladder Aspiration (SBA) is commonly used for febrile children to obtain a urine sample to investigate pyrexia. We describe a case when it was used to avoid hospital transfer and overuse of medications for a patient who could not be catheterised due to pre-existing phimosis. Our patient was 92 years old and deteriorated over 5 days. His PPC/PPD was home. He was well supported in the community but had troublesome agitation in the last day of life. On examination he was pulling at his groin and a palpable bladder confirmed urinary retention. Three community professionals attempted urinary catheterisation without success. Midazolam 2.5 mg was given subcutaneously three times throughout the day with little effect. Reluctantly the family requested hospice admission due to his agitation and carer fatigue. After two further attempts to catheterise the patient at the hospice, we sought advice from the Urology team who suggested attempting SBA to avoid transfer to hospital. We obtained consent from the patient’s next of kin who agreed that the patient would prefer to remain at the hospice and would accept the small risks associated with the intervention. We marked 2–4 centimetres above the midline pubic symphysis, cleaned the skin and laid sterile towels. Four millilitres of 1% lidocaine (25-gauge needle) were used to infiltrate the skin and soft tissues. Under negative pressure we inserted a 21-gauge needle until urine was aspirated. We removed ~350 millilitres of urine with sequential 50 millilitre syringes. The insertion site was subsequently bandaged. The patient remained settled for his remaining time and did not require any additional pro re nata medications for agitation. He died comfortably 6 hours later. While Suprapubic Bladder Aspiration is not a first choice to manage painful urinary retention in agitated dying patients it could be considered when other methods have failed.