The transurethral suprapubic endo-cystostomy (T-SPeC): a novel suprapubic catheter insertion device

Abstract

Background and purpose: Current methods of suprapubic cystostomy (SPC) catheter insertion may be difficult for patients in poor health and can result in significant morbidity and mortality. These include a highly invasive open procedure, as well as the use of the percutaneous trocar punch methods, commonly associated with short-term SPC. We present the first human experience with the Transurethral Suprapubic endo-Cystostomy (T-SPeC(®)) device, a novel disposable device used for introducing a suprapubic catheter via a retrourethral (inside-to-out) approach similar to the Lowsley technique.

Patients and methods: Four men at St. Mary's General Hospital in Kitchener Ontario, Canada, received the T-SPeC device (model T7) under general anesthesia.

Results: Patients had no complications from catheterization using the T-SPeC T7 Surgical System. The mean surgical time of the four procedures was 9.7 minutes, with a range of 7.9 to 13.5 minutes, including instrument preparation and cystoscopy. All four procedures were highly accurate and rapid. There were no complications and minimal blood loss from the procedure.

Conclusions: We found that the T-SPeC device allows for efficient and safe insertion of a suprapubic catheter in an outpatient setting and may be a useful addition to the urologic armamentarium. The T-SPeC Surgical System facilitates rapid and precise suprapubic catheter placement.

FIG. 1.

Schematic of the T-SPeC Surgical System T7 device. The rear advancement handle advances the cutting blade (15F) from inside the bladder, through the bladder wall and abdomen, and pulls the catheter connected to the bayonet connector on the coaxial coil back through the surgical pathway for placement in the bladder. The locking mechanism in the rear handle locks the advancement handle, which controls the blade advancement. The mast guides the alignment guide arm down to the patient's abdomen before the creation of the surgical pathway. Abdominal thickness can be measured using the graduated mast. The positioning arm provides the surgeon with the blade exit point. The cutting blade makes a small incision (15F) through the bladder wall, fascia, and abdomen. It is housed within the sound and is deployed by the rear advancement handle. The capture housing accepts the surgical blade once it has passed through the patient's bladder wall and abdomen. The blade and capture housing can be removed for disposal by twisting the housing.

FIG. 2.

Surgical technique for the T-SPeC Surgical System. Insertion of the lubricated sound through the urethra (A). Angling of the sound toward the abdominal wall (B). Alignment of the positioning arm and blade capture housing (C). Advancement of the blade attached to a coaxial coil from the tip of the sound through the abdominal wall (D). Removal of the blade capture housing (E–F). Attachment of the catheter to the bayonet connector on the coaxial coil above the skin surface (G). The catheter visible at the meatus (H). Disengagement of the catheter by transection with scissors just above the bayonet connector (I). Visualization of the catheter tip in the bladder (J). Inflation of the catheter balloon with 10 mL of sterile water and cystoscopic confirmation of the balloon at the dome of the bladder (K–L). Anchoring of the catheter to the skin using a 3-0 nylon stitch (M).

FIG. 3.

T-SPeC Surgical System procedure time and accuracy. Procedure times for the four patients, as well as the mean time, are shown. The procedure time is broken down into cystoscopic bladder review, tray open/assemble, surgical procedure, and suture. Accuracy for the four procedures is shown in the lower right corner.