Suprapubic bladder puncture
The suprapubic bladder puncture is a small diagnostic procedure used to obtain urine from the urinary bladder that is free of impurities from the urethra and the external genitals.
execution
The prerequisite is a bulging urinary bladder so that the peritoneum is lifted and not affected by the puncture needle. The filling of the bladder can be ensured by sonography, usually percussion and palpation are sufficient. After the skin has been disinfected, the puncture is carried out under sterile conditions in the midline, a cross finger above the pubic bone (“suprapubic”) with a needle with an outer diameter of only 0.6 mm and an attached 10 ml syringe. Prior local anesthesia is not necessary because the puncture needle is very thin and the puncture, which is performed quickly in one go, is almost painless. The aspirated urine is used for sediment analysis and urine culture.
Application area
The bladder puncture is performed almost exclusively in women, since it because of the - short urethra and its proximity to - compared to the man Vaginal - and anal area to contamination of a spontaneous midstream urine may occur. Discharge from the vagina and difficulties in obtaining “clean mid-stream urine” due to frailty, physical disability, severe obesity and other reasons can be causes of false positive results from jet urine. The puncture urine allows a clear distinction between a "pseudo-bacteriuria" or "pseudo-leukocyturia" from a urinary tract infection . In the case of a urinary tract infection, there is the possibility of delimiting the triggering germ from mixed flora as an admixture from the genital tract or anal area in order to initiate targeted antibiotic therapy.
The bladder puncture must not be performed if the bladder is not completely filled, adhesions in the lower abdomen and bladder tumors.
The use of a bladder puncture - in exceptional cases also a single urethral catheterisation - can in certain cases help avoid unnecessary treatments of simulated "urinary tract infections". In the case of catheterisation, however, there is in principle the possibility of introducing germs into the urinary bladder, in contrast to suprapubic bladder puncture.
The diagnostic bladder puncture must be differentiated from the discharge puncture in the event of urinary retention and from the puncture for the introduction of a suprapubic catheter for long-term urinary diversion in the event of an outflow problem below the bladder.
literature
- B. Grabensee: Checklist nephrology . Thieme-Verlag, Stuttgart-New York 1998, p. 18, ISBN 3-13-106331-9
- K.-M. Koch (Ed.): Clinical Nephrology . Verlag Urban and Fischer, Munich-Jena 2000, p. 88, ISBN 3-437-21730-5
- H. Koehler: Urinary tract infection . In "Wolff / Weihrauch: Internal Therapy. 2008/2009". Ed. TR Weihrauch, 17th edition. Urban and Fischer, Munich and Jena 2002, p. 683, ISBN 978-3-437-21804-0
- P. Fiegel, D. Höffler: Bladder puncture required . Deutsches Ärzteblatt, Volume 107, Issue 46, November 19, 2010, pp. 824-25