Malpositioned Suprapubic Catheter Results in Perforation of Penile Urethra and Septic Shock

Placement of suprapubic catheters (SPCs) has a relatively low complication rate and is well tolerated by most patients. Most complications take place during initial catheter placement or during replacement. Malposition of the catheter may cause serious damage to the bowel, bladder, or urethra. Care must be taken to ensure proper placement and functionality by the provider. We describe the case of a 66-year-old male with a history of neurogenic bladder and indwelling SPC presenting to the emergency department 36 hours after catheter replacement with bright red blood from the penile urethra, abdominal pain, fever, and hypotension. Computed tomography scan revealed that during replacement the SPC had passed into the penile urethra, with the bulb fully inflated causing rupture of the urethra with resultant sepsis. This case illustrates the importance of confirming SPC placement prior to bulb inflation and patient discharge.