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Suprapubic Cystostomy

at Cedars-Sinai Marina del Rey Hospital

The specialists at Cedars-Sinai Marina del Rey Hospital possess the vast knowledge required to treat patients with conditions like yours. For a suprapubic cystostomy, these specialists will use only the latest and the most advanced technology and techniques of treatment in order to improve the condition you are suffering from. Being a revolutionary procedure, at our facility in Los Angeles, you will make the most important step in your recovery.

Cystostomy is a term for the creation of a surgical opening into the urinary bladder. Suprapubic cystostomy or suprapubic catheterization refers to a procedure that helps drain the bladder and is indicated as an alternative when an individual is not able to urinate appropriately and urethral catheterization becomes either impossible or undesirable. In this procedure, a catheter, which is led out of the lower abdomen is introduced into the bladder in order to drain it. The two approaches by which suprapubic cystostomy can be performed are:

  • Open approach: An incision is made just above the pubic symphysis.
  • Percutaneous approach: The catheter is introduced directly through the abdominal wall, above the pubic symphysis, with or without guidance through ultrasound or visualization through flexible cystoscopy.

Suprapubic cystostomy procedure is considered in conditions when you cannot urinate and at the same time, urethral catheterization is not possible.

  • Acute urinary retention: A urethral catheter cannot be passed because of the enlarged prostate secondary to benign prostatic hyperplasia or prostatitis, urethral strictures, or bladder neck contractures as a result of previous surgery.
  • Narrowing of the urethra
  • Urethral trauma: Urethral disruption is associated with pelvic fractures or saddle-type injuries.
  • Complicated lower genitourinary infection: acute bacterial prostatitis with associated urinary retention, and in Fournier's gangrene, which requires several genitourinary debridement procedures, a urethral catheter may impede wound care.
  • Requirement for long-term urinary diversion: in patients with neurogenic bladder as a result of spinal cord trauma, stroke, multiple sclerosis, or neuropathy.

The procedure is also indicated if damage to the urethra needs to be avoided and if surgery should be done on the urethra or the surrounding structures.

The percutaneous suprapubic cystostomy procedure involves percutaneous placement of a suprapubic catheter either using a sharp, punch trocar or by means of different methods such as:

  • Localization of the bladder by palpation or by application of the Lowsley retractor
  • Seldinger technique using peel-away sheath introducer
  • Direct cystoscopic visualization
  • Direct ultrasonographic visualization

In most cases requiring percutaneous suprapubic cystostomy, local anesthesia is sufficient to manage the pain during the procedure. However, in patients with spinal cord trauma, general or regional anesthesia is used. In addition, for uncooperative patients, sedation may be added to local anesthesia.

In the majority of cases, a sharp obturator or trocar stylet is employed to obtain percutaneous access to the bladder. In other cases, the Seldinger technique may be used. A spinal needle is inserted to gain access to the bladder, followed by the aspiration of urine out of the needle. A guiding wire is passed through the needle, after which the needle is withdrawn and a catheter is advanced over the wire to reach the bladder.

Steps Involved in the Procedure 

Step 1: After anesthesia produces numbness in the area, the surgeon locates your bladder with the help of imaging guidance such as an ultrasound.

Step 2: Insertion of a needle into your lower abdomen and your bladder.

Step 3: A wire will be guided along the needle into the bladder to prepare the insertion of a catheter.

Step 4: A catheter will be inserted into the bladder overlying the wire. Then, the catheter will be sutured in place.

The entire procedure may last for about 10-45 minutes. Postoperative pain and discomfort may be managed with medicines.

Post-operative complications of suprapubic cystostomy are rare, but, as with any medical procedure, there may be some complications, which include:

  • Transient hematuria or bloody urine
  • Anesthesia reaction
  • Infection and bleeding
  • Formation of blood clots
  • Mucous or mucopurulent discharge around the exit site of the catheter
  • Bowel perforation and damage to other visceral organs in the abdomen

Restriction of your activities is important while you recover. You will be instructed on the hygiene measures to be followed to take care of the stoma, and the way to change the catheter and collection bag. You should take the medications such as pain relievers and antibiotics as advised by your surgeon. Call your doctor as soon as you come across problems such as pain or cramps, redness at the catheter site, catheter slips out, catheter failing to drain, changes in frequency, odor, appearance, or volume of urine, fever with chills, and bloody urine.