Suprapubic cystostomy
Encyclopedia
A suprapubic cystostomy (also known as a vesicostomy or epicystostomy) is a surgically-created
connection between the urinary bladder
and the skin which is used to drain urine
from the bladder in individuals with obstruction of normal urinary flow. Urinary flow may be blocked by swelling of the prostate (benign prostatic hypertrophy), traumatic disruption of the urethra
, congenital defects
of the urinary tract, or by obstructions such as kidney stones passed into the urethra, and cancer
. It is also a common treatment used among spinal cord injury patients who are unable or unwilling to use intermittent catheterization to empty the bladder, and cannot otherwise void due to detrusor sphincter dyssynergia.
Initially, a thin tube (catheter
) is placed through the skin just above the pubic bone into the bladder, often with the assistance of ultrasound
imaging. This catheter initially remains in place for up to a month while the tissue around it scars and forms a tract (sinus
) between the bladder and the body exterior. After the formation of scar tissue is complete, the catheter is replaced periodically in order to help prevent infection
s.
Indications for suprapubic catheters include: 1. failed urethral catheter, 2. long term usage (if left in urethral long terms catheters can lead to acquired hypospadias and recurrent/chronic UTIs, urinary tract infection
s)
Contraindications: 1. need to rule out bladder cancer in cases of clot retention, 2. lower abdominal incisions with likelihood of adhesions, 3. pelvic fracture
Complications: 1. UTIs 2. Blockage 3. Bladder Stones 4. Bladder cancer 5. bypass track by urine
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
connection between the urinary bladder
Urinary bladder
The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
and the skin which is used to drain urine
Urine
Urine is a typically sterile liquid by-product of the body that is secreted by the kidneys through a process called urination and excreted through the urethra. Cellular metabolism generates numerous by-products, many rich in nitrogen, that require elimination from the bloodstream...
from the bladder in individuals with obstruction of normal urinary flow. Urinary flow may be blocked by swelling of the prostate (benign prostatic hypertrophy), traumatic disruption of the urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...
, congenital defects
Congenital disorder
A congenital disorder, or congenital disease, is a condition existing at birth and often before birth, or that develops during the first month of life , regardless of causation...
of the urinary tract, or by obstructions such as kidney stones passed into the urethra, and cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
. It is also a common treatment used among spinal cord injury patients who are unable or unwilling to use intermittent catheterization to empty the bladder, and cannot otherwise void due to detrusor sphincter dyssynergia.
Initially, a thin tube (catheter
Catheter
In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...
) is placed through the skin just above the pubic bone into the bladder, often with the assistance of ultrasound
Ultrasound
Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...
imaging. This catheter initially remains in place for up to a month while the tissue around it scars and forms a tract (sinus
Sinus (anatomy)
Sinus is Latin for "bay", "pocket", "curve", or "bosom". In anatomy, the term is used in various contexts.A sinus is a sack or cavity in any organ or tissue, or an abnormal cavity or passage caused by the destruction of tissue...
) between the bladder and the body exterior. After the formation of scar tissue is complete, the catheter is replaced periodically in order to help prevent infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
s.
Indications for suprapubic catheters include: 1. failed urethral catheter, 2. long term usage (if left in urethral long terms catheters can lead to acquired hypospadias and recurrent/chronic UTIs, urinary tract infection
Urinary tract infection
A urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...
s)
Contraindications: 1. need to rule out bladder cancer in cases of clot retention, 2. lower abdominal incisions with likelihood of adhesions, 3. pelvic fracture
Complications: 1. UTIs 2. Blockage 3. Bladder Stones 4. Bladder cancer 5. bypass track by urine