SUPRAPUBIC

CATHETERIZATION
ANDRIE RHOMDHON kURNIAWAM
Definition

Cystostomy
:

the insertion of a catheter into the

bladder via the anterior abdominal
wall.

(Mosbys Medical Dictionary 8th edition)

 Anatomy Abdominal Wall

CAMPBELL WALSH
UROLOGY 10TH ED. 2012
 Anatomy Abdominal Wall

CAMPBELL WALSH UROLOGY 10TH ED, 2012

 ANATOMY BLADDER

Located extraperitoneally
Vascular supply :
-internal illiac artery
a. vesicalis sup,
a. vesicalis medialis,
a. vesicalis inferior
-Obturator artery
-Inferior gluteal artery
3 surfaces :
Superior
2 inferolateral surfaces
Posterior

Grays Anatomy, 8th 2011

Urinary bladder relation with another
organs

(Ross and Wilson, anatomy and physiology, 2004)

 Indications

Urethral stricture

impacted urethral stone

bladder neck contractur

Suspicious Urethral Rupture

(BJUI guidelines.SPC practice guideline.2012)

Contraindication

Carcinoma of the bladder.

Carcinoma of the bladder.
Anticoagulation and antiplatelet treatment.
Anticoagulation and antiplatelet treatment.
Abdominal wall sepsis.
Abdominal wall sepsis.
The presence of a subcutaneous vascular
The presence of a subcutaneous vascular
graft
graftininthe
thesuprapubic
suprapubicregion
region(e.g.
(e.g.aafemoro-
femoro-
femoral
femoralcrossover
crossovergraft).
graft).

(Harrison, et al. BAUS SUPRAPUBIC CATHETER PRACTICE GUIDELINES. 2010)

Type

Trocar cytostomy
(percutaneus cystostomy)
Open cystostomy
TROCAR CYSTOSTOMY
Role

Palpable bladder
NO suspicious abnormal anatomy
of bladder, eg:
abdominal / pelvic surgical
procedure
posterior urethral rupture

(Harrison, et al. BAUS SUPRAPUBIC CATHETER PRACTICE GUIDELINES. 2010)

 Equipment

1. Trocar set
2. Hecting set
Half slot
3. Blade no 15
4. Povidone iodine 10%
5. Gauze
6. Silk 3-0
7. 10 cc syringe Obturator
8. Lidocaine 2%
9. Sterile linen
10. Urine catheter
11. Urobag
Trocar
12. Sterile water
13. Sterile gauze
14. jelly
Equipment
LOCAL ANESTHETIC

Administer local
anaesthetic
approximately 2 3cm
above the symphysis
pubis in the midline

www.NHS.UK
SMALL INCISION

make a small incision

at this point

www.NHS.UK
CREATE TRACK

inject local
anaesthetic along a
track from the skin
down to the bladder
perpendicular to the
www.NHS.UK
skin
feed the trocar to
the caudal, gently
push the trocar
into the bladder
with a twisting
action
 Remove the
obturator and
leave the slot.
Insert Foley catheter
through the slot
and inflate the
balloon, make sure
that the balloon
was fixed properly

Remove the slot

Sticth the skin and
put sterile dressing
Do Rectal Touche
Complication
Durante op:
Intravascular injection of LA
Bleeding
False route to peritoneal cavity

Early Postop:
Haematoma from LA

Late Postop
Infection of opening site
Hematuria
OPEN CYSTOSTOMY
INDICATION

When there was operation scar on

lower abdominal region
Posterior urethral rupture
Failure of trocar cystostomy
Equipment

Sterile linen
2 x 10ml Syringe
Desinfectant (Povidone Iodine 10%)
Foley Catheter size 18-20 Fr
Urobag
Plain 3-0
Chromic 2-0
Polypropylene 3-0
PGA 3-0
Sterile gauze
Doek clamp
Sterile gown
Equipment
 Knife 11 and 22 +
Metzenbaum

Minor Set,
sterile gloves

Langenback

Pean
Forceps Kocher Allis
clamp Clamp
STEPS

Patient in supine position

with general or regional
anesthesia
Desinfection with Povidon
Iodine 10%
Demarcated the operation
field

Start the midline vertical

incision 2 fingers above
the symphisis about 3-
(Hinmans Atlas of5cms
Urologic Surgery,3rd ed)
 Incise through
fascia, sharply
incised and
widened with the
scissors

(Hinmans Atlas of Urologic Surgery,3rd ed)

 Gently split the
muscle

(Hinmans Atlas of Urologic Surgery,3rd ed)

Extraperitoneal fat and
peritoneum overlying
the bladder seen
Reflect the peritoneum
upward with gauze
piece

(Hinmans Atlas of Urologic Surgery,3rd ed)

 Identify bladder
Take 2 stay suture
with plain 3-0
Put a stab incision
over the bladder
with No.11 knife

(Hinmans Atlas of Urologic Surgery,3rd ed)

 Widened the incision
field with retractors
Evaluate the bladder

(Hinmans Atlas of Urologic Surgery,3rd ed)

 Put a Foleys catheter.
Inflate the balloon with 10 ml
distilled water
Do the closure of the bladder
in 2 layer with plain catgut
for mucosa, and chromic for
serosa
Sticth the skin and put sterile
dressing
Do rectal touche
(Hinmans Atlas of Urologic Surgery,3rd ed)
 Complications of Cystostomy

Intraopera
Early Postop Late Postop
tive
Bleeding Hematuria Surroundin
g organ
injury
Other
infections
(Harrison, et al. BAUS SUPRAPUBIC CATHETER
PRACTICE GUIDELINES. 2010)
FOLLOW UP

Remove the suture on 5-7 days post op

Referred to urologist for correction of the
underlying disease
Routine cystostomy tube care (every 2
weeks)

(Harrison, et al. BAUS SUPRAPUBIC CATHETER

PRACTICE GUIDELINES. 2010)
THANK YOU