Suprapubic Cystos

Review Procedure
Suprapubic Bladder
Catheterization
(Percutaneous Cystostomy) LOGO

29 April 2009
Emergency Medicine Procedures

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www.themegallery.com

Contents
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1 II Introduction

2I Indications and Contraindications

3 Equipments

4 Patient Preparation and Techniques

5 Complications


Introduction
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 Complaint of lower genitourinary symptoms is
most common Urologic Problems
 Urine play role for diagnosis and management
 Transurethral is preferred method
 When the transurethral route is
contraindicated
 A Percutaneous approach becomes the solution


Introduction
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 Suprapubic bladder catheterization has
become the treatment of choice for the patient
with acute urinary retention
 Commonly performed in the trauma patient
with a known or suspected urethral injury
 Use local anesthesia
 It is a relatively safe procedure but does have
potential complications that are significant.


Indications
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 Iatrogenic urethral injuries
 Obstructing urethral lesions
 Bladder neck lesions
 Enlarged prostates
 Urethral strictures
 Urethral scarring
 Ubstructing phimosis
 Urethral foreign body
 Traumatic urethral or prostatic disruption


Contraindications
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 Patients with a coagulopathy
 Prior lower abdominal surgery

 Relative Contraindications
 History of pelvic cancer or pelvic radiation therapy,
ascites, urinary tract infections, or who are
uncooperative


Equipments
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 Percutaneous cystostomy catheter kit
 Foley catheter, 14 to 16 French
 60 mL catheter-tipped syringe
 10 mL syringes
 24 to 25 gauge spinal needle, 3 inches long
 No.11 Surgical scalpel blade on a handle
 3.0 nylon suture
 Needle driver
 Povidone iodine solution


Equipments
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 Local anesthetic solution, 1% lidocaine
 4x4 gauze squares
 25 gauge needle, 1 inch long
 18 gauge needle
 Urine meter or urine leg bag
 Sterile towels
 Sterile gloves
 Sterile drapes
 Tincture of benzoin
 2 inch tape
 Ultrasound machine (optional)

Patient Preparation
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 Risk and benefit discussion
 Obtain an informed consent
 Place the patient supine
 Apply povidone iodine solution to the lower
abdomen


Techniques
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 Seldinger Technique with a Peel-
Away Sheath

 Obturator Technique


TIPs
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 Midline has no vessels
 Don’t move needle it s might injure the
bladder


Aftercare
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 Secure the catheter to the abdominal wall
 Place 4x4 gauze squares over the pubic
symphysis
 Apply tincture of benzoin to the abdominal
wall and allow it to dry
 Tape over the catheter and gauze


Aftercare
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 Examine the puncture site twice a day for any
signs of infection
 If removed within 7 days, heal without
complications
 After 10 to 14 days, the tract is epithelialized
and mature
 The catheter may be exchanged through the
mature tract


Complications
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 Bowel perforation
 Intraabdominal viscera injury
 Uncontrolled hemorrhage
 Vascular injury
 Peritonitis
 Catheter misplacement


Suprapubic Cystos

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