Suprapubic Cystos

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Review Procedure

Suprapubic Bladder

Catheterization (Percutaneous Cystostomy)

29 April 2009Emergency Medicine Procedures

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www.themegallery.com

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Contents

II Introduction1

I Indications and Contraindications2

Equipments3

Patient Preparation and Techniques4

Complications5

LOGOIntroduction

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


LOGOIntroduction

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.


LOGOIndications

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


LOGOContraindications

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


LOGOEquipments

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


LOGOEquipments

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)


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LOGOPatient Preparation

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

abdomen


LOGOTechniques

Seldinger Technique with a Peel-Away Sheath

Obturator Technique


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LOGOTIPs

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

bladder


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LOGOAftercare

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


LOGOAftercare

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


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LOGOComplications

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


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Health & Medicine

Suprapubic Cystos