Suprapubic cystostomy
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suprapubic cystostomy, urinary diversion
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Suprapubic cystostomy
- 1. SUPRAPUBIC CYSTOSTOMY (SPC) Dr Bashir Yunus Surgery Resident AKTH 4/28/2015 bbinyunus2002@gmail.com 1
- 2. OUTLINE • DEFINITION • INDICATIONS • TYPES • PRE-OPERATIVE PREPARATION • PRE-INCISION • EXPOSURE AND PROCEDURE • CLOSURE • POST-OP MGT • COMPLICATIONS 4/28/2015 bbinyunus2002@gmail.com 2
- 3. DEFINITION • A form of urinary diversion, in which a self retaining catheter is placed into the bladder via the suprapubic region for purpose of draining urine. 4/28/2015 bbinyunus2002@gmail.com 3
- 4. INDICATIONS • Urine retention when urethral catherization fails. • Ruptured urethra • Urethero-cutenous fistulae • Periurethral abscess • Extravasation of urine • Chronic retention in neurogenic bladder 4/28/2015 bbinyunus2002@gmail.com 4
- 5. TYPES • OPEN OR PERCUTENEOUS • TEMPORAL OR PERMERNENT • EMERGENCY OR ELECTIVE 4/28/2015 bbinyunus2002@gmail.com 5
- 6. PRE-OP PREPARATION • History and examination for likely cause for the need of SPC • Investigation may depend on the indication; • Pcv, u/Ecr, clotting profile, Abd USS. • Informed consent • Pre-op shaving • Pre-op antibiotics 4/28/2015 bbinyunus2002@gmail.com 6
- 7. PRE-INCISION • ANAESTHESIA • Local • Spinal or • GA • POSITION • Supine • Surgeon, assistant and nurse scrub, and gowned. The skin is prepared; cleaning from the nipple line to the mid-thigh and draped exposing the suprapubic region 4/28/2015 bbinyunus2002@gmail.com 7
- 8. INCISION • Transverse incision along the skin crease 2 finger breadth above the pubic symphisis (heals better less likely to herniate) • Subumbilical median incision, 3-5cm long, 3cm from symphysis 4/28/2015 bbinyunus2002@gmail.com 8
- 9. EXPOSURE • The incision is deepened into the subcutaneous tissue; fascia camper and scamper, securing hemostasis. • Langenberg retractor placed and edges retracted to expose the rectus sheath • A nick is made on the rectus sheath transversely on the midline, artery forceps are placed on the cut lips and held by surgeon and assistant, the incision is extended on both sides laterally • The rectus sheath is freed from the rectus muscle by sharp dissection at the middle and blunt laterally. • The muscles are separated at the midline with artery forceps and the retractor repositioned and retracted laterally. 4/28/2015 bbinyunus2002@gmail.com 9
- 10. • The transversalis fascia, preperitoneal fat and peritoneum are carefully pushed upwards by guaze dissection until the bladder is exposed • The bladder is pale, thin wall vessels courses over the surface and can be aspirated with needle and syringe • The wall of the bladder is fixed with two stay sutures(silk 1-0) • Using electrocautery or knife, a transverse incision is made about 2cm distal to the fundus between the stay sutures. • The bladder is then emptied by suction • The interior explored with the finger to exclude calculi, diverticuli and tumour 4/28/2015 bbinyunus2002@gmail.com 10
- 11. • The suprapubic catheter is placed through the abdominal wall by a stab incision in the upper skin flap, inserted into the bladder. • The catheter is secured with a purse string (vicryl 2-0) • The balloon is then inflated • The catheter then anchored to the skin with nylon 2-0, before wound closure and continuous drainage established 4/28/2015 bbinyunus2002@gmail.com 11
- 12. CLOSURE • The wound is closed in layers with a drain in the prevescical space • Rectus is approximated with vicryi 2-0 • Rectus sheath nylon 1 • Skin with nylon2-0 • Wound is cleaned and dressed 4/28/2015 bbinyunus2002@gmail.com 12
- 13. POST OP MGT • Antibiotics • Analgesics • Monitoring urine output 4/28/2015 bbinyunus2002@gmail.com 13
- 14. COMPLICATIONS • Haematuria • Prevesical fluid collection • Surrounding organ injury • Catheter blockage • Encrustation and retained catheter • Dislogment • Skin site infection • UTI • Stone formation • Urothelial neoplasm 4/28/2015 bbinyunus2002@gmail.com 14
- 15. REFERENCES • E A BADOE ET AL ;PRINCIPLES AND PRACTICE OF SURGERY INCLUDING PATHOLOGY IN THE TROPICS, 4TH EDITION • FARQUHARSON’S TEXTBOOK OF OPERATIVE GENERAL SURGERY, 8TH EDITION • CAMBELL UROLOGY 4/28/2015 bbinyunus2002@gmail.com 15