Cystostomy: definition, technique. Patient care after surgery
Cystostomy is an operation to create a cystostomy - a connection between the bladder and the external environment for urine drainage. A cystostomy is an opening in the wall of the abdomen and bladder through which a tube is inserted into the bladder cavity.
Testimony
Urine normally accumulates in the bladder and is then excreted due to the contraction of the detrusor of the bladder and the relaxation of its sphincter.
Cystostomy of the urinary bladder in men and women is performed when it is difficult to pass urine naturally through the urethra. The reasons may be:
- benign and malignant tumors (in particular, prostate adenoma in men);
- hypertrophy (growth) of the mucous membrane of the urinary bladder;
- scars of its wall;
- atonia (absence of normal tone) of the bladder wall;
- neurological disorders due to which the bladder wall loses its ability to contract.
Cystostomy is performed in the operating room or dressing room. A disposable sterile trocar cystostomy kit is usually used. In critical cases, if there are difficulties with transporting the patient, cystostomy can be performed in a hospital ward or at home.
Preparation
Preparation for cystostomy is simple:
- taking a shower;
- if necessary – emptying the large intestine naturally;
- shaving hair in the pubic region and suprapubic region of the front abdominal wall.
Puncture of the urinary bladder with a trocar is an invasive manipulation, therefore, before cystostomy, the patient is examined:
- general blood test;
- blood sugar analysis;
- general analysis of urine;
- ultrasound examination of the bladder;
- coagulogram.
Technique of bladder puncture with a trocar
For complete outflow of urine from the bladder, a trocar cystostomy is performed. This is a puncture of the walls of the abdomen and bladder with the help of a trocar - a surgical tool similar to a screwdriver with an attached hollow tube.
For trocar cystostomy, local anesthesia is used using novocaine, lidocaine or their modern analogues. The position of the patient is lying on his back.
Technique of suprapubic cystostomy in women and men:
- a catheter is inserted into the bladder through the urethra and the bladder is filled with furacilin through it. This is necessary so that the wall of the bladder gets closer to the front abdominal wall - so during the procedure you can avoid traumatizing the loops of the intestine;
- perform analgesia;
- a small skin incision is made in the suprapubic area - to facilitate trocar insertion;
- the surgeon inserts the end of the trocar into this wound and, with a sharp movement, punctures the deeper layers of the anterior abdominal wall and bladder wall, plunging the trocar tube into the lumen of the bladder. The puncture should be done under the control of the index finger of the hand holding the trocar - the finger inhibits too deep penetration of the trocar;
- the stylet is pulled out, a cystostomy catheter is inserted into the trocar tube (it is called a Foley catheter and is a rubber tube);
- the trocar is pulled out;
- the catheter is sewn to the skin with several stitches so that it does not slip out of the bladder.
Possible complications
The procedure for applying a cystostomy is technically simple. But during its implementation, some complications may arise:
- bleeding due to damage to blood vessels passing through the site of cystostoma formation;
- injury of the intestinal loop;
- injury of the opposite wall of the bladder.
Thanks to the filling of the bladder, the chance of such complications is small.
Course of the postoperative period
Care for the patient after surgery consists in caring for the postoperative wound, which is treated based on the general principles of antiseptics. Also, after performing a cystostomy, it is necessary to monitor the condition of the cystostomy and the efficiency of urine outflow through the catheter.
Pain after puncture cystostomy is an indication for prescribing painkillers.
The doctor determines the time after which the catheter should be removed.
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