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Cystostomy means the insertion of a catheter through the lower part of the abdominal wall into the bladder. It is commonly called supra pubic fistula (SPF).
It is a life saving procedure in some cases. It is used both for diagnostic reasons as to inject the bladder with contrast dye, to measure the pressures inside the bladder or verify a fluid collection inside the bladder in women (after exclusion of pregnancy). It is used frequently in the treatment of urinary retention as in the inability to evacuate the bladder incases of enlargement of the prostate, injury to the urethra or after operations.
It is also considered as a safety valve to evacuate the bladder after urological operations and until the patient is able to evacuate the bladder spontaneously himself.
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bladder catheter set
Who qualifies for the operation?
Children who have operation to the urethra, patients with urinary retention due to whatever reason and in some cases of prolonged catheterization and hospitalization.
How does the operation work?
The insertion of a catheter into the bladder through the lower abdominal wall is a simple procedure which requires experience. The urologist must exclude pregnancy of the female patient in the first instance. The bladder must be filled with at least 300 ml of fluid or urine.
The patient leys on his back. The lower abdominal area is shaved and disinfected. The bladder is filed with 300 ml of saline if not well filled, felt or seen at the lower abdominal area. The bladder is controlled with ultrasonography. The area above the symphesis bone and the tract of the puncture are infiltrated with local anaesthesia. A special needle containing a balloon catheter is inserted through a small wound to the bladder under ultrasonography control. When urine appears, the needle is withdrawn and the catheter is connected to a urine bag. The balloon of the catheter is filled with distilled water and the catheter is fixed to the skin. The wound is dressed as usual.
It is important that the urologist be sure that the catheter is in the bladder through the clear urine coming out of the catheter. The catheter drains bloody urine sometimes. This is due to the dilated veins which rupture when the pressure inside the bladder gives up suddenly.
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bladder catheter set
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hygienic catheter valve
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nephrostomy catheter
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hygienic catheter valve
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Frequently asked questions (FAQ):
- Is the insertion of a supra pubic fistula (SPF) an outpatient procedure?
Yes, it is a simple outpatient procedure which is done in local anaesthesia.
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- How can you reach the bladder through the lower abdominal wall?
The bladder leys insides the pelvis and it is limited above by the abdominal coverings. When it is filled it distends outside the pelvis and becomes superficial and visible. The urologist can feel it through the abdominal wall and can puncture it through this way.
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- What are the possible complications of this operation?
There may be bleeding, injury to the prostate or failure to puncture the bladder.
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- Is it harmful to puncture through the prostate?
It is very rare. It happens only when the prostate is very big and the bladder is not distended enough. This complication is easily avoidable.
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- Is the suprapubic catheter also possible for women?
Yes, provided that they are not pregnant.
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- Can one live with the SPF?
Yes, many of the patients with enlarged prostate can live with the catheter provided that it is changed every 6 weeks to prevent the deposition of Calcium around it. The catheter is connected to a urine bag and is inserted in a special trouser to be invisible. It is possible also to close the catheter with a special plug and to move around. When there is a sensation of full bladder, you can evacuate the bladder over the SFP by removing its plug.
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- How can you prevent Calcium deposition around the catheter?
This is done through the intake of urine acidifiers and the change of catheter every 6 weeks.
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- What are the alerting signals of complications?
Most important is the wetting of the dressing, fever and the observation that no urine comes out.
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