Definition & Overview
A cystostomy is a procedure wherein the urinary bladder and the skin are surgically connected to drain the urine through a tube that comes out through the abdominal wall. It is necessary for patients who are unable to urinate normally due to bladder obstruction or other medical conditions that disrupt any part of the urinary tract or the normal functioning of kidneys resulting in urine retention.
The use of a cystostomy tube, also known as a suprapubic catheter, is one of the less invasive means of urinary diversion and can be used both temporarily and in the long term.
Who Should Undergo and Expected Results
Cystostomy is offered for patients those who suffer from the following medical conditions:
- Benign prostatic hypertrophy – This refers to a condition wherein the prostate gland becomes enlarged, causing either partial or complete blockage of the urine that passes through the urethra.
- Traumatic injury to the urethra, or the tube responsible for carrying urine out of the body
- Congenital defects of the urinary tract
- Kidney stones – Urinary retention is a serious complication of kidney stones or urinary tract stones, which occur as a complication of dehydration.
- Cancer – Malignant tumours that affect any part of the urinary tract can cause urine obstruction.
- Spinal cord injury – Any injury to the spinal cord can easily affect the muscles that make up part of the lower urinary tract
- Bladder neck contractures
- Urethral strictures
- Complex lower genitourinary tract infection
- Neurogenic bladder
- Any blockage due to inflammation
A cystostomy restores the patient’s ability to urinate to prevent any complications associated with urine retention.
However, there are contraindications for this procedure, such as coagulopathy, history of bladder cancer, pelvic cancer, or a previous abdominal surgery. Patients with orthopaedic hardware implanted due to a pelvic injury may also not be able to accommodate the suprapubic tubes safely and without complications.
How is the Procedure Performed?
Prior to the procedure, the patient will undergo a physical exam, imaging scans, blood tests, and urine tests.
The placement of a suprapubic catheter is a quick and easy procedure that does not require the use of specialised equipment. It can be performed either through an open or percutaneous approach.
In an open cystostomy, the surgeon makes a small infraumbilical incision above the pubic area to gain access to the urinary tract. In a percutaneous cystostomy, the surgeon injects a catheter directly through the abdominal wall, then uses ultrasound as a guide as he performs the rest of the procedure.
After the procedure, the catheter will remain in place while the tissue forms a tract between the bladder and the external surface of the body. Once the scar tissue successfully forms in the said tract, the catheter can be removed from time to time to prevent possible infections.
The entire procedure can take anywhere between 10 and 45 minutes, depending on which approach is used. Patients who undergo the percutaneous method may be able to go home on the same day, whereas open approach patients may need to stay in the hospital overnight.
Possible Risks and Complications
There are some potential complications associated with the procedure, such as:
- Tube obstruction
- Accidental dislodgement
- Damage to nearby structures including the bowel
- Blood clots
- Adverse reaction to anaesthesia
In order to prevent any complications from occurring in the long term, patients are taught how to handle their tubes and how to drain their bladder.
The risk of suffering from complications following a cystostomy is higher in patients who have a history of smoking and drinking, or underlying medical conditions, such as diabetes, obesity, bleeding disorders, and bladder cancer.
Neff D.M. “Suprapubic Cystostomy.” http://health.cvs.com/GetContent.aspx?token=f75979d3-9c7c-4b16-af56-3e122a3f19e3&chunkiid=620496
Aguilera PA., Choi T., Durham BA. (2004). “Ultrasound-guided suprapubic cystostomy catheter placement in the emergency department.” The Journal of Emergency Medicine. http://www.jem-journal.com/article/S0736-4679(03)00380-9/abstract