Suprapubic Cystostomy

A 93-year-old man with advanced prostatic cancer had a 1000 ml urinary retention (video Residual Urine Volume (Ultrasonography)), hydronephrosis (video Hydronephrosis and Hydroureter), and an increased plasma creatinine level. If a ultrasonography device is available, check the position and volume of the bladder before the procedure. The puncture site is anaesthetized with a long needle. Make sure that the needle is in the bladder by aspirating urine. The cystostomy catheter is inserted into the needle up to the first position mark. Make a stab incision into the skin to facilitate the penetration of the cystostomy needle. Insert the needle into the bladder with a brisk thrush - if inserted too slowly, the point of the needle may push the bladder wall towards the back wall. About 2/3 of the catheter lenght is inserted into the bladder, after which the needle is pulled back and cleaved. If the catheter has no balloon, fix it to the skin with a firm stitch. If the catheter has an inflatable balloon, inflate it and push the catheter back gently until the balloon prevents further pulling. If the urine becomes bloody, keep pulling for about 5-10 min to compress the site of puncture in the bladder wall with the balloon. For catheter replacement see video Replacing a Cystostomy Catheter Using a Guide Wire)

Suprapubic Cystostomy