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 candidate for Cystostomy

  • 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

 Cystostomy pre-operation

  • STOP all aspirin and all aspirin-containing medicines from one week before surgery
  • STOP all nonsteroidal anti-inflammatory medications from two days before surgery

Your operation occurs near the bowels so your preparation involves an intermediate-level bowel prep, as follows.

  • 2-Bottles of or Neomycin Enemas
    • Night before
    • Morning of the surgery
  • Magnesium Citrate
  • 2-Fleets Enemas
  • DO NOT EAT any solid foods, including juices with pulp from 8 hours before your surgery
  • Children under 5 years of age are to be given a bath using an over the counter antibacterial soap.
  • Minors (anyone less than 18 years old) must be accompanied by a parent or legal guardian to sign the operative consent fount

Cystostomy procedure

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.

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.

Cystostomy recovery and post-op

  • No heavy lifting (more than 15 lbs.) for 4 weeks
  • Use the stairs infrequently. Take one step at a time, and have assistance available.
  • No sexual activity for 6 weeks after surgery.
  • Resume a regular diet at home. Take high calorie supplements if appetite is poor.
  • If you have a special diet secondary to Diabetes, Renal Disease, Liver Disease, etc. you may resume eating when tolerated.

Cystostomy Risks

  • Leakage
  • Infection
  • Irritation
  • Tube obstruction
  • Accidental dislodgement
  • Damage to nearby structures including the bowel
  • Blood clots
  • Adverse reaction to anaesthesia