SUPRAPUBIC CYSTOSTOMY

Cystostomy is a procedure that is done to bypass the drainage system of the bladder. It consists of a silicone or latex tube, called a Foley catheter, that is inserted through the skin and the abdominal wall into the bladder.

This is usually done at the hospital as an outpatient procedure. More often it is done under a local anesthetic with IV sedation.

A cystostomy is indicated for:

1.       Recurrent urinary infections.

2.       Inability to empty the bladder completely.

3.       Leakage of urine.

Care of the suprapubic cystostomy:

1.  Initially when there is a recent wound around the catheter, this should be cleansed once every third day with soap and water. Neosporin can be applied and a gauze should be used to cover it. However, after the sutures are out, it would be much better to leave it to air day so there would be less chance of an infection.

2.  Because this catheter is a foreign body, there will always be a reaction which consists of red tissue and possibly some yellowish discharge around the catheter. This is a normal finding, and It should not be cultured or disturbed. One should not use hydrogen peroxide because this will prevent healing. After the sutures are removed, it is best to leave this open so it will dry up when exposed to air.

3.  Since the catheter is a foreign body, there will always be a urinary tract infection if we culture or do a microscopy on the urine. This is not a necessary thing to do because a little infection is expected and it will not cause, in my opinion, any harm to the patient. However, if chills and fever occur, then definitely a culture should be taken and antibiotics started.

4.  There is no need for prophylactic antibiotics. Prophylactic antibiotics are usually given to prevent infections before they start. The treatment usually consists of an antibiotic once a day given to patients who have suprapubic catheters. This however, should not be done because it will not help the situation and may even harm the patient if he or she gets infected with antibiotic-resistant bacteria.

5.              Fluids: Patient should be offered at least 60 ounces of fluids per day to keep the catheter from plugging often. This will also prevent calcifications from depositing on the catheter.

6.              Change of catheter: This should be done once a month or once every six weeks. Usually this can be done without difficulty by a member of the family that we can teach, or a nursing home staff member. It is important to note that if the catheter comes out and is not replaced within 24 hours, then surgery may be needed to replace it in the bladder.

7.  Suprapubic cystostomy is a reversible procedure. If a patient is having too many difficulties, then we can simply remove the catheter; and the wound will heal within 24 hours.

NOTE: After a stroke, some patients have nerve damage to the bladder. This may result in a bladder that is very lax and cannot push the urine out, or a spastic bladder that leaks urine constantly. In the first situation, a cystostomy usually works very well. However, if the bladder is spastic, then even when a patient has a cystostomy, he or she may still leak urine. Such patients are placed on a bladder relaxant. If this doesn't work, then they may have to have surgery to close the bladder neck so they will not continue leaking urine.