With some diseases of the genitourinary system of various etiologies, people are not able to go to the toilet in a small way on their own. One of the most effective methods of urinary excretion is trocar epicystostomy. During the surgical operation, an incision is made in the lower part of the abdominal cavity and a special catheter is installed, which is connected to the urinal. Such a measure can act as both a temporary and permanent solution to the problem. Let's take a closer look at what this modern technique is, how it is carried out and for what purposes it is used.
When is a urinal installed?
The main cause is acute urinary retention (ICD code 10 - Z93.5). This problem can develop in people as a result of a variety of factors, but among the main doctors are the following:
- mechanical urethral block;
- bladder dysfunction;
- constant stay in stressful situations;
- psychosomatic disorders;
- inflammatory lesions of the pelvic organs;
- spinal or brain injury;
- various infectious and viral diseases.
Regardless of the cause, the only treatment is to insert a urinary catheter, since medical therapy for paradoxical ischuria is powerless.
Indications for surgery
Let's take a closer look at this. Trocar epicystostomy is one of the most common methods of treatment used in modern urological practice. This is due to the fact that it allows you to effectively solve a huge number of problems. Among the main indications for the appointment, the following can be distinguished:
- acute ischuria, in which the release of urine in a natural way is impossible;
- urinary retention caused by emotional shock;
- formation of blood clots or purulent plugs;
- mechanical damage to the bladder;
- benign prostatic hyperplasia;
- cancer;
- urethritis;
- various bladder pathologies;
- need for medication;
- emergency flush;
- treatment of some gynecological diseases in women;
- perinatal diagnosis of anomalies.
For any of the above problems, bladder drainage can improveremoval of accumulated urine and improve the patient's well-being.
Contraindications for catheter insertion
This aspect should be given special importance. Despite its effectiveness, epicystostomy may not be performed in all cases. Here it is necessary to take into account the clinical picture and the diagnosis of each patient. Among the main contraindications, qualified specialists distinguish the following:
- low bladder capacity;
- cystitis and paracystitis, occurring in an acute form;
- blockade of the urethra by blood clots;
- bladder cancer;
- contracted sphincter;
- large scars;
- groin hernia;
- omission of the urea;
- acute urethritis;
- excessive obesity.
If a patient has any of these problems, the doctor selects alternative methods of treatment based on the clinical picture and laboratory results.
What is required for surgery?
This treatment is not free. It is rather difficult to name the specific amount that the operation will cost. It all depends on what medications and procedures the patient will need for the rehabilitation period. For surgical intervention, you need to buy a set for trocar epicystostomy. Includes:
- cystostomy catheter;
- introducer needle with mandrel;
- retainer;
- syringe;
- disposablescalpel;
- clip.
In addition to the main set, a fixing bandage will also be needed, which is applied to the patient after the installation of the catheter and urinal.
How is a bladder epicystostomy performed?
Let's take a closer look at this. Surgical intervention for acute urinary retention is no longer aimed at improving the well-being of a person, but at saving his life. After all, if there is a rupture of the bladder, it will lead to a very painful death. Doctors resort to epicystostomy in cases where it is not possible to install a urinal for any reason in the standard way.
As mentioned above, the patient is made an incision on the abdomen and a special trocar catheter is installed. It is not only responsible for removing waste fluid from the body, but also allows you to enter medicinal solutions in the treatment of various diseases.
Surgical intervention is carried out in stages. However, before performing it, the doctor needs to familiarize himself with the medical history, as well as obtain the results of some additional tests. This is necessary in order to select the most appropriate therapy program and reduce the likelihood of complications. The technique of trocar epicystostomy is as follows:
- The surgeon makes a small incision just below the navel.
- A urine catheter is inserted between the muscle fibers and inserted into the bladder.
- A drain tube is inserted through whichexcrete urine.
- The patient is sutured and a sterile dressing is applied.
The operation is performed using a cystoscope, thanks to which all actions are performed with high accuracy.
Flaws of the procedure
In acute urinary retention (ICD code 10 - Z93.5), epicystostomy is by far the most effective treatment. However, this method is not ideal. It also has certain disadvantages. According to qualified specialists, the main one is the increased sensitivity of the skin around the catheter. But here the patients themselves are most often to blame, who do not adhere to basic hygiene standards. If you take good care of yourself, then the syndrome disappears on its own after a while. It also happens that some area at the incision site loses sensitivity, but it returns after the catheter is removed. Also, certain difficulties during the operation arise when the patient has problems with obesity. It is very difficult to insert a tube through a large layer of adipose tissue.
Consequences of the operation
In medical practice, there are cases when, after trocar epicystostomy, urine is still poorly drained from the bladder. If you do nothing and do not go to the doctor for a long time, then this is fraught with the following problems:
- development of an infectious disease;
- acute pyelonephritis;
- kidney inflammation.
A special cause for concern and a good reason to see a doctormay become intense and pronounced symptoms. Among the most disturbing are the following:
- high body temperature;
- acute abdominal pain;
- cloudy urine with an unpleasant odor;
- reddening of the skin around the catheter;
- purulent discharge.
It is also worth consulting with a specialist if urine does not enter the urinal for a long time. This is especially true in cases where bladder catheterization was performed in women bearing a child. Congestion and inflammation can adversely affect pregnancy and endanger it.
Common patient mistakes
After trocar epicystostomy, patients must follow certain rules so that the rehabilitation period passes very quickly and without unnecessary problems. The main one is flushing the catheter. According to doctors, for this, people use various antiseptics, which is strictly prohibited, since this creates a high risk of infection. If urosepsis begins, accompanied by an inflammatory lesion of the bladder, this can be fatal even if you go to the hospital in a timely manner.
Rules of care
One of the most important aspects of any surgical intervention is rehabilitation. But it depends not so much on the skill level of a specialist, but on the patient himself and his compliance with all prescriptions. For recovery to take placenormal, special care required after trocar epicystostomy.
Drainage and catheter are made of special inert materials, however, they are still perceived by the body as foreign bodies, so there is a high probability of rejection or an allergic reaction, which, in turn, can lead to anaphylactic shock. To avoid this, you must adhere to the following rules:
- Wash your hands thoroughly with soap and water before and after handling your catheter.
- Monitor the level of urine in the urinal and empty it in a timely manner.
- Fix the urinal on the body and never place it on dirty surfaces.
- Disinfect drain points with special antibacterial agents.
- Wash your incision in the morning and evening.
As for taking a bath or shower, water procedures are not prohibited in principle. But doctors advise to refrain from them throughout the entire rehabilitation period. As practice shows, it is because of bathing that allergic reactions most often develop.
Life after surgery
Bladder puncture deals a severe blow to the psyche and self-confidence. And there are reasons for this, because the inability to go to the toilet on your own is a humiliation for any man and woman. In addition, the presence of a urinal introduces certain inconveniences into a person's daily life. The following simple steps will help you get used to it faster and enter a normal rhythm.tips:
- You need to monitor the water balance. Consuming plenty of fluids will reduce the likelihood of developing stagnant processes.
- You should give up black tea and coffee, soda and alcohol for a while. These drinks have an irritating effect and also slow recovery.
- Daily menu should be adjusted. It is necessary to exclude s alty, spicy and sour foods from it. It can lead to constipation and various serious complications.
If you follow a he althy diet and follow the basic rules of personal hygiene, then there should be no problems. But if you notice any of the symptoms described above, you should immediately seek medical help.
Changing a catheter at home
It is very dangerous to do this on your own, because due to lack of knowledge and experience, you can accidentally injure the body. But if such a need arose, then replace according to the following algorithm:
- Empty the bag.
- Lie on your back, bend your knees and spread them apart.
- Treat the tube with an antiseptic.
- Empty the contents of the catheter balloon with a 10 ml syringe.
- Carefully remove the tube from the urethra and insert a new one.
This instruction is applicable to all genders. But you should go for an independent replacement only as a last resort, when there is no other way out. If possible, the procedure should be carried outprofiled specialist.
Conclusion
Acute urinary retention is a serious problem that poses a threat to human life. But thanks to epicystostomy, doctors can adjust the output of urine. Many people are afraid of this operation and do not want to go for it, because they do not know how they will be shown to people. But there is nothing wrong with that. After getting used to the urinal, you can return to your usual life and continue to do ordinary things.
