Trocar cystostomy is a urological operation performed for severe urinary retention. It is prescribed in the event that conventional catheterization through the urinary canal is not possible. This operation is necessary to save the patient's life, because the violation of the outflow of urine is deadly. How is this procedure carried out? And what rules must be observed in the postoperative period? We will consider these issues in the article.
Procedure description
Trocar cystostomy is an operation that provides artificial excretion of urine. During the procedure, a suprapubic puncture of the bladder is made with a special instrument - a trocar. A drainage tube is inserted into the organ cavity to drain urine (cystostomy). At the same time, urine is collected in a special bag - a urinal, which is attached with adhesive tape to the patient's body.
Thus induring the procedure, artificial paths are formed for the withdrawal of urine. This operation is considered vital, because urine retention is extremely dangerous. Such a surgical intervention is performed when it is impossible to insert a catheter through the urethra.
This operation has been used in urology for about 25 years. However, in the past, such a procedure often led to infectious complications and trauma to the peritoneum. For this reason, cystostomy was used only in extreme cases. Doctors prescribed this procedure with great care.
Today, disposable sterile sets for trocar cystostomy have been developed and produced. Their use significantly reduces the risk of infection during catheter insertion. This helps to avoid such dangerous complications as inflammation and phlegmon of the perivesical tissue. Such consequences of the operation were often observed in the past.
Modern sterile sets for trocar cystostomy allow you to perform this procedure in the most gentle way. This reduced the chance of injury. Therefore, at present, the list of indications for such a procedure has expanded significantly.
Absolute readings
The operation of trocar cystostomy is considered vital in acute and chronic violation of the outflow of urine, provoked by the following injuries:
- bladder rupture;
- violation of the integrity of the urethra;
- urethral injuries during urological procedures.
With such damage, it is impossible to entercatheter into the urethra and allow a natural outflow of urine. Therefore, urine can only be removed through a puncture in the abdominal wall and bladder.
The procedure is also indicated for severe urinary retention, accompanied by septic complications and intoxication of the body. In this case, the operation is performed on an emergency basis, since urosepsis poses a danger to the patient's life.
Relative readings
In some diseases, urethral catheterization is significantly difficult. In such cases, the decision on the need for trocar cystostomy is made by the doctor. Relative indications for surgery are the following pathologies:
- prostate adenoma;
- bladder tumors.
In such diseases, the bladder is squeezed by a neoplasm or an enlarged prostate gland. Therefore, inserting a catheter into the urethra is quite difficult. This can lead to tissue trauma, so it is safer to ensure the excretion of urine in a puncture way.
Cysostomy can also be used in the first stage of urological operations. Before some surgical interventions, it is necessary to completely remove the urine from the bladder.
Are there any contraindications
This procedure has no contraindications. After all, it is carried out in order to save the life of the patient. If the patient is diagnosed with urinary retention, and it is impossible to insert a catheter through the urethra, then cystostomy is the only way to prevent the death of the patient from intoxication andurosepsis.
Equipment required
Disposable trocar cystostomy kit includes the following instruments:
- trocar;
- drainage tube (cystostomy);
- extenders and conductors;
- urinal.
Let's consider the device of these devices in more detail.
Trocar is an instrument for bladder puncture. It consists of the following parts:
- Stiletto. This is the pointed part of the tool. With its help, a puncture of the wall of the bladder is made.
- Tube. This device is a tube with an empty channel inside. A stylet is inserted into it and a puncture is performed. A drainage tube is placed in the same channel when it is inserted into the bladder.
Drainage tube (cystostomy) is a device for artificial outflow of urine. It is made from polyvinyl chloride. One end of the tube is inserted into the bladder, and the other is designed to drain urine into the reservoir. The drainage is equipped with a special balloon, with which the device is held in the organ cavity. Tubes are produced in various diameters and lengths.
The urinal is a reservoir for collecting urine. It is equipped with a special valve for emptying.
Currently, improved kits for trocar cystostomy are being produced. They include such models of trocars, which also serve as drainage. This ensures higher sterilityprocedures.
Methodology
Before a trocar cystostomy, a general and biochemical blood test is taken from the patient. The patient is then prepared for the operation. The hair in the lower abdomen and pubic area is completely shaved off. The puncture site is treated with antiseptics. This intervention is performed under local anesthesia, general anesthesia is usually not required.
The operation is carried out in several stages:
- A small incision (about 7-8 mm) is made on the skin with a scalpel.
- A trocar is inserted through the resulting wound and the bladder wall is pierced with a stylet. The instrument is placed in the organ cavity to a depth of 5-6 cm.
- The stylet is removed from the trocar channel. Then, a drainage tube is inserted into the cavity of the instrument and its end is placed in the bladder. The accuracy of its location is estimated at the beginning of the emptying of the organ. Then the drainage is fixed with a balloon. The other end of the tube is attached to the urinal.
If a trocar-drainage is used, then the puncture and drainage are carried out simultaneously. Such an instrument facilitates the operation and prevents urine from entering the abdominal wall.
Trocar cystostomy is not a complex intervention. However, after its implementation, careful care for the postoperative field and drainage is necessary.
Consequences
Modern instruments for cystostomy minimize the risk of injury and infection. However, the following complications cannot be completely ruled out:
- peritoneal injury;
- violation of the integrity of blood vessels;
- accidental puncture of opposite bladder wall;
- prostate adenoma damage;
- injury to intestinal tissues.
To prevent such consequences, the patient is placed on his back before the operation, and the lower part of the body is raised. With this position of the body, the intestines move away, and the bladder is available for manipulation. In some cases, the procedure is performed under ultrasound guidance, which ensures high accuracy of the operation.
How to care for a cystostomy
After a trocar cystostomy, care for the skin, drainage, and urinal must be meticulous and constant. This will help to avoid postoperative complications. The following rules must be followed:
- The skin at the exit of the drain should be kept clean. It must be carefully washed with soap and wiped with antiseptic solutions.
- After cystostomy, it is necessary to refuse to visit the bathhouse, swimming in the pool and taking baths. For hygiene procedures, you can only use the shower.
- The drain tube must be protected from damage and kinks.
- You need to make sure that water does not get into the drainage. This device must never be washed. Otherwise, an infection can enter the bladder along with the fluid. When taking a shower, the tube should be pinched.
- The urine outflow reservoir should be kept below the level of the bladder.
- The urinal must be regularly emptied with a valve and rinsed with disinfectants. The disposable reservoir needs to be replaced in time.
- Periodically, it is necessary to change the tube to drain the urine. The frequency of drain changes is determined by the doctor.
Complications in the postoperative period
Complications during the use of the drainage system are rare. They usually appear when the rules of care are violated. Neglect of hygiene and careless handling of the cystostomy can lead to the following consequences:
- infectious cystitis;
- discharge of blood from the cystostomy;
- drain tube prolapse.
If you feel worse, have pain and bleeding, you should immediately visit a doctor. If necessary, the drainage system is replaced.
For many patients, the installation of a drainage tube causes psychological trauma. After all, this requires careful care of the postoperative field and catheter, in addition, patients often suffer from an unpleasant odor. However, cystostomy is a temporary measure. After the course of treatment and ensuring the natural excretion of urine, the drain is completely removed.
