When is an open cystostomy necessary?
In case of a collapsed bladder, adhesions after surgery on the pelvic organs, or a pelvic fracture with a hematoma, a “blind” puncture risks damaging the intestine or blood vessels. Open access under spinal anesthesia allows you to open the bladder under visual control, remove clots or stones, install a wide drainage and securely suture the wall of the bladder to the skin - such a fistula is easier to maintain during long-term wear. Through the formed channel, tube replacement and endoscopic operations are possible in the future. After treating the cause, the cystostomy closes within a few days.
When is a cystostomy needed?
- acute urinary retention when it is impossible to insert a catheter (urethral stricture, large adenoma, urethral trauma);
- chronic urinary retention with a large volume of residual urine in patients for whom surgery is still contraindicated;
- urethral rupture due to pelvic fracture - urine diversion before urethroplasty;
- neurogenic bladder when self-catheterization is impossible;
- long-term diversion of urine after operations on the urethra and bladder;
- severe urethritis and prostatitis, when a urethral catheter is contraindicated.
Life with a cystostomy
The tube is connected to a urine bag, which is attached to the leg; The surrounding skin is treated daily. The drainage is changed every 4–8 weeks on an outpatient basis. Cystostomy is a temporary measure: after treatment of the cause (TUR/HoLEP adenoma, urethroplasty), it is clamped, the bladder is trained and removed, the fistula closes in 2–5 days. Patients with a permanent cystostomy are taught self-care.
