How to place a trocar cystostomy
The bladder must be full (with urinary retention it is already full) - under ultrasound, a point is determined 2-3 cm above the pubis, the skin is anesthetized, a 5 mm incision is made, and the bladder is punctured with a trocar with a drain placed on it. When urine appears, the drainage moves into the bladder, the trocar is removed, the drainage balloon is inflated or the curl is straightened, the tube is fixed to the skin and connected to the urinal. The patient immediately feels relief. After 4 weeks, when the canal has formed, the tube is changed on an outpatient basis.
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.
