Procedure in the office
The skin around the fistula is processed, the balloon of the old catheter is deflated, the tube is removed, and a new Foley catheter of the required diameter (usually 18–22 Ch) is immediately inserted through the channel; the balloon inflates, urine flows through the tube - the position is correct. When the canal is narrowed, a guide or bougie is used. The patient is taught care and the date of the next replacement is recorded. For patients with permanent cystostomy, the clinic maintains a replacement schedule.
Why and when to change
Cystostomy drainage becomes encrusted with salts, becomes clogged and becomes a source of infection, so it is changed regularly every 4–8 weeks (silicone - less often, latex - more often), and unscheduled - if it becomes clogged, urine leaks past the tube, or falls out. The first replacement is 4 weeks after installation, when the canal is formed.
If the drain falls out
The fistula tract narrows after just a few hours, so if the tube falls out, you need to go to the clinic on the same day: the canal can still be passed through with a catheter or expanded with bougies. A day later, a repeat puncture cystostomy may be required.
