Suprapubic cystostomy

Suprapubic cystostomy is a surgical procedure in which a small opening is created into the bladder through the lower belly. The surgeon inserts a catheter into the cut/hole to allow the urine to drain from the bladder.

This catheter helps you empty your bladder when you cannot do it on your own.

The kidneys produce urine that passes through the thin tubes known as ureters to the bladder. The bladder is a triangle-shaped hollow organ located inside the lower abdomen. It stores the urine before it flows out via the urethra.

The catheter tube inserted so inside the bladder such that the urine passes through the catheter instead of the urethra.

The procedure is also referred to as vesicostomy or suprapubic catheter insertion.

Your healthcare practitioner will perform this surgery if you have urinary retention (incomplete emptying of urine from the bladder after urinating). Symptoms of urinary retention include:

• Pain in the lower abdomen 
• Slow stream of urine
• Urination frequently but in small quantities
• Urge to urinate again just after you have urinated
• Problems while initiating the urine flow

The following conditions can cause urine retention:

• Spina bifida
• Enlarged prostate or benign prostatic hyperplasia
• Stones or deposits of calcium in the urinary tract
• Constipation 
• Infections like prostatitis, urinary tract infection and sexually transmitted diseases 
• Trauma
• Barrier at the outlet of the bladder because of urethral stricture (narrowing of the ureter) or scar tissue 
• Prolapse of pelvic organs (a condition in which the organs in the pelvis such as the bladder, bowel or uterus shift from their normal position due to loss of muscle support)
• Tight muscles in the pelvic floor

You may also require this surgery if: 

• A catheter cannot be placed in your urethra
• You want to have an easier changing process and maintenance of catheter 
• A previous catheter placement through the urethra has caused complications for you
• You will need to have a catheter in your body for a very long time
• You need to have surgery of the urethra or adjacent regions 
• You want to avoid urethral damage

This surgery is avoided in individuals with the following conditions:

• Bladder cancer 
• A bladder that is not easily palpable or not distended and cannot be localised on ultrasound examination 
• Coagulopathy (a bleeding disorder in which blood loses its ability to coagulate) 
• Pelvic cancer 
• Previous surgeries involving the lower abdominal or pelvic regions

Before performing this surgery, the following preparations are required:

• Diagnostic tests: You will need to undergo a physical examination as well as the following tests before the surgery:

  • Blood test
  • Urine test 
  • Imaging tests (scans)
• Medicines: 
  • You should share information regarding any medications, herbs or supplements you take with your healthcare practitioner.
  • The doctor will ask you to stop some medicines up to one week before the surgery. For example, you will need to stop consuming blood-thinning medicines like aspirin or warfarin.
• Fasting:
  • You may need to fast from eight hours before the surgery until you are deemed fit to eat after surgery. 
  • You can drink clear fluids like water before the procedure if your doctor permits.
• Lifestyle:
  • Inform your doctor if you drink alcohol or smoke. These habits can increase your risk of complications after the surgery.
  • Inform your doctor if you are using an implanted heart device such as pacemaker or defibrillator.
• Driving:
  • You will need to ask someone (close relative or friend) to drive you home after the surgery.

You will be asked to sign a consent form stating your permission for the procedure.

The following steps are performed during this surgery:

• A hospital gown will be provided to you to change into. 
• A healthcare practitioner will clean your abdominal and genital areas with a disinfecting solution. 
• You will be given antibiotics either via injection or orally. 
• An anesthesiologist will give you local anaesthesia to numb the area of surgery. Local anaesthesia or a pain-killer jelly will also be applied inside your urethra.
• The surgeon will use a cystoscope or ultrasound (which will allow the doctor to see inside the bladder) to locate your bladder. This will also later help him/her to place the suprapubic catheter.
• Once it is located, the surgeon will fill your bladder with fluid to visualize the lining of your bladder. You may have an urge to urinate when this happens. If it is painful, let the doctor know.
• Next, the surgeon will make a cut on your belly at the site of surgery, just above your pubic hairline. 
• Through the cut, the surgeon will insert a needle in your lower abdomen and then carefully into your bladder. 
• To prepare the site for insertion of the catheter, the surgeon will use a wire or sheath.
• Using the wire/sheath as a guide, the surgeon will insert the suprapubic catheter inside your bladder and stitch it in place. The position of the catheter will be confirmed with the flexible cystoscope.
• An inflated balloon will be placed in to keep the catheter in the correct position. 
• Finally, the surgeon will cover the stoma (the opening on the abdominal skin for the catheter and urine) with gauze/bandages.

This whole procedure takes about 10–45 minutes. 

Usually, a hospital stay can last for a day after the surgery. Your recovery and vitals will be monitored in the hospital. A healthcare provider will provide you with medicines for your pain and help you eat until you can on your own. You will also be taught to take care of the catheter.

Once you are home, you will need to take the following care:

• Care of skin near the catheter:

  • The skin around the catheter should be thoroughly washed with soap and water.
  • Gently pat the area until it is dry. 
  • Your doctor may allow you to take a shower two days after the surgery.
  • Use swimming pools, bathtubs, or hot tubs only after approval from your doctor.
  • You must avoid the application of cream, powder or spray on the skin near the catheter.
  • Apply bandage as instructed by your doctor.
• Catheter care:
  • You should change the catheter every four to six weeks.
  • Ensure that you have washed your hands with soap and water before changing the catheter.
  • Your drainage bag should be kept below the waist to prevent the backflow of urine into the bladder.
  • Avoid the disconnection of the catheter to a drainage bag for efficient working. 
  • If the tube is not draining, check for any kinks and move it around. 
  • Avoid removing the catheter on your own without supervision.

To change the catheter, you will need to adhere to the following instructions:

• Lubricate your new catheter at the end that will be inserted inside the belly.
• Clean the surgical site with a sterile solution.
• Remove the air out of the balloon with the help of a syringe.
• Carefully remove the old catheter.
• Insert the new catheter in the same position and as far in as the older one was inserted.
• Wait until there is flow of urine.
• Inflate the balloon with the help of sterile water and connect the drainage bag to the catheter to collect urine.

Other care:

• You will need medicines (which will be prescribed by the doctor) for the proper functioning of your bladder. 
• You need to drink plenty of water (8-12 glasses) for a few days after surgery 
• You should avoid physical activity for almost one or two weeks
• You will be needing following items for changing the catheter: catheter pack, lubricating jelly, sterile solution for cleaning and gloves, drainage bag, and syringes.

When to see the doctor?

Inform your healthcare practitioner if you are facing any of the following symptoms:

• Blood in the urine 
• Pain or cramps 
• Catheter coming out of the cut (hole) 
• Urine not draining out through the catheter
• Fever or chills
• Changes in incidence or volume of urine 
• Changes in odour or appearance of urine 
• Redness or soreness at the surgical site 
• The appearance of stones or grits in your urine 
• Burning sensation while urinating 
• Difficulty in changing or vacating the drainage bag

This surgery can have the following complications: 

• Reactions occurring due to anaesthesia 
• Bleeding or infection at the surgical site
• Damage to the bowel
• Blood clots formation in body

You will need a follow-up appointment to remove the catheter after the fulfilment of its purpose. If the catheter is not removed, you may need to follow up for catheter replacement regularly.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.