Trocar cystostomy is a urological operation that is performed with severe urinary retention. It is prescribed if normal 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 does this procedure go? And what rules must be observed in the postoperative period? We will consider these issues in the article.
Description of procedure
Trocar cystostomy is an operation that provides artificial excretion of urine. During the procedure, suprapubic puncture of the bladder is done with a special tool - a trocar. A drainage tube is inserted into the organ cavity for the outflow of urine (cystostomy). In this case, urine is collected in a special bag - an urinal, which is attached with adhesive tape to the patient's body.
Thus, during the procedure, artificial pathways are formed to remove urine. This operation is considered vital, because urine retention is extremely dangerous. Such surgery 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.
Nowadays, disposable sterile sets for trocar cystostomy have been developed and are being produced. Their use significantly reduces the risk of infection during catheter insertion. This helps to avoid dangerous complications such as inflammation and phlegmon of near-bubble 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 likelihood of injury. Therefore, at present, the list of indications for such a procedure has expanded significantly.
Absolute readings
The operation of a trocar cystostomy is considered vital in acute and chronic violation of the outflow of urine provoked by the following injuries:
- rupture of the bladder;
- violation of the integrity of the urethra;
- urethra injuries in urological procedures.
With such injuries, it is impossible to insert a catheter into the urethra and provide a natural outflow of urine. Therefore, urine excretion can be carried out only 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 carried out on an emergency basis, since urosepsis is a danger to the patient's life.
Relative indications
In some diseases, urethral catheterization is significantly difficult. In such cases, the decision on the need for a trocar cystostomy is made by the doctor. Relative indications for surgery are the following pathologies:
In such diseases, the bladder is compressed by a neoplasm or an enlarged prostate gland. Therefore, it is rather difficult to insert a catheter into the urethra. This can lead to tissue trauma, therefore it is safer to ensure the excretion of urine by the puncture method.
Cystostomy can also be used in the first stage of urological operations. Before some surgical procedures, urine must be completely removed from the bladder.
Are there any contraindications
This procedure has no contraindications. After all, it is carried out in order to save the patient's life. 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 and urosepsis.
Necessary equipment
The following instruments are included in the disposable kit for trocar cystostomy:
- trocar;
- drainage tube (cystostomy);
- extension cords and conductors;
- urinal.
Consider the device of these devices in more detail.
A trocar is a bladder puncture tool. It consists of the following parts:
- Stylet. This is the pointed part of the instrument. With its help, a bladder wall is punctured.
- 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.
A drainage tube (cystostomy) is a device for the artificial outflow of urine. It is made of 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 spray, with which the device is held in the body cavity. Tubes with different diameters and lengths are produced.
The urinal is a reservoir for collecting urine. It is equipped with a special valve for emptying.
Improved kits for trocar cystostomy are currently being produced. They include such trocar models that simultaneously serve as drainage. This provides a higher sterility procedure.
Methodology
Before conducting a trocar cystostomy, a general and biochemical blood test is taken from the patient. Then the patient begins to prepare for surgery. 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 is made on the skin (about 7-8 mm) with a scalpel.
- A trocar is introduced through the wound formed, and with the help of a stylet, the wall of the bladder is pierced. The instrument is placed in an organ cavity to a depth of 5-6 cm.
- A stylet is removed from the trocar canal. 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 evaluated at the beginning of the emptying of the organ. Then the drainage is fixed using a balloon. The other end of the tube is attached to the urinal.
If trocar drainage is used, then puncture and drainage are carried out simultaneously. Such an instrument facilitates the course of the operation and prevents urine from entering the abdominal wall.
Trocar cystostomy is not a complex intervention. However, after its implementation, careful care of the postoperative field and drainage is necessary.
Effects
Modern tools for cystostomy can minimize the risk of trauma and infection. However, the following complications cannot be completely ruled out:
- peritoneal injury;
- violation of the integrity of blood vessels;
- accidental puncture of the opposite wall of the bladder;
- damage to prostate adenoma;
- injury to intestinal tissues.
To prevent such consequences, before the operation, the patient is laid on his back, and the lower body is raised. With this position of the body, the intestines move away, and the bladder is accessible for manipulation. In some cases, the procedure is carried out under the control of ultrasound, which ensures high accuracy of the operation.
How to care for a cystostomy
After trocar cystostomy, skin care, drainage and urine collection should be thorough and constant. This will help to avoid postoperative complications. The following rules must be observed:
- The skin in the drainage area should be kept clean. It must be carefully washed with soap and wiped with antiseptic solutions.
- After cystostomy, you must refuse to visit the baths, swimming in the pool and taking baths. For hygiene procedures, only a shower can be used.
- The drain pipe must be protected from damage and kinks.
- Care must be taken to ensure that water does not enter the drainage. This device must never be rinsed. Otherwise, infection with the fluid may enter the bladder. During showering, the tube should be pinched.
- The urine outflow reservoir should be kept below the level of the bladder.
- The urinal must be emptied regularly with a valve and flushed with disinfectants. The disposable tank must be replaced on time.
- Periodically, it is necessary to change the tube to drain urine. The frequency of the drainage change is determined by the doctor.
Complications in the postoperative period
Complications while using the drainage system are rare. They usually appear in violation of the rules of care. Neglect of hygiene and careless handling of cystostomy can lead to the following consequences:
- infectious cystitis;
- the release of blood from a cystostomy;
- loss of drainage tube.
If you feel worse, the appearance of pain and bleeding, you must urgently visit a doctor. If necessary, the drainage system is replaced.
For many patients, installing 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 the natural removal of urine, the drainage is completely removed.