Suprapubic Cystostomy is contraindicated in Carcinoma of bladder.

In this procedure skin is a surgical connection is made between bladder and abdomen skin and mallicot’s cathetor is introduced.

Block in passage of urine can be due to

Benign prostratic hypertrophy

Traumatic urethera

Congenital defect

stone in urethra

Spinal cord injury

Steps of suprapubic cystostomy

1. give general anaesthesia or spinal anaesthesia

2. clean the abdomen with bedadiene and spirit

3. make a 5-6 cm vertical incision on abdomen wall at mid line an 2 finger above the pubic

symphisis.

4. we cut skin,superficial fascia, linea alba, we split the transversus

abdominus muscle, and peritonium is seperated by blunt dissection.

5. Now we check the bladder by spirating the urine with syringe or by looking vesicular plexus.

6. give two stitches, make an incision and insert mallicot’s cathetor and stich the layers by layers and done.

Below is the video demostration of Suprapubic cystostomy, here we are not using mallicot’s cathetor, but we are using ready made cathetor like trocar and cannula, its easy to insert, fix, and remove, it is being fixed inside bladder by inflating a balloon. Now watch the video below on youtube.

1. Take consent from patient, tell about procedure to the patient.

2. Hide the patient behind curtains so that privacy is maintained.

3. Wear Off pants and underwear of patient. Patient should lie in supine position with legs seperated apart.

4. Wear Sterile Gloves. Watch video below demonstrating how to wear gloves in sterile manner.

5. Clean glans, shaft, scrotum and surrounding area of penis.

6. Hold the penis below the glans by your left hand and insert around 10 ml of xylocaine jelly inside urethera by syringe as shown in video below. Wait for 3 minutes for jelly to work. Do not un hold penis otherwise xylocaine will flow out.

7. Now take Foley’s catheter in your right hand and insert in penile urethera till it reaches ‘y’ part of catheter.

8. Urine will start flowing, so attach urine collecting bag with catheter.

Note: if urine does not flow that indicates either patient has voided urine just few minutes before or it xylocaine jelly has closed the holes of catheter, so just push 5-6 ml of normal saline by syringe into the bladder through the hole where urine collecting bag will be attached.

9. Just inflate the balloon of catheter by pushing 10-20 ml of normal saline in catheter. However in case of children only 2-3 ml of normal saline is injected and never inflate the balloon when catheter tip is some where in urethera otherwise you will rupture the urethera.

Note: retracted fore skin of penis should be covered back other wise you will cause phimosis to the patient.

10. Retract back extra catheter from bladder and fix the urine collecting bag on bedside and its tube to the leg of patient so that pulling effecting is reduced.

Watch out the video demonstration of the above steps in video below

Below is a video demonstration on how to wear sterile gloves by Sterilefield