Epicystostomy

The introduction of a puncture epicystostomy is a (mostly acute) procedure that ensures the derivation of urine suprapubically from the bladder. This is the introduction of a urinary catheter through the abdominal wall. In some cases, epicystostomy is chosen as a permanent urinary diversion solution with regular catheter changes.

Indications for establishing a puncture epicystostomy include acute urinary retention, if it is not possible to insert a urinary catheter through the urethra - e.g. in the case of urethral stricture, Benign prostatic hyperplasia, pressure from the outside. Furthermore, epicystostomy is indicated for urethral injury. It can also be part of a surgical procedure (open prostatectomy, urethral surgery).

Execution
The conditions for establishing an epicystostomy are suitable coagulation parameters (INR < 1,2, or 1,3) and sufficient bladder filling. After disinfecting the surgical field, we infiltrate the abdominal wall with a local anesthetic. We perform the puncture under ultrasound control 2-3 cm above the symphysis. We guide the puncture channel at an angle of 80–90 °. The epicystostomy catheter is fixed in the bladder with an inflated balloon, for catheters without a balloon, the epicystostomy is fixed with a suture to the skin. The catheter then drains the urine into a collection bag. Regular exchanges are after 3-4 weeks, during which time the puncture channel is already healed.

Possible complications

 * Discomfort in the area of ​​the bladder in the sense of having to urinate.
 * Local infectious complications at the site of the puncture channel.
 * Urinary tract infections.
 * Bleeding — in case of massive bleeding, surgical revision is necessary.
 * Intestinal loop injury — a rare complication, especially when the bladder is small. After that, an open revision with loop treatment is necessary.
 * Acute urinary retention due to obstruction or kinking of the catheter.

related articles

 * Strictures of the urethra
 * Urinary Diversion