A suprapubic cystostomy or suprapubic catheter (SPC)[1] (also known as a vesicostomy or epicystostomy) is a
surgically created connection between the
urinary bladder and the skin used to drain
urine from the bladder in individuals with obstruction of normal urinary flow. The connection does not go through the
abdominal cavity.
Urinary flow may be blocked by swelling of the prostate (
benign prostatic hypertrophy), traumatic disruption of the
urethra,
congenital defects of the
urinary tract, or by obstructions such as
kidney stones passed into the urethra, and
cancer. It is also a common treatment used among spinal cord injury patients who are unable or unwilling to use intermittent catheterization to empty the bladder, and cannot otherwise void due to
detrusor sphincter dyssynergia.
Initially, a thin tube (
catheter) is placed through the skin just above the
pubic bone into the bladder, often with the assistance of
ultrasound imaging.[2] This catheter initially remains in place for up to a month while the tissue around it scars and forms a tract (
sinus) between the bladder and the body exterior. After the formation of scar tissue is complete, the catheter is replaced periodically in order to help prevent
infection.
Medical uses
Failed urethral catheter,
Long term usage (if left in urethral long terms catheters can lead to acquired
hypospadias and recurrent/chronic UTIs,
urinary tract infections).
Illustrations
Various settings of a 6
French pigtail catheter with locking string, obturator (also called stiffening cannula) and puncture needle. A. Overview B. Both obturator and puncture needle engaged. C. Puncture needle retracted. Obturator engaged. D. Both obturator and puncture needle retracted. E. Locking string is pulled (bottom center) and then wrapped and attach to the superficial end of the catheter.
Illustration depicting the correct way to secure the tubing and leg bag of a suprapubic catheter on a male.
Illustration depicting the correct placement of a suprapubic catheter on a female.
Illustration depicting the proper way to clean around a suprapubic catheter.
Contraindications
Need to rule out bladder cancer in cases of clot retention
Lower abdominal incisions with likelihood of adhesions
The "suprapubic cystotomy" is a specialty of the fictional physician
Stephen Maturin in
Patrick O'Brian's twenty-one volume series on the
Royal Navy during the
Napoleonic era.[4] In modern medical terminology, "cystotomy" without the "s" refers to any surgical incision or puncture into the bladder, such as to remove urinary calculi or to perform tissue repair and reconstruction. "Cystostomy" is surgery specifically to provide drainage.[5]