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Cystostomy: tube
Synonym(s): Prepubic (suprapubic catheterization, prepubic urine drainage
Introduction
- A cystostomy tube permits drainage of urine from the bladder directly through the abdominal wall.
- Cystostomy tubes are considered when other less invasive means of obstruction relief or urinary diversion are not possible (eg transurethral catheterization, intermittent cystocentesis), or when more radical surgical procedures are not feasible to relieve distal urinary tract obstructions (eg in case of invasive neoplasia).
- Cystostomy tubes provide a practical, relatively simple avenue of temporary or long-term urinary diversion for dogs and cats with outflow obstruction of the bladder or urethra, or disruption of the urethra.
- Placement of cystostomy tubes does not require specialized equipment, and can be performed either at the time of primary surgical treatment of the urinary obstruction or trauma, or as an emergency procedure to help stabilize an obstructed uremic patient.
- There are a number of potential complications, most of which are avoided with proper surgical and aseptic technique during placement. Technical details for successful placement and management of tube cystotstomies are described below.
Uses
- Cystostomy tubes are indicated for urinary diversion in dogs and cats with either functional or mechanical obstruction of the bladder or urethra Urethra: obstruction, distal urinary tract disruption, or neurologic or idiopathic bladder atony. Common causes of obstruction in small animals include trauma Bladder: trauma rupture Urethra: rupture, inflammatory disorders, urinary calculi Urolithiasis, and neoplasia Bladder: neoplasia Urethra: neoplasia.
- These tubes can be used for short-term diversion to help stabilize patients until primary relief of the obstruction or repair of a traumatic urinary tract disruption is performed.
- In addition, cystostomy tubes may be helpful for management of permanent or slowly responsive neurological or detrusor dysfunction conditions of the bladder (causing urine retention), or as palliative treatment for nonresectable tumors of the bladder or urethra when other successful treatments are not available or possible.
Advantages
- Cystostomy tube placement is relatively quick and easy to perform. The procedure does not require specialized equipment, although special catheters (ports) may be preferred for long-term or permanent diversion in selected patients.
Disadvantages
- This invasive procedure carries with it the expense, and all the inherent risks associated with transabdominal wall catheter placement such as leakage, infection, dehiscence, irritation of the stoma site, tube obstruction, and accidental dislodgement.
- Proper management requires careful monitoring and handling of the tube, and draining of the bladder at least 3-4 times daily. Good owner and patient compliance is necessary for success of this diversion technique.
Technical problems
- These tubes must be placed aseptically, ensuring that the tube is adequately fixed to the body wall and sealed within the bladder. In addition, secure fixation of the bladder to the body wall is required to help reduce risk of urine leakage into the peritoneum should the tube become accidentally damaged or pulled prematurely, or if the bladder becomes overdistended before strong adhesions to the wall have developed. The bladder wall must be healthy enough to support sutures well, otherwise leakage into the abdomen around the tube site is likely.
Alternative techniques
- If the obstruction is temporary, the bladder wall expected to be healthy, and early surgical treatment of the obstruction or traumatic lesion is planned, intermittent, carefully performed, cystocentesis Cystocentesis may be an effective, less invasive method of urine diversion.
- Likewise, if the obstruction can be relieved via simple catheterization Urethra: catheterization, a tube cystostomy may not be necessary.
- For lodged calculi located just proximal to the os penis in the dog, a urethrotomy is a less invasive and less complicated alternative to tube cystostomy.
- Temporary drainage (with percutaneously implanted multilumen tubes or active suction systems) of the peritoneal cavity alone may be effective in stabilizing toxic patients before early surgical repair of the obstruction or trauma (especially if the bladder wall is ruptured Bladder: trauma rupture and severely damaged).
Time required
Preparation
- 10-15 min.
Procedure
- 15-30 min.
Decision taking
Criteria for choosing test
- Be sure there are no other less invasive options for urinary diversion. If the bladder wall is severely affected, either provide additional intraperitoneal drainage, or consider other diversion options.
Risk assessment
- Be sure all appropriate diagnostic tests have been performed, and the patient is stable and can handle general anesthesia without undue risk. An emergency tube cystostomy may be performed under local or regional anesthesia (eg epidural Anesthesia: epidural) to avoid the risks involved when general anesthesia is performed on a toxic patient.
Requirements
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Preparation
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Technique
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Aftercare
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Beck A L, Grierson J M, Ogden D M et al (2007) Outcome of and complications associated with tube cystostomy in dogs and cats: 76 cases (1995-2006). JAVMA 230 (8), 1184-1189 PubMed.
- Stiffler K S, McCrackin Stevenson M A, Cornell K K et al (2003) Clinical use of low-profile cystostomy tubes in four dogs and a cat. JAVMA 223 (3), 325-329 PubMed.
- Hayashi K, Hardie R J (1995) Use of cystostomy tubes in small animals. Comp Contin Ed Pract Vet 25 (12), 928-935 ResearchGate.
- Smith J D, Stone E A, Gilson S D (1995) Placement of a permanent cystostomy catheter to relieve urine outflow obstruction in dogs with transitional cell carcinoma. JAVMA 206 (4), 496-499 PubMed.