Percutaneous technique for enlargement of cystostomy tract

PERCUTANEOUS OF CYSTOSTOMY

BHUPINDER STEPHEN

TECHNIQUE

FOR ENLARGEMENT

TRACT

SINGH,

M.D.

P COHEN,

M.D.

From the Division of Urology, Department of Surgery, University of Maryland Hospital, and Sinai Hospital of Baltimore, Maryland

Several small-caliber catheters are commonly available for performing a temporary cystostomy to relieve urinary retention. Retrograde catheterization may be unsuccessful or undesirable. Medical problems may preclude operative correction of the obstructive pathology, and a permanent suprapubic cystostomy is then indicated. We have developed a quick nonoperative technique for the conversion of a small-caliber cystostomy tract into a larger and easily maintained permanent one. A Suprapubic Cystocath (Dow-Corning) is in place. The bladder is distended with saline through this polyethylene tube. A 0.038 guide wire is introduced into the bladder, and the tubing of the Cystocath is removed while advancing the wire. The tissues surrounding the wire are infiltrated with a local anesthetic. Amplatz fascial dilators are passed over this guide wire in exactly the same manner as that for renal access in percutaneous procedures (Fig. 1A). This dilatation is done to one size larger (2 F) than the intended cystostomy tube. Teflon sheaths (Fig. 1B) are supplied with the 24-F through 30-F dilators. The appropriate Teflon sheath is slid over the dilator which is then withdrawn, and a finger is quickly placed on the Teflon sheath to prevent bladder decompression, A Foley catheter is inserted through the sheath into the bladder and its balloon inflated. The Teflon sheath is cut on one side after withdrawing it over the Foley catheter. A suprapubic cystostomy of the desired size is thus established. We have used this technique successfully in several patients without complication. The precautions are the same as for the procedure, viz. a distended bladder and a slight Trendelenburg

320

FIGURE

Amplatz

(A) Amplatx fascial 1. fascial dilator with sheath.

dilators;

(B)

position. The entire conversion takes only ten minutes and can be done on an outpatient basis. #8 16th Avenue at Ritchie Highway Brooklyn Park, Maryland 21225 (DR. SINGH)

UROLOGY

/ MARCH

1987

I

VOLUME

XXIX, NUMBER 3