Puncture bladder

Indications. Acute urine delay with prostate adenoma; in the postoperative period; When damaged urethra.

Technique. Percussively determine the filling of the bladder urine. Punning a half-empty bubble is dangerous due to the possibility of damage to intestinal loops. In the middle line of the abdomen over Lone, the thin needle produces intradermal and subcutaneous infiltration anesthesia. Then a thicker needle through anesthetized area is carried out into the bubble cavity, as shown in Fig. 10.18. After emptying the bubble, the needle is removed. The place of puncture is treated with alcohol and closed with a gauze ball.

Fig. 10.18.

Epicistostomy (overlaying fistula on the bladder)

Indications. The need for a long-term unnatural diversion of urine under cancer or prostate adenoma, damage and scar stricture of urethra.

Technique. Under local infiltration anesthesia, a vertical median incision of the anterior abdominal wall is 8-10 cm long over the Lona Jim. The straight muscles of the abdomen share and disseminate hooks to the sides. The gauze ball is separated from the front wall of the bladder fascia with a fold of peritoneum. Two ligatures are applied to the front wall of the bubble, between which the bubble cavity is opened.

Initially, the muscle shell is dissected, under which it is separately captured by two clamps and reveal the movable mucous membrane of the bubble. The cavity is examined with a finger and insert the usual drainage tube with the side hole. On the wall of the bubble around the tube impose absorbable seams, sealing the wound of the bubble. The tube is fixed to the skin of the firmware ligature (Fig. 10.19). For the drainage of the bubble it is convenient to use a special catheter of the pezzhera, which has a fixing side on the intrapaulous end.

Fig. 10.19. Urinary bladder drainage through fistula (epicistant)

Urinary bladder drainage with trochar

Indications. The same as for ordinary epicistostomy.

Methodik It is technically much easier and the operation itself is less trauma. Under the local infiltration anesthesia, a spicked scalpel is made of a cross-puncture of the skin over the lannie articulation in the middle line of the abdomen. Throkar is introduced into the skin wound and slightly rotational movements promote it deep into the urinary bubble cavity. The direction of administration of the Troacar is the same as the needles when the bladder puncture (see Fig. 10.18). Remove the stylet and on a metal tube (sleeve) of the Troacar to the bubble cavity is inserted with a drainage tube, which is fixed to the skin of the firmware ligature (see Fig. 10.19). Instead of an ordinary tube, it is convenient to use a fole catheter with an inflatable cuff at the distal end, which prevents the fallout of the catheter from the bladder. After removing this catheter, the remaining small wound of the abdominal wall heals independently and relatively quickly.

The drainage of the bladder is a medical and diagnostic procedure, which is in the introduction of tubular drainage or special catheters into the cavity. The drainage installation is usually made as a sharp urination delay or after the completion of cystotomy. Through the drainage, the urine separated from the body of the wound is removed from the body. Also with the help of a drainage system in the bladder are introduced medicinal products and washing its cavity by antiseptic solutions is carried out.

The procedure can be repeated periodically, or the drainage is installed on a long time. The method of removing intremal content (passive, active, flow-aspiration) in each particular case is determined by the attending physician.

Main indications

Indications for bladder drainage serve:

• involuntary cessation of urination due to the pathologies of the urogenital system (tumors, stones, strictures, damage to urethra, prostate adenoma, etc.);
• retention of urinary in neurological disorders, after childbirth and operations on the abdominal organs;
• the need to remove the intremal content and the introduction of drug funds for therapeutic purposes;
• selection of content for culture, microscopic studies;
• determination of residual urine and body volume.

How to prepare for the procedure

At the stage of preparation for the procedure, antibacterial therapy is carried out. If there is an operational intervention, the attending physician appoints a survey on the list of laboratory and diagnostic research defined by it. Measures are taken to identify individual contraindications to drainage. With any method of installing drainage, painkillers are used. Before puncture and cystostomy, there is a normal premedication and preparation of the operating field.

Features of the procedure

All manipulations are performed in the hospital. The optimal position of the patient is lying on the back. In most cases, tubular drainage of different diameters made of latex, polyvinyl chloride, silicone is used. Methods of introducing into the bladder - through the urethra, supocrous puncture and cystostomy.

After installing the drainage in the cavity of the organ, the passive drainage is carried out in an open vessel, active - mainly with a syringe. The tank for washing is located near the bed of the patient. On average, about 200-300 ml of medicinal substances is used for daily washing. Medical staff is monitored by the character and quantity of Drainage separated. All drainages should be sterile and applied once. The skin around them is processed by antiseptics, gauze napkins are changed regularly.

The catheterization of the bladder, the "Golden Standard" of therapy in the event real threat occurrence infectious disease After removing the prostate gland. The catheter with prostate adenoma is used for the internal administration of anti-inflammatory and therapeutic preparations, as well as improved urination functions.

In which cases, the prostate adenoma is derived

The catheter with prostate adenoma is installed in the postoperation period. Required immediately after the operation. Catheterization reduces pressure and irritation on the tissue damaged during surgical intervention.

Drainage of the bladder with DGPH brings the following benefit:

The urinary catheter with the prostate adenoma facilitates postoperative therapy. There is a chance of developing pathologies in which natural urination becomes impossible. In such cases, a cystostom (analogue of catheterization) is established. The tube is excreted through the wall of the peritoneum, and not a urethral canal.

Ways to install a catheter with prostate adenoma

After conducting surgery, the surgeon who conducted resection or evaporation decides on the installation of a drainage tube. Methods of catheterization are different, differ in the purpose, danger of complications and are prescribed strictly according to individual indications:

• Traditional catheterization - at the same time, the solution is installed by the Foley catheter. The device has a type of flexible tube with a special cylinder at the end. After administration through the urethral channel, the bubble is inflated to secure drainage in the bladder. On the other end of the fole tube, the urine collection tank is attached, as a rule, fixed to the foot of the patient.
  Through the catheter, in the prostate water antiseptics and antimicrobial preparations, remove the remnants of dead tissue. The device is effective in short-term use.

• The removal of the handset through the belly - the catheterization was called - cystostom. The main difference is that the tube is removed in the side. For this, a small incision is made in the abdominal cavity, which introduces drainage.
  The established cystostomtoma with prostate adenoma without proper care, the cause of infection, a complete sepsis of the body or an infectious disease. For this reason, the tube put in abdominal cavity Extremely rarely, only if the usual catheterization is not effective.

• Supply drainage - alternative to the abdominal cystostomom. The tube is excreted through the pubery, which is associated with less traumatic patient.

When determining what method of drainage will be the best, the surgeon takes into account possible complications and contraindications, as well as the actual state of the patient's health.

As far as the tube is put on the prostate adenoma

The duration of the installation of the catheter with prostate hyperplasia is determined by the degree of invasiveness of the operation, the state of the patient at the time of surgical intervention and the rate of postoperative restoration of the body:

• Type of surgical intervention:
  1. Minimally invasive methods: Vaporization and ablation require short-term catheterization, which is not more than a day. Manipulations on the installation and removal of drainage are carried out during mandatory hospitalization for 2-3 days.
  2. After the tour, the period of wearing increases to 2-3 days.
• The patient's condition before the operation - if the indicators of residual urine were more than 200 ml, after removing the adenoma, leave the catheter for up to 4-5 weeks. For the period of catheterization, the patient's recovery rate is influenced.
• Postoperative recovery - can only get rid of the tube in cases where the patient is amended, urination is normalized. With an unfavorable coating of circumstances, the drainage is left to complete recovery of the patient.

Catheterization is necessary, but carries a certain danger of the patient's health. The purpose of the attending physician to restore the patient's health in a short time and remove the drainage system.

Possible complications due to drainage input

Catheter is a foreign body in the body. Immediately after installation, the immune system perceives drainage as a threat, which leads to possible complications. With prolonged wearing, purulent and blood discharge from the tube are observed, allergic reactions are not uncommon, concomitant diseases occur:

• - chronic or acute inflammation of the urethra, which causes irritation and infection due to the long-lasting tube.
• - inflammation of the bladder. Developed due to infection in the cavity. Cystitis causes frequent and painful urination. The disease often occurs as a post-strammic effect of wearing drainage.
• Adenomit is the inflammatory process of the prostate gland. The symptoms of the disease is the same as with a traditional adenome, which negates all the positive effects of operational intervention.
• - In this case, the inflammatory process goes into a permanent stage. The diagnosis is made after inflammation continues for more than 3 months. The inflammation catalyst that fell inside the catheter infection has caused the disease.
• Acute prostatitis - arises due to the ingestion of the urethra and urinary tract of staphylococcal and ureaplasmen of staphylococcal and ureaplasmen. The reason is insufficient compliance with hygiene during the wearing catheter.
• Orhepidemite - inflammation of eggs and appendage. Arises as by-effect Infectious factor in the prostate gland. It is characterized by extensive lesions of the tissues, rashed like herpes like.
• Pyelonephritis - the defeat affects the tissues of the urinary system. The main blow falls on the kidneys.

If we consider that the listed diseases are often accompanied by allergic reactions and other violations in the work of the urogenital system, it becomes obvious, the need to strictly observe hygiene during the wearing catheter and the reduction of drainage wearing time.

Care of installed cystostomy

If a classic medical catheter with a vocariety for any indications cannot be put, a long-term wearing of the drainage system is required, a cystostomtoma is installed.

During hospitalization, care for patients with a drainage tube will be medical personnel. After discharge, the patient and his relatives will need to take care of the state of the catheter. This is done as follows:

• The skin around the entrance is regularly washed with boiled water, a solution of manganese or furacin.
• Skin section dryly wipe and lubricate lassary pasta.
• Control the constant outflow of urine. If the fluid has ceased to act, the problem is due to the fact that the catheter fell, the tube was blocked or leaned.
• Care of the catheter is required inside the drainage system located in the bladder. Requires regular washing system. So you can prevent the catheter by sand and getting inside the infectious agents.
  For washing, a jeene device with a wash filled into it is for washing: 3% boric acid or furaciline, at a concentration of 1K 5000. From the system disconnect the urinary researcher, the syringe is connected and about 40 ml of the substance are introduced, after which they disconnect the syringe from the system. From the tube will leave the remnants of urine and garbage.
  The procedure is repeated as long as clean water does not go from the drainage.
• The system's replacement is carried out 4-8 weeks after installation. The first time manipulation is carried out in the clinic. Replacement is performed independently.

The skin around the catheter during long-term wearing can grow, which leads to the fallout of the drainage. There is a small leakage through the hole around the inserted catheter, which requires constant processing of the skin area with special solutions. If the situation is not corrected independently, qualified medical care will be required.

How to replace the catheter with prostatic hyperplasia

Re-installation of the catheter is performed after 4-8 weeks. The replacement is performed by a urologist. If the patient is immobilized, manipulations are held at home.

There are no specific timing, indicating the gap through which the tube must be changed. A surgeon or a urologist decide the issue of reinstalling individually, according to the testimony of the patient's health and vital activity.

Previously, it was recommended to simply process the inserted tube with antiseptics, without the need to get a drainage system. But studies have shown extremely negative influence A similar approach to the immune system and the flora of the bladder. The replacement technique does not give the body to get used to the action of antibiotics, which is especially important in infectious damage.

At the same time requires the correct operation of bag-shaped urinary. Recommendations are prescribed to empty the container when it is filled with approximately half. After a week of use, replace the uniform to a new one.

After the appointment of catheterization, the attending physician is interested in the maximum short terms Drainage of the patient's bladder. Long wearing is shown only in extreme cases and is fraught with complications.

Epicistostoma is a special catheter introduced into the bladder through the abdominal cavity and intended for urine outflow. It is a rubber tube, one of the ends of which is supplied to the uniform. The drainage of the bladder is assigned in the event of a violation of natural urine outflows.

In a healthy person, urinary process looks like this: urine filtered in the kidneys, through the ureters enters the bladder. There it accumulates and stretches its walls. At a certain point, a signal is sent to the brain that talks about the need for urination. Under the influence of parasympathetic stimulation, the urethra sphincter relaxes and urine outflows.

The urodynamic violation can be caused by mechanical damage to the bladder, various pathologies, as well as the inability to self-evacuation of urine. The process of installing epitistostomas is called cystostomy. The main testimony to the drainage of the bladder are:

• prostate adenoma;
• the inability to install a urethral catheter;
• damage to the urethra and bladder;
• stagnation of urine, provoked by improper work of the urinary bubble sphincter.

Preliminary procedures

Before cystostomy, the patient is forbidden to take blood carrier drugs that can provoke bleeding during surgery. The patient must pass a number of mandatory analyzes, including:

• general urine analysis;
• general blood analysis;
• on blood sugar;
• on blood clotting.

The drainage of the bladder is carried out in a three-star method using local anesthesia. Mandatory condition for such an operation is a filled bladder. With the help of the catheter, Furacilin is introduced into it to avoid random injuries of neighboring organs and facilitating the input of the trochar.

On the skin of the patient, there is a small incision through which the trocar is introduced. The stale part of the tool is removed and the foul catheter is introduced instead. Then the Troacar itself is removed, the catheter is left in the urinary bubble cavity. Drainage is fixed on the skin with the superimposition of several seams.

Postoperative period

Epicistostom requires regular and careful care. At least twice a week, it is necessary to wash the bladder with a solution with antiseptics, in order to exclude stagnation of urine and salt sediments. The inexpensive and effective drug is Furacilin. In pharmacies, ready-made solutions are sold, which eliminates the need own cooking Wash liquid.

An important component when careing the cystostomom is a hygienic component. A set of measures aimed at minimizing the risks of infection with infections includes regular care for composite parts of the catheter and a semiconductor area adjacent to drainage. The place of occurrence of cystostomas in the abdominal cavity is washed daily with warm soap solution or hygienic wipes The catheter washed with smooth longitudinal movements at least 1 time per day. With emptying of the urinary (it is carried out when it is filled with half), it is necessary to prevent all sorts of contacts of its surface with the toilet surface.

In the postoperative period, the change of cystostomomas is resolved after 6 weeks after its installation. In the future, the drainage replacement should be carried out at least once a month.

With a qualitatively conducted surgical intervention, the risk of complications are small. To avoid suppuration and inflammatory processes, the operation should be carried out under conditions of complete sterility and include antibacterial therapy. In case of individual intolerance, an antiseptic in a patient may have an allergic reaction. The presence of blood in the urine, its turbidity and lack of selection are alarming symptoms and require a planned medical examination.

Cystostomtoma or junk fistula is a channel that connects the bladder cavity with an external environment by means of a drainage tube.

It is established to drive the contents of the bladder at the impossibility of the patient.

Cistostomy -, in which a section of the bladder wall is cut, with its further drainage and the formation of a supraid fistula.

The purpose of such a procedure is to ensure free urine outflows in case of unsuccessful catheterization.

It can be carried out by minimally invasive methods: capillary, trocar cystostomy.

Indications and contraindications

Indications for carrying out such an operation are divided into absolute and relative. Absolute include:

• and urethra;
• the formation of a false stroke of urethra;
• acute urine delay, complicated.

Relative readings are:

• prostate hypertrophy in men;
• requiring further surgical treatment, the first stage of which is to lead urine.

There are no contraindications to conducting cystostomy, since when the catheterization is not possible, the installation of a supraid fistula is the only way to remove urine from the body and save the patient from the right death.

How is the operation?

The epicistostomy procedure does not require special training. With a planned installation of a supraid fistula, the patient gives a common and biochemical blood test.

The pubic hair is launched before the procedure, the prolque location is processed by an alcoholic betadine or other antiseptic solution and local anesthesia is performed. Next, proceeds to the introduction of a trocar.

Trokar cystostomy is performed when temporary drainage of the bladder is necessary. The procedure is characterized by low traumaticity and speed of custostomy overlay (fistula). This method has some drawbacks.

With a troparic cystostomy, there is a risk of urine penetration in tissue surrounding drainage or catheter, which creates conditions for the development of infection and urine chatek. As a result, a trocar-drainage was created, equipped with a polychlorvinyl tube with stilettia inside, which made it possible to carry out a long drainage of the bladder with its simultaneous puncture.

Such a device allows you to perform a manipulation without urine from entering the front abdominal wall, thanks to the stale, which after its removal closes the slot in the tube.

Conducting cystostomy troccar occurs in several stages. The doctor produces a small incision into which the trocar is introduced, then punctures the front perringe wall and introduces the catheter to the urinary bubble cavity. A urhydrition will join the catheter.

If the procedure is carried out by trocar-drainage, the device is administered immediately, without additional manipulations, the doctor simultaneously punctures the abdominal wall and. Next removes the rod to close the lumen of the drain tube (mandren or stellet) and fixes it.

After recovery (if possible), the catheter is retrieved, the fistula is delayed independently.

Complications during procedure

There are a number of possible complications during and after the procedure. Operational risks include:

• possible damage to the peritoneum;
• possible damage to blood vessels;
• possible intestinal damage;
• wound the opposite wall of the bladder;
• wounds of prostate adenoma with its availability.

Such complications may entail the development of sepsis, urinary chapels, the formation of hematomas, thrombosis and the formation of blood clots at the site of the installation of custostomas. Rarely dropping drainage.

In order to prevent damage to the nearby internal organs, cystostomy is carried out in the Trendelenburg position with a complete bladder (volume of at least 400 ml). With this position, the patient is on the back at an angle of 45 degrees, the pelvis is located above the head.

Such a situation provides good access to the organs of a small pelvic, as the intestines and the gland shift in the upper body of the abdominal cavity.

How is the procedure for men?

The procedure for the installation of the urinary cystostomoma in men with such pathologies as various injuries of urethra, such as its damage due to improper installation of the catheter (the formation of a false move) or its rupture as a result of an accident, etc.

The prostate hyperplasia is the main disease at which the cystostomy is carried out in men. The injuries of the bladder, the presence of malignant processes of urination organs, the initial stage of reconstruction of the organs of the urogenital system - all this is indications for the installation of cystostomas.

Acute, which is a response to an infection, such as Wrost, eliminates the input of the catheter through the urethra, which is a direct indication to install a supraid fistula.

Postoperative period

After conducting custostomy, as a result of passive impellers, there are risks of such complications as the development of acute cystitis, or pyelonephritis, chronic renal failure, loss of the bladder tone (), urerohydronphrosis, etc.

All events in the postoperative period should be aimed at minimizing such complications.

When wearing cystostomomas, there is a violation of the functioning (atrophy) of the bladder and the urinary system as a whole. Therefore, in the postoperative period, the patient needs to mimic independent urination using a certain technique, which is to training the bladder.

After a three-cup cystostomy, start training is recommended on the 3rd day.

Patients need to constantly control the volume of urine. This allows you to install the tank of the bladder and to identify its dysfunction in a timely manner (if any). With long-term wearing cystostomas, you need to monitor the condition of the wall of the bladder.

In case of pathological changes, it is timely anti-bacterial and antiseptic therapy. Keep under control the condition of the urinary tract through ultrasound control.

How to care for the cystostomy?

W. the course behind the cystostoma can be carried out at home:

1. The urefactor, which joins the drainage tube or catheter, must be tightly fixed to the body and regularly empty it with subsequent disinfection. If a disposable uroofer is to replace.
2. It is necessary to monitor the condition of the skin around the suplocked fistula, every day to carry out their treatment with soap solution or chlorhexidine.
3. Do not allow the skin around the wet cystostomy.
4. Replace the catheter once a month. If necessary, rinse it.

Possible postoperative complications

First of all, the wearing of cystostoma inflicts the patient a psychological trauma. An unpleasant smell, fistula, caring for a drainage tube and urinal significantly reduce the quality of life. In addition, the long-term installation of a suplamp fistula can provoke ascending infections with the risk of the occurrence of Urosepsis, the function of the bladder is disturbed, chronic cystitis develops.