Trauma Skills 4:
Suprapubic Cystostomy
This procedure is indicated when a male patient has a urethral or prostatic obstruction or injury that prevents or contraindicates the insertion of a urinary catheter. This can be an emergency in a head injured patient or a patient with urinary sepsis. This technique is minimally invasive and can be performed using good sterile technique.
- Locate the bladder by palpation or ultrasound to determine if distended.
- Prep the skin just above the pubis and insert the exploring needle of an Arrow percutaneous cavity drainage set into the bladder. Aspirate about 2 mL of urine and re-inject it while watching with ultrasound. Turbulence in the bladder will be seen, confirming correct placement.
- Insert the guidewire into the bladder and, before removing the needle, make a stab wound through the fascia into the bladder with a #11 scalpel blade held against the needle. Pass the 14 French dilator over the guidewire into the bladder. Remove the dilator leaving the guidewire in place.
- Pass the 14 French curved drainage catheter over the guidewire into the bladder. Insert it all the way to its hub. Connect the catheter to bladder drainage tubing and bag. Suture the catheter to the skin.
Reference
Ruiz E. Pelvic, sacral, and acetabular fractures in Emergency management of skeletal injuries, Ruiz E, Cicero JJ eds. St. Louis, Mosby-Yearbook 1995:115-154.