Epicystostomy (cystostomy)

Epicystostomy — is a procedure during which a catheter is inserted directly into the bladder through a small opening in the lower abdomen. Through it, urine is drained into a special urine collection bag. This method is used when natural urination is impossible and inserting a conventional catheter through the urethra is unsuccessful or contraindicated.

At «Oxford Medical», epicystostomy is performed by experienced urologists in a modern surgical inpatient facility. The procedure is performed using modern equipment, which allows the doctor to accurately carry out the necessary manipulations and monitor the course of the intervention.

If placement of an epicystostomy has been recommended to you, make an appointment for a consultation with a urologist. The doctor will review the examination results, explain how the procedure will be performed, and how to properly care for the catheter after placement.

Epicystostomy can be performed using a puncture or open surgical method. Both options make it possible to insert a catheter directly into the bladder, but they differ in the method of access and the extent of the intervention.

Types:

• Puncture (trocar) epicystostomy. The catheter is inserted through a small puncture in the lower abdomen using a special instrument — a trocar. This is a less traumatic option that is usually used when the bladder is sufficiently full and there are no obstacles to safely performing the puncture.
• Open epicystostomy. Access to the bladder is obtained through a small surgical incision. This method is used if puncture catheter placement is technically impossible or cannot be performed safely.

The urologist determines which method will be optimal in a particular case, taking into account the clinical situation and examination results.

Epicystostomy is also performed if it is impossible to insert a conventional catheter through the urethra or if its use is undesirable. The epicystostomy may be temporary or remain in place for a longer period — depending on the cause of the urination disorder and the further treatment plan.

Before epicystostomy, the doctor takes into account the patient's general condition and the specific features of access to the bladder. In some cases, the procedure needs to be postponed, while in others — another method of catheter placement should be chosen.

The main contraindications include:

• blood clotting disorders that could not be corrected before the intervention;
• infection or pronounced inflammation of the skin in the lower abdomen;
• a bladder tumor in the area of the planned catheter placement;
• pronounced ascites;
• significant anatomical changes after surgeries on the pelvic organs or lower abdomen.

For puncture epicystostomy, it is additionally important that the bladder is sufficiently full and that the catheter can be safely passed into it. If puncture access is not suitable, the doctor may choose an open surgical method.

Before the procedure, the urologist assesses the patient's general condition, reviews the results of previous examinations, and clarifies whether there have been any previous surgeries on the pelvic organs or lower abdomen.

Before epicystostomy, it is usually necessary to undergo:

• a general blood and urine test;
• a biochemical blood test;
• a coagulation test;
• an electrocardiogram;
• bladder ultrasound;
• additional examinations if indicated.

Ultrasound makes it possible to assess the location and filling of the bladder and choose a safe site for catheter placement. This is especially important with the puncture method.

Preparation on the day of the intervention depends on the type of anesthesia. If epicystostomy is performed under general anesthesia, no food should be consumed for 8 hours before the surgery, and drinking clean still water should be stopped 2 hours before. With local anesthesia, a fasting period is usually not required. Before puncture epicystostomy, the bladder should be sufficiently full, so immediately before the procedure it should not be emptied unless instructed by the doctor.

Epicystostomy surgery is performed under local or general anesthesia — the type of anesthesia depends on the selected method and the patient's condition. Most often, the puncture method is used, in which the catheter is inserted through a small puncture in the lower abdomen under ultrasound guidance.

Epicystostomy — course of the surgery:

• Anesthesia. Before the intervention begins, local or general anesthesia is administered.
• Access to the bladder. During puncture epicystostomy, the doctor inserts a special instrument through the anterior abdominal wall under ultrasound guidance. With the open method, a small surgical incision is made.
• Catheter placement. A catheter is inserted into the bladder through the created opening and fixed so that it remains in the correct position.
• Connection of the urine collection bag. The catheter is connected to a bag for collecting urine, and the free outflow of urine is checked.
• Completion of the procedure. The catheter insertion site is treated and covered with a sterile dressing.

After puncture epicystostomy, the patient usually remains under observation for several hours and, if their condition is stable, may return home the same day. After open epicystostomy, hospitalization may last 1–2 days depending on the extent of the intervention and the course of the postoperative period.

After placement of an epicystostomy, it is important to regularly care for the catheter and the skin around it. This helps maintain free urine drainage and reduces the risk of irritation and infection.

Main care rules:

• gently wash the skin around the catheter with warm water every day and dry it thoroughly;
• make sure that the catheter does not kink or become pulled during movement;
• keep the urine collection bag below the level of the bladder so that urine can drain freely;
• empty the urine collection bag regularly and do not allow it to become overfilled;
• do not disconnect the catheter from the urine collection bag unless necessary;
• attend catheter replacement appointments and follow-up examinations on time.

Doctors at «Oxford Medical» recommend not changing the position of the catheter on your own and not attempting to flush it without medical instructions. Scheduled replacement of the epicystostomy catheter is performed by a medical professional at intervals determined by the urologist. Proper care and timely replacement help maintain normal urine drainage and reduce the risk of infectious complications.

After placement of an epicystostomy, complications occur infrequently, but they cannot be completely ruled out. Some problems are related to the catheter itself, so it is important to care for it properly and contact a urologist promptly if unusual symptoms appear.

Possible complications include:

• urinary tract infection;
• blood in the urine or bleeding at the catheter insertion site;
• catheter blockage and impaired urine drainage;
• dislodgement or displacement of the catheter;
• urine leakage around the epicystostomy;
• irritation or inflammation of the skin around the catheter;
• bladder spasms;
• spread of infection to the upper urinary tract with the development of pyelonephritis.

Doctors at «Oxford Medical» recommend contacting a urologist if urine stops flowing into the urine collection bag, severe pain appears in the lower abdomen or lower back, the temperature rises, the urine becomes cloudy or develops a strong odor, or the catheter accidentally falls out. Such symptoms require examination and timely medical care.

The price of cystostomy depends on the method used to perform the procedure and the type of anesthesia. You can review the prices for medical services in advance here. A doctor can accurately guide you regarding the cost and explain the specifics of the procedure during a consultation. To make an appointment, use the online appointment form or contact the contact center.

The information is for informational purposes only and does not replace a consultation with a doctor.

Sources:

• British Association of Urological Surgeons
• U.S. National Library of Medicine
• European Association of Urology Nurses