Bladder drainage. Care of the urinary catheter Contraindications for nephrostomy

Nephrostomy is a surgical procedure performed under X-ray or ultrasound guidance.

The operation is aimed at draining urine from the kidney through a special tube (nephrostomy or drainage).

Typically, the procedure is performed when the ureters are blocked and urine accumulates in the collecting system.

The nephrostomy is carried out through the skin and muscles in the lumbar region, renal tissue, ending in the abdominal cavity system of the kidney.

The drainage drains the fluid into a sterile urine bag. The operation is performed in the operating room under intravenous anesthesia.

Purpose of manipulation

The main purpose of installing a nephrastomy is to restore and normalize the outflow of urine from one or both kidneys, which is most often necessary for patients with oncology.

The lack of normal urine excretion is dangerous and carries the threat of non-stop damage to the kidney tissue, which as a result is completely destroyed. That is, kidney dysfunction may become irreversible.

In some cases, drainage is installed temporarily for patients and is used to approach the upper tracts of the urinary system (ureter and kidneys).

Once kidney function has been restored, the stoma is removed. But in serious cases (with irreversible and major tissue damage), the catheter may remain permanently.

A nephrastomy is also placed for lithotripsy (intrarenal stone crushing), to perform chemotherapy, install stents, or to prepare for subsequent surgery.

The operation can also be performed to carry out special examinations. A person requires artificial outflow of urine when its natural secretion is disrupted.

The operation can be performed for some diseases and pathological processes:

• urolithiasis;
• tumors in the pelvis (cysts in the kidneys, tumor formations in the vagina, prostate, bladder);
• with acute hydronephrosis;
• with excretory anuria;
• when removing coral stones;
• with strictures of the urethra and ureter;
• with metastatic damage to the abdominal organs and if there is compression of the organ by tumor accumulations.

Restoring urinary outflow prevents the development of hydronephrosis (expansion in the cavity system of the organ), acute renal failure, pyelonephritis (inflammation of the kidney tissue).

In emergency cases, it is important to first remove the accumulated fluid, after which it comes to restoring the natural outflow of urine.

Contraindications for surgery

All contraindications to surgical intervention are established by the attending physician or council.

The main restrictions for installing a nephrostomy tube:

• arterial hypertension which cannot be corrected;
• diseases related to bleeding disorders, a history of thrombocytopenia or hemophilia;
• use of anticoagulants or blood thinning medications, these include heparin, aspirin, etc.: you should stop consuming them no later than a week before surgery.

Preparatory activities

Preparation before nephrastomy is carried out in the same way as before other operations.

First, the patient must pass a standard set of tests (urine, blood). Various examinations are carried out (biochemical analysis, microflora culture, checking clotting time and blood sugar levels).

If there are no contraindications to surgery, after tests, an ultrasound examination of the kidneys and an x-ray are performed.

After determining the disease and the volume of accumulated fluid in the kidneys, additional examinations may be prescribed:

• computed tomography of the kidneys;
• urography;
• computed tomography of the peritoneal space.

The patient is examined by an anesthesiologist, his reaction to anesthesia and other drugs is determined.

No special antibiotic therapy is prescribed before elective surgery.

In case of inflammation in the bladder and the spread of infection, taking antibacterial drugs is aimed at eliminating the inflammatory process. They are prescribed by a doctor in the required dosage and volume.

Progress of the operation

There are two types of surgery to insert a nephrostomy into the renal cavity:

• open (intraoperative);
• percutaneous puncture nephrostomy.

The old fashioned way - painful and unpredictable

The open type of operation is characterized by the installation of a stoma (drainage) during abdominal surgery of the kidney.

To do this, tissue is cut in the lumbar region down to the damaged organ. When the renal fat capsule is reached, it is sutured to the skin and several sutures are placed.

Then, at the same level, the kidney and pelvis are cut, where a rubber tube is inserted. It is fixed by sewing it to the skin with one seam. The rest of the skin incision is sutured.

A modern method with minimal consequences

A puncture operation is characterized by a puncture of the skin in the area where the affected organ is located. To penetrate the required area, the doctor operates using ultrasound or x-ray examination.

The rubber tube is connected to a special storage container with a valve, into which urine will accumulate while the stoma is in the kidney.

Experts advise changing the tube frequently, as salt deposits accumulate on it. The operation takes about half an hour.

After the recovery period is over, the drainage is removed, and the fistula heals on its own for several weeks.

Drainage care

Basically, after the operation, the patient is sent home on the same day with detailed instructions from the attending physician. The patient should not engage in sports or physical activity.

Proper care of the nephrostomy and carrying out preventive measures to protect against possible inflammation in the kidney are also important. A salt-free diet is required so that the flow of urine is not delayed.

After abdominal surgery, standard care is required. The tube is removed after a fistula tract appears to allow fluid to drain away.

Regardless of the timing of catheter installation, it requires careful care:

1. To avoid urinary infection, it is advisable to regularly flush the drainage with saline solution.
2. Also the puncture wound area should be clean, you need to wash it with antiseptic solutions (furacillin or chlorhexidine), applying a sterile bandage.
3. Periodic cleaning of the urine bag. The urinal has a sealed clasp and a special mark indicating the fluid level at which the device needs to be changed. If the bag is not changed in a timely manner, backflow of urine into the renal pelvis is possible. Because of this, kidney infection, suture divergence and increased blood pressure are possible.
4. Constant flushing of the kidney. Active drainage should be used. To do this, 2 stomas are placed in the pelvis. By applying an antiseptic to one stoma, a washing liquid with stagnant urine and sand residues comes out of the second.

Possible complications

Primary complications relate to the process of surgery and stoma placement.

For example, during an operation with an incision, an artery near the kidney can be damaged. Because of this, severe hemorrhage appears in the retroperitoneal tissue with the appearance of a retroperitoneal hematoma.

The danger of a hematoma is that it becomes infected, which will require surgery in this area. Blood may also appear in the urine, causing the doctor to make an incorrect diagnosis and prescribe incorrect treatment.

Secondary complications are associated with infection of the organ. Postoperative pyelonephritis of the secondary type is characterized by aggressive development and is poorly eliminated with antibacterial therapy.

The pathological process can be corrected with modern antibiotics.

Patient's opinion

Review of a man who, due to illness, had a nephrostomy installed in his kidney.

The nephrostomy is removed after normalization of urine outflow through the urethra. Before this, the patency of the channels is checked by introducing dye into the tube.

You should contact professionals who comply with European safety regulations and have the appropriate certificates.

1pochki.ru

Nephrostomy: general information

What is a nephrostomy? The procedure is an operation to carry out a special stoma-drainage, stent or catheter (which is determined by the characteristics of the disorders) through the skin in the lumbar area up to the renal structure and with output to the outside. The manipulation is carried out under X-ray or ultrasound control. Less commonly used is abdominal surgery to install the device. The task is to remove biofluid, which, in case of certain disorders (more often - blockage of the ureter) accumulates in the cavity of the renal collecting structure of the kidneys. The urine flows through the tube into a sterile urine bag. The operation, called nephrostomy, is performed under full anesthesia (intravenous) in the manipulation room.

A stoma is placed to establish and stabilize the regular drainage of urine from the kidneys and restore the functionality of one or both kidneys. Nephrostomy is most often performed on cancer patients. The importance of the operation is that by ensuring urine drainage, irreversible destruction of kidney tissue due to urine accumulation is prevented. Often the operation is used as a temporary measure where the device is removed after serving its purpose. In particularly difficult cases, an ostomy needs to be in place for life.

Return to contents

Indications for kidney nephrostomy

When crushing kidney stones, a nephrostomy is installed.

A nephrostomy is installed to perform:

• crushing kidney stones;
• chemotherapy;
• stent attachments;
• preparation for further surgery;
• special examinations.

A catheter is placed in the kidney when the outflow of urine is obstructed due to the following pathologies and conditions:

• neoplasms in the kidney or other area of ​​the pelvis;
• narrowing of the ureter;
• stones in the kidneys, ureter, bladder;
• expansion of the pyelocaliceal complex (hydronephrosis).

Return to contents

Contraindications

The decision to catheterize the kidney is made by a doctor or a council of specialists. The operation may be prohibited in the following cases:

• a persistent increase in blood pressure that cannot be corrected with medication;
• blood clotting disorders and pathologies accompanied by plasma dilution;
• treatment with blood thinning drugs that cannot be cancelled;
• condition with hydronephrosis.

Return to contents

Preparation for manipulation

Kidney ultrasound is performed to diagnose the condition of the kidneys.

Renal catheterization requires the same preparatory measures as other types of surgery. The first sets of urine and blood tests are taken: a general and biochemical test, bacterial culture, assessment of the rate of coagulation and glucose in the blood plasma are performed. To check the condition of the kidneys and determine the volume of accumulated biofluid, a set of diagnostic procedures is used: ultrasound, CT, urography. The patient is consulted and examined by an anesthesiologist to determine the response to anesthesia. Taking antibiotics before manipulation is not required if there is no infection or other inflammation in the urinary system. 8 hours before the procedure, the patient should not consume milk or dairy products or eat liquid foods. Only non-concentrated broths and water are allowed, which must be discarded 3 hours before the procedure.

Return to contents

Progress of the operation

Nephrostomy is performed in two ways:

• open or intraoperative;
• percutaneous puncture.

In open surgery, renal drainage is installed and the organ is opened. To do this, an incision is made in the lumbar area to the fat capsule of the damaged organ. The kidney is cut together with the pelvis, a flexible tube is inserted and secured with one suture. When a nephrostomy is installed, stitches are applied to the inlet. The procedure is performed under general anesthesia. The technique is used extremely rarely due to the long rehabilitation period and the greater number of consequences.

Puncture nephrostomy is a modern minimally invasive method of catheter insertion. To control the introduction, an ultrasound machine or x-ray equipment is used. Before inserting the puncture needle, local anesthesia is given. After the needle is inserted, a contrast agent is released to highlight the placement of the drainage tube. The total duration of the operation ranges from 30 minutes to an hour. The risk of developing perioperative consequences during percutaneous nephrostomy is minimal, largely due to the patient’s ability to hold his breath, which will ensure the immobility of the kidney and, therefore, ensure safe insertion of the catheter. During puncture execution, the outlet channel is fixed in three ways:

• through the pelvic loop;
• by means of an inflating balloon;
• sewing to the skin (more often).

Return to contents

Operating on special groups of patients

The set includes all the necessary equipment for nephrostomy.

A nephrostomy drainage channel is placed not only on adults, but also on children of different ages (there are cases where a stoma was placed on newborns), and on pregnant women according to indications. This need is associated with congenital anomalies of the urinary system (in a child), pyelonephritis or hydronephrosis, with stones during pregnancy, which are severe and dangerous for bearing a fetus. This group of patients remains in the hospital for the entire treatment period until the stent is removed. To install nephrostomy drainage, only puncture nephrostomy is used.

List of indications for nephrostomy in pregnant women:

• all forms of jade;
• an inflamed tumor (carbuncle) in the cortex of the kidney;
• abscess without purulent-septic reaction;
• purulent destructive pyelonephritis.

Return to contents

How to care for and clean drainage at home?

After nephrostomy, the patient goes home with detailed instructions from the doctor on how to care for the drainage and prevent inflammation. During the entire period of wearing the catheter, physical activity is prohibited, otherwise the nephrostomy may fall out; a salt-free diet is observed. To prevent urinary infection, regularly wash the wound and drainage with sterile saline solution. If the catheter is installed for a long-term or lifelong period (for life), the nephrostomy is periodically replaced. In particular, renephrostomy is required when the drainage tube is blocked by salts contained in urine. The same manipulation is required if the catheter falls out, which cannot be allowed until a natural fistula tract has formed for the outflow of urine due to the risk of infection and problems. Replacement is made within 24 hours.

The norm is the detection of blood in urine in the first 2-3 days after the insertion of a stoma. Subsequently, the urine contains traces of red blood cells.

Nephrostomy care should always be as thorough as possible.

You need to care for your stoma through the following procedures:

• Rinse the nephrostomy with saline solution (20 ml of 0.9% sodium chloride). You can wash it at home if you follow your doctor’s recommendations. If you need to change the device. For this purpose, special kits are sold that contain a removable adapter and the tubular catheter itself.
• Wound care by rinsing with an antiseptic. You need to rinse the inlet with an antiseptic (“Furacillin”, “Chlorhexidine”), followed by applying a sterile, dry bandage. If a gauze dressing is used, it is changed daily. When using a sterile transparent dressing, change it every 3 days.
• Emptying the urinal after reaching the level marked on the device. If the replacement is untimely, there is an increased risk of biofluid reflux into the drainage and kidney, excess pressure in the renal pelvis with suture divergence and loss of drainage.
• Active kidney lavage. The technique is used when a paired organ is infected. To do this, two stomas are inserted: through one, a washing solution is supplied, through the second, stagnant urine with traces of sand is removed.
• Keeping dry. The patient needs water treatments (bath, swimming are prohibited), but it is important to keep the area around the wound dry for at least 14 days.
• Providing protection. If a patient is undergoing chemotherapy through a stoma, it is important to provide protection in the form of sterile gloves when emptying the urine collection container.
• Providing assistance. A patient with a nephrostomy needs the assistance of at least two people to change dressings and empty the urine bag, especially with double drainage.

Return to contents

Possible risks

There are primary (operative) and secondary (postoperative) complications of renal nephrostomy. During the manipulation, there is a risk of damage to the pararenal artery with the development of bleeding into the retroperitoneal space with the formation of a hematoma, which can become infected, which will require abdominal surgery. Less often, incorrect treatment is carried out against the background of detection of blood in the urine during the first day, as a consequence of a breakthrough of the resulting perioperative hematoma.

There are more risks during abdominal surgery, more often - urinary leakage, bleeding, and kidney infection. Secondary disorders develop in the form of postoperative pyelonephritis, which is characterized by its aggressive nature and resistance of the infection to antibiotics. Eliminating the disease will require more expensive medications and a longer recovery period. Therefore, if your temperature suddenly rises to 38 °C or higher, you should urgently call a doctor.

Return to contents

Stoma removal

Indicators of successful treatment, after which the nephrostomy can be removed, are:

• formation of a fistula tract to ensure the natural outflow of urine (in patients with severe pathologies);
• restoration of normal urine drainage through natural urinary drainage channels.

Usually drainage is carried out for 10-15 days. Pregnant women are not recommended to use nephrostomy for more than 4 days due to the high risk of developing disorders. In any case, removal of the nephrostomy is prescribed by the attending physician based on the results of control tests and assessment of the degree of restoration of urinary diversion function. An equally important indicator is the absence of irreversible diffuse damage to the renal parenchyma (fiber).

etopochki.ru

Purpose of nephrostomy

A drainage tube placed in the kidney serves as a kind of adapter for urine. The resulting urine is freely discharged into a special container that looks like a container, which is a urinal.

This surgical procedure is usually performed for people with cancer, to stabilize the process of removing urine from the body.

How long do people live with nephrostomy? With proper care, you can live from 10 to 20 years with a drainage tube.

When installing a nephrostomy, most pathological abnormalities are excluded, as well as kidney amputation.

How to care for a nephrostomy

After surgery, the nephrostomy drain must be carefully protected and cared for. After completion of the surgical procedure, the patient leaves the medical facility and carries out all mandatory preventive measures prescribed by the surgeon at home.

Before going home, the patient is carefully counseled about how to care for the nephrostomy after surgery. For example, any physical activity is strictly prohibited, as the device may fall out of the percutaneous hole. Next is support for a special diet (table No. 7 is usually recommended), as well as breathing exercises.

Caring for an implanted nephrostomy consists of the following points that are mandatory:

• The drainage tube must be washed daily with a special sterile solution.
• The puncture puncture must be treated with an antiseptic daily. To prevent the cut from bleeding, it is recommended to apply gauze bandages to it, which need to be changed every few days.
• It is necessary to monitor the amount of urine in the container. Once it is full, there is a risk of urine flowing back into the kidney, which is fraught with serious complications, including the formation of serious inflammation, as well as the development of an infectious disease or urolithiasis.
• If there is an infection in the affected organ, the kidney must be flushed. For these purposes, two nephrostomies are implanted into the patient. Urine is excreted through one tube, and saline solution enters through the second.
• It is important to remember that all manipulations associated with the nephrostomy and the entire included set must be performed with special gloves. The equipment must be sterile and also remain sealed.
• It is strictly forbidden to take a bath, visit a bathhouse or other similar places in the first few weeks after the operation.
• If a person is in serious condition, he needs the help of an outsider. The urinal container must be emptied on time.
• Care for pregnant women at home should be carried out exclusively under the supervision of a doctor. At the slightest deviation, the tone of the uterus is disrupted and danger looms over the life of the unborn child. Therefore, it is recommended to call a local doctor at home or, if possible, visit the doctor yourself.

You can live a long time with an implanted nephrostomy without feeling any discomfort. If you follow all the doctor’s recommendations, the chance of relapse of the disease, as well as the development of viral diseases, is reduced to zero.

Rehabilitation

After the operation, the patient is transferred to the inpatient department, where rehabilitation measures are carried out. To begin with, salt is completely excluded from the patient’s diet, even in the smallest proportions. Every day the patient is treated with wounds and the gauze bandage is changed. Initially, during the postoperative period, the person is cared for by medical staff, but after a few days he is sent home, where he continues his independent rehabilitation.

Special conditions for rehabilitation in pregnant women. With a drainage tube, some representatives of the fair sex find it very difficult to move, but thanks to the implanted device, the risk for mother and child is significantly reduced. As for labor, in 85% of cases a caesarean section is performed, although at the request of the woman in labor they can occur naturally. If the need for nephrostomy arises at 6-7 months of pregnancy, then after the operation, the woman remains in custody in a medical institution.

Patients often worry about how long they can live with an implanted device. Life expectancy with a nephrostomy is 10-20 years, but you can live much longer if you follow all the specialist’s recommendations, and first of all, control your diet. For many years, treatment table No. 7 has been actively practiced. Its peculiarity is that all products are prepared absolutely without salt, and the food consumed by the patient must be enriched with calories.

Thus, optimal conditions are created for the damaged organ, which allow the damaged organ to regenerate much faster. Another condition for successful rehabilitation is careful wound treatment. To exclude the possibility of a dangerous infection, as well as the development of inflammatory processes.

Physical activity is excluded, otherwise the tube may fall out. Despite all the failure and deplorable situation, it is necessary to adhere to the established recommendations for successful kidney regeneration.

But what to do if the drainage suddenly falls out? It is strictly forbidden to install a fallen tube yourself. Only a specialist in this field, guided by his knowledge and special equipment, can carry out restoration.

mpsdoc.com

Nephrostomy - what is it? Functions

As you know, in the case of cancer, it is not always possible to perform a radical operation and at the same time preserve the functions of the organ. Sometimes the tissue affected over a large area must be completely removed to avoid the spread of cancer. In other cases, on the contrary, radical surgery is impossible due to severe disturbances in the functioning of the body. For this purpose, palliative surgical interventions were invented. They do not lead to a cure, but help restore the physiological capabilities of the body. Palliative operations are performed in all areas of oncology, urological care is no exception.

So, in order to improve the excretory function of the body and save a person from endogenous intoxication, nephrostomy is performed. It involves placing a drainage tube into the collecting system of the kidney. The free end of the nephrostomy is brought out, that is, to the surface of the skin. A special container is connected to it, and the outflow of metabolic end products is carried out, bypassing the bladder, ducts and urethra.

This operation is a palliative type of care, so the doctor should think carefully about whether a particular patient needs a nephrostomy. What it is and how to care for it, he will explain to the patient before surgery. And the installation of renal drainage is performed only with the written consent of the patient or his relatives. In this case, it is necessary to assess the general condition of the patient and find out whether such an operation can be performed.

Indications for nephrostomy delivery

Like any artificially created drainage, the nephrostomy in the kidney performs a vital function. Most often it is installed for oncological diseases of the genitourinary system. Less often - with other serious urological pathologies. There are special indications according to which a nephrostomy is installed. The operation is performed if the following indications for nephrostomy exist:

1. Cancer of the kidney or other organs of the urinary system.
2. Hydronephrosis.
3. Urolithiasis with a predominance of large stones.
4. Tumor metastases of any location, compressing the pelvic organs.
5. Obstruction of the ureter due to external compression or strictures.

Nephrostomy helps not only to restore the outflow of fluid from the body, but also to prevent the occurrence of an inflammatory process. As a result, it is possible to avoid chronic and acute kidney failure.

Such an operation does not always mean that artificial drainage will be in the body permanently. In some cases, after special treatment (surgery, chemotherapy), the nephrostomy is removed. Sometimes restoration of urine outflow is necessary while diagnostic procedures (stenting) are performed.

Contraindications to nephrostomy

Despite the urgent need for surgery, nephrostomy cannot always be performed. Contraindications include the following conditions:

• blood clotting disorder;
• uncontrolled arterial hypertension;
• taking anticoagulants.

Diseases in which blood clotting is impaired include hemophilia, hemorrhagic vasculitis, thrombocytopenic purpura, etc. With these pathologies, any surgical interventions are life-threatening. The same applies to taking anticoagulants - medications that thin the blood. A nephrostomy is not installed in cases of high blood pressure, which cannot be corrected with medication. Surgery in this condition is contraindicated due to the risk of stroke and cardiogenic shock.

Preparation for nephrostomy placement

In cases of obstruction of the outflow of urine, which cannot be eliminated with medication, a nephrostomy in the kidney is needed. The operation to install it, as a rule, does not take much time, but requires the patient to stay in the hospital.

Diagnostic tests should be performed before proceeding with the surgical procedure. Among them are a general and biochemical analysis of blood, urine, and coagulogram. If the cause of anuria (impaired urine outflow) is not clear, instrumental examinations are required. These include excretory urography, kidney ultrasound, computed tomography.

Nephrostomy technique

Patients naturally want to know why a nephrostomy is needed, what it is and how it is installed. It should be noted that removing the drainage tube from the kidney to the surface of the skin is considered a simple operation for experienced surgeons. It is performed both under general anesthesia and with local anesthesia. Nephrostomy is performed quickly, within 15-20 minutes. However, after the operation the patient must be monitored. This is necessary to assess the restoration of urine outflow. There are 3 options for nephrostomy. Among them:

1. Performing open surgery.
2. Laparoscopic drainage installation.
3. Percutaneous nephrostomy.

Most often the last option is performed. Installation of a nephrostomy by puncturing the skin and underlying tissues is better tolerated by patients. In addition, percutaneous surgery is considered less traumatic compared to open surgery. It is performed under ultrasound or radiography control.

The surgical technique includes puncture of the skin, fatty tissue, muscles and renal parenchyma using a puncture needle. While performing a nephrostomy, the doctor watches the monitor. This is very important, since it is necessary to accurately enter the pyelocaliceal system without damaging the surrounding tissue. After inserting the needle, a drainage tube is installed, the free side of which is connected to the urinal.

When is a nephrostomy removed?

If the operation was performed for the purpose of performing medical procedures (chemotherapy, stenting of kidney vessels), the nephrostomy is removed after restoration of the physiological outflow of urine.

Sometimes a drainage tube is installed indefinitely. Most often with severe cancer. In this case, the nephrostomy tube needs to be replaced periodically. It must be performed in an operating room. Unlike the initial surgery, tissue puncture is not required as a fistula is created.

Recovery after surgery

Recovery after nephrostomy occurs quickly. Already on the first day, the patient can move around the ward with a drainage tube. Antibiotics should be taken after surgery for 5-7 days to prevent infection. Within 2-3 days, blood may enter the urine bag. This occurs due to trauma to the kidney vessels. After 3 days the bleeding stops. An ultrasound is performed to monitor the outflow of urine.

Nephrostomy: self-care at home

Since drainage is a foreign body for the body, it can become infected at any time. Every patient who has a nephrostomy is warned about this. The catheter should be maintained regularly. Methods for preventing the infectious process include:

1. Rinsing the drainage tube with saline solution and antiseptics. For this purpose, the drug “Chlorhexidine” or “Furacilin” is used.
2. Applying a sterile dressing to the area of ​​the postoperative wound.
3. Timely emptying of the urine bag.
4. Check with a doctor every 2 weeks.

Patients who have a nephrostomy should not exercise or lift heavy objects. Kinking the drainage tube can lead to complications, so the catheter should be in one position.

A cystostomy or suprapubic fistula is a channel that connects the bladder cavity with the external environment through a drainage tube.

It is installed to drain the contents of the bladder if the patient is unable to do so.

Cystostomy - in which an incision is made in the wall of the bladder, with its further drainage and the formation of a suprapubic fistula.

The purpose of this procedure is to ensure free flow of urine in case of unsuccessful catheterization.

It can be performed using minimally invasive methods: capillary, trocar cystostomy.

Indications and contraindications

Indications for such an operation are divided into absolute and relative. The absolute ones include:

• and urethra;
• formation of a false urethral meatus;
• acute urinary retention, complicated.

Relative indications are:

• prostatic hypertrophy in men;
• , requiring further surgical treatment, the first stage of which is urinary diversion.

There are no contraindications to cystostomy, since if catheterization is impossible, installation of a suprapubic fistula is the only way to remove urine from the body and save the patient from certain death.

How is the operation performed?

The epicystostomy procedure does not require special preparation. During the planned installation of a suprapubic fistula, the patient undergoes a general and biochemical blood test.

Before the procedure, pubic hair is shaved, the puncture site is treated with an alcohol solution of betadine or another antiseptic, and local anesthesia is administered. Next, the trocar begins to be inserted.

Trocar cystostomy is performed when temporary drainage of the bladder is necessary. The procedure is characterized by low trauma and rapid application of a cystostomy (fistula). This method also has some disadvantages.

With trocar cystostomy, there is a risk of urine penetrating into the tissue surrounding the drainage or catheter, which creates conditions for the development of infection and urine leakage. As a result, a drainage trocar was created, equipped with a polyvinyl chloride tube with a stylet inside, which made it possible to carry out long-term drainage of the bladder with its simultaneous puncture.

This device allows you to perform manipulation without urine getting on the anterior abdominal wall, thanks to the stylet, which, after being removed, closes the gap in the tube.

Trocar cystostomy is performed in several stages. The doctor makes a small incision into which a trocar is inserted, then punctures the anterior abdominal wall and inserts a catheter into the bladder cavity. A urinal bag will be attached to the catheter.

If the procedure is carried out by trocar drainage, then the device is inserted immediately, without additional manipulations, the doctor simultaneously punctures the abdominal wall and. Next, remove the rod to close the lumen of the drainage tube (mandrin or stele) and fix it.

After recovery (if possible), the catheter is removed and the fistula heals on its own.

Complications during the 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;
• injury to the opposite wall of the bladder;
• injury to prostate adenoma, if present.

Such complications can lead to the development of sepsis, urinary leakage, the formation of hematomas, thrombosis and the formation of blood clots at the site of the cystostomy. Rarely loss of drainage.

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

This position provides good access to the pelvic organs, as the intestines and omentum move into the upper abdominal cavity.

How is the procedure performed in men?

The procedure for installing a bladder cystostomy in men occurs in the presence of pathologies such as various injuries to the urethra, for example, its damage due to improper installation of the catheter (formation of a false passage) or its rupture as a result of an accident, etc.

Prostatic hyperplasia is the main disease for which cystostomy is performed in men. Injuries to the bladder, the presence of malignant processes of the urinary organs, the initial stage of reconstruction of the organs of the genitourinary system - all of these are indications for the installation of a cystostomy.

Acute, which is a response to an infection, such as urosepsis, excludes the insertion of a catheter through the urethra, which is a direct indication for the installation of a suprapubic fistula.

Postoperative period

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

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

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

After trocar cystostomy, it is recommended to start training on the 3rd day.

Patients need to constantly monitor the volume of urine output. This allows you to establish the capacity of the bladder and promptly identify its dysfunction (if any). When wearing a cystostomy for a long time, you need to monitor the condition of the bladder wall.

If pathological changes occur, promptly carry out antibacterial and antiseptic therapy. Keep the condition of the urinary tract under control through ultrasound monitoring.

How to care for a cystostomy?

U cystostomy can be done at home:

1. The urine collector, which is attached to the drainage tube or catheter, must be tightly fixed to the body and emptied regularly, followed by disinfection. If the urine collector is disposable, replace it.
2. It is necessary to monitor the condition of the skin around the suprapubic fistula and treat it every day with a soap solution or chlorhexidine.
3. Do not allow the skin around the cystostomy to get wet.
4. Replace the catheter once a month. If necessary, rinse it.

Possible postoperative complications

First of all, wearing a cystostomy causes psychological trauma to the patient. An unpleasant odor, getting the fistula wet, and caring for the drainage tube and urinal significantly reduce the quality of life. In addition, long-term installation of a suprapubic fistula can provoke ascending infections with the risk of urosepsis, bladder function is impaired, and chronic cystitis develops.

Quite often, during pathological processes in the human body, often of a urological nature, there is a need to drain the bladder, that is, to create an artificial outflow of urine from the bladder reservoir cavity. In modern medical practice, this process is carried out using a whole set of modified devices (catheters) made from various materials. Bladder catheterization is used for both diagnostic and therapeutic purposes.

Indications for the drainage procedure are individual and depend on many reasons. Typically, these are patients with urological problems. A drainage system is required:

• When examining the urethral tract for the presence of obstruction in patients who have lost the ability to perform independent movements, which led to their long-term delay (more than 12 hours) and the development of acute pain syndrome, which may be a consequence of dysfunction of the innervation of the urinary tract, a strong inflammatory process in the urethra, the presence of stones or tumor formations in the organs of the urinary system themselves and in the tissues adjacent to it.

• For laboratory monitoring of urine for microflora - for greater reliability of the results, sterile urine is taken directly from the reservoir bladder cavity.
• If necessary, diagnostics with a contrast agent.
• For washing the bladder cavity from stagnant urine, pus, or bloody clots formed as a result of infectious and inflammatory processes or surgical interventions.
• Indications for catheterization are for patients who have undergone surgical interventions on the organs of the urinary system, which contributes to the processes of complete regeneration and recovery.
• And finally, for patients in a coma who have lost the ability to perform independent movements.

Absolute contraindications to catheterization are due to:

• the patient has infectious urethritis;
• pathological disorders that prevent the flow of urine into the bladder cavity;
• injury to the bladder and urethral tract;
• the presence of blood in the urethra and scrotum;
• signs of the presence of vesical reflux;
• potential complications such as acute prostatitis or penis fracture;
• real risk of infection of MP from the outside.

Bladder drainage methods

Depending on the condition of the patients and the purpose of drainage, catheterization of the bladder in women and other patients of various ages can be one-time, carried out periodically (intermittent catheterization) or installed permanently. For each specific case, its own drainage system is selected.

A one-time catheterization procedure is used:

• if it is necessary to remove urine from the reservoir bladder cavity for a diagnostic assessment of the bladder condition and collect urine for laboratory monitoring;
• y, to stabilize the condition just before childbirth;
• if necessary, medicinal irrigation of MP reservoir tissues.

For such purposes, disposable catheters are used. The duration of the procedure does not exceed 2 minutes, and the minimal presence of a drainage tube in the body minimizes the risks of additional infection and the development of other complications.

The procedure of continuous catheterization has been used since the middle of the last century for chronic urinary problems. The drainage is left in the bladder reservoir for a long time. It is installed via the urethral route or through a cystostomy (an incision in the pubic area of ​​the abdomen). But, as studies show, prolonged drainage promotes the formation of calculi (stones) in the urinary excretion system and increases the risk of malignant tumors in the bladder.

According to international studies and recommendations of the Association of Urologists, permanent catheters should not be installed for more than 2 weeks.

The method of intermittent drainage has been widely used since the end of the 20th century instead of constant drainage. The method is based on 4, 6 single catheterizations during the day, which imitates the normal processes of urine excretion by single drainage. This technique poses the lowest risk of developing functional disorders in the kidneys, infectious and other disorders. Can be used for many months and years without causing any harm to health.

Types of urinary drainage systems

There are different types of bladder catheters, differing in material, size and modification, women's, men's and children's, soft (rubber), hard or rigid (metal) and semi-soft (synthetic), equipped with additional internal channels (from 1 to 3) , for permanent and temporary drainage. Let's look at some of them used in medical practice:

• The Nelaton (Robinson) drainage system is the simplest version of a rubber or polymer catheter. Designed for intermittent drainage in uncomplicated cases. Made from polyvinyl. Under the influence of body temperature it becomes soft. Equipped with two side openings and a closed rounded end. They are used by both men and women, differing only in length - women’s from 12 to 15 cm, men’s up to 40 cm. The sizes are marked with different color coding. A special hydrophilic coating when interacting with moisture makes it slippery, which does not require additional lubrication, and minimizes the risk of additional infection.

• Mercier (Timman) system - equipped with an elastic curved tip, two holes and one outlet channel. It is used for complex infectious and inflammatory processes against the background of adenomatous growths in the prostate or stenosis of the urethral tract.
• Nelaton system with Timman tip - has the characteristics of the basic system, but the curved tip of the above device helps to drain patients with the presence of a prostate.
• Catheter for long-term use of the Pezzer system. It looks like an ordinary rubber tube, equipped with two outlet channels and a retainer in the form of a thickening of the tube.
• Foley drainage catheter is the most popular type of drainage in urology. It is an excellent option for long-term use. Equipped with a special balloon (filled with sterile liquid) holding the device inside the MP. Through this catheter, the bladder is washed, medications are administered, or urine is removed into a urinal attached to the end of the tube.

The drainage modification of this system (Foley catheter) can be different:

• two-channel with a common passage for the outflow of urine and washing of the bladder and the channel through which the balloon fluid is introduced;
• three-channel with an additional channel for the administration of medications, made of latex with silicone coating (cheap option), which eliminates the deposition of salts inside the catheter, or from silicone coated with silver (expensive option), which inhibits bacterial replication and reduces the risk of infection;
• two-channel with a beak-shaped Timman tip, which is the most convenient option for catheterization against the background of the prostate and its hyperplasia;
• with options for women's and children's modifications (shorter in length and with a smaller diameter).

Drainage with rigid (metal) systems is carried out in rare cases today. In usual practice, catheterization is used with a soft catheter, which minimizes the risk of injury to the urethra.

In each specific case, the drainage system is selected by a doctor and installed by medical personnel. Self-drainage is fraught with serious consequences, additional infection and the development of dangerous complications, since the procedure requires special preparation and knowledge of certain rules of the installation algorithm.

Self-catheterization is carried out only in emergency cases, when it is not possible to call a doctor, or medical assistance is too late.

Preparation for drainage manipulation

The preparatory period for catheterization of patients consists of several stages, including:

• preliminary examination by a doctor to clarify the absence of contraindications;
• maintaining a certain nutritious diet (excluding fried and spicy foods, alcohol and sweet drinks with gas) a couple of days before the procedure;
• thorough preparation of the patient by a specialist (treatment of the genitals with an antiseptic, familiarization with catheterization techniques).

At the next stage, a special kit for catheterization is selected, including:

• A set of sterile materials needed for the procedure - gauze, cotton swabs and napkins.
• Disposable medical gloves.
• Painkillers and sterile solutions to facilitate insertion of the catheter drainage tube.
• Sterile plastic tweezers and a cone-shaped Janet syringe.
• Antiseptic solution and genital preparation.
• Tray for receiving urine.

Related article:

Features of MP drainage in adults

Drainage of the bladder organ in men is associated with the peculiarities of the anatomical configuration of the urethra (long and curved) and the different structure of its sections - prostatic, membranous and cavernous, which makes it quite vulnerable and sensitive to various types of damage.

The algorithm for performing bladder catheterization in men is determined by a specific, sequential technique for introducing a drainage device.

• Drainage can be administered to men in a standing or lying position. The classic method is to lie on a couch with your knees bent.
• The procedure begins with treating the head of the penis with an antiseptic, instilling sterile glycerin into the urethral slit and treating the end of the catheter tube with the same.
• A container for collecting urine is placed between the patient's legs. If a permanent system is installed, the patient is given recommendations on its care. Sometimes a patient who has undergone surgery is offered surgery to remove the stoma.
• The next stage is the introduction of the system. Using antiseptic tweezers, the doctor, at a distance of 6 centimeters from the edge, grabs the catheter tube and gradually immerses it into the urethra. To prevent uncontrolled movements, the head of the penis is slightly squeezed.

• Reaching the cavity of the urinary reservoir by the catheter is marked by the release of urine.
• After the urine is released, the system tube is connected to a syringe with sterile furatsilin for subsequent washing of the bladder reservoir. If necessary, intravesical drug therapy is carried out in parallel.
• After intravesical lavage, the system is removed from the urethral cavity and disinfected. To avoid complications, the system is removed from the bladder after complete release of liquid or air from the balloon retainer.
• Remains of drops, solution or urine are removed from the penis with a sterile napkin, and the patient is advised to lie down for an hour after the procedure.

The features of the catheterization algorithm in women differ little from the technical features of installing a drainage system in men.

• The procedure for bladder drainage in women is performed lying on a couch with knees bent and legs apart. The woman is washed, after which the vessel is removed.
• A tray is installed at the base of the legs to collect urine.
• The folds of the labia are treated one by one. Then they are pulled apart with the doctor’s fingers and the urethral tract is treated with an antiseptic.
• The base of the catheter is carefully, using circular movements, immersed to a depth of 5 cm into the urethral cavity, the second end is placed in the urine receiving tray. The output of urine indicates the presence of a tube in the bladder reservoir.
• Upon completion of urination, an intravesical rinsing procedure is carried out with a sterile solution using a Janet syringe until the bladder cavity is completely cleansed.
• The flushing solution is dispensed into the tray, the system is carefully removed, and the urethra is treated with a uroseptic.

MP drainage in children

The algorithm for bladder catheterization in children, unlike adults, requires special care by the doctor or his assistant during the procedure, taking into account all the age characteristics of the child. The technique of catheterization of the bladder in children is carried out in compliance with strict antiseptic rules, on which, in the literal sense of the word, the life of the child may depend.

• Carefully select a drainage device to avoid injury - size appropriate for age.
• Strict adherence to all antiseptic standards to help prevent infection.
• Carrying out manipulation on the filled MP (determined by ultrasound results).
• Ensuring good lighting of the workplace to avoid mistakes.

Catheterization of bladder in girls

When draining the bladder reservoir in girls, a minimum amount of antiseptics is used to treat the perineum to reduce the risk of bacterial infection from the outside.

• The doctor carefully spreads the child’s labia minora a short distance to minimize the possibility of violating the integrity of the frenulum.
• The system tube should be inserted without effort. If free administration is not possible, the manipulation is stopped until the presence of obstacles to the outflow of urine is determined.
• To avoid twisting the tube into a spiral, its insertion is stopped at the first appearance of urine outflow.

• After the bladder is emptied, the system is quickly but carefully removed to prevent infection from the outside.
• Removing the system with force is unacceptable, since the tube may twist into a knot. In this case, the presence of a urologist is necessary.

As you can see, this manipulation requires certain skills and knowledge, so it must be carried out by a qualified specialist so that everything goes painlessly and without complications, and the results help in prescribing an effective course of therapy.

Urinary bladder catheterization in boys

Drainage of the bladder in boys involves introducing the system in different positions - lying or standing.

• The head of the penis is wiped with an antiseptic, the catheter is treated with purified liquid petroleum jelly.
• The foreskin of the penis, if not circumcised, is gently pulled back to expose the urethral opening. It should be taken into account that newborn babies may have signs of physiological phimosis.
• To avoid reflexive mictions, the base of the penis is slightly squeezed.
• To prevent kinking of the urethral canal, the penis is pulled upward, as if sitting on a drainage tube.
• If visibility of the urethral opening is poor, a drainage tube is inserted through the expanded preputial space of the penis.

If there is resistance in the external urethral sphincter, light pressure may be used. The manipulation continues after the urethral spasm has passed. If the procedure is not possible due to an obstacle, it is postponed until the causative factor is determined.

Possible complications

The specificity of the catheterization procedure itself, even with all compliance with the prescribed rules, does not guarantee the absence of the development of possible complications. They can manifest themselves:

• additional infection of bladder and urethral tissues;
• damage to the mucous membrane of organs;
• development of pyelonephritis and catheterization fever;
• rupture of the urethral canal.

How to recover after catheterization

Depending on the diagnosis and the general health of the patient, a bladder drainage system may be installed for a long period of time, after which it is very difficult for the patient to restore the process of independent voiding. There is a special program for this, which, through training sessions, helps to quickly cope with the problem. An indispensable condition is that classes must be systematic. The classes consist of not many and not at all difficult exercises:

• Lie on your back and for 2, 3 minutes alternately raise your legs together and separately.
• Place your fists in the area of ​​the bladder organ, squat down, focusing on your heels, inhale deeply, and as you exhale, bend forward as low as possible. Do the bends up to 8 times.
• Kneel down and clasp your hands behind your back. Take a deep breath. As you exhale, slowly bend forward as low as possible. We perform up to 6 times.
• Lying on your back, place your arms along your body, legs straight. We begin to gradually relax from the toes.

When starting recovery, do not forget to coordinate the exercises with your doctor; they may be contraindicated for you. You should not self-medicate, trust a specialist. Because every such patient must be under the constant supervision of a doctor.

An epicystostomy is a special catheter inserted into the bladder through the abdominal cavity and designed to drain urine. It is a rubber tube, one of the ends of which is connected to a urinal. Bladder drainage is prescribed if the natural outflow of urine is disrupted.

In a healthy person, the process of urination is as follows: urine, filtered in the kidneys, enters the bladder through the ureters. There it accumulates and stretches its walls. At a certain point, a signal is sent to the brain indicating the need to urinate. Under the influence of parasympathetic stimulation, the urethral sphincter relaxes and urine flows out.

Urodynamic disturbance can be caused by mechanical damage to the bladder, various pathologies, as well as the inability to independently evacuate urine. The process of installing an epicystostomy is called cystostomy. The main indications for bladder drainage are:

• prostate adenoma;
• inability to install a urethral catheter;
• damage to the urethra and bladder;
• stagnation of urine caused by improper functioning of the bladder sphincter.

Preliminary procedures

Before cystostomy, the patient is prohibited from taking blood-thinning drugs, which can cause bleeding during surgery. The patient must undergo a number of mandatory tests, including:

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

Bladder drainage is performed using a trocar method using local anesthesia. A prerequisite for such an operation is a full bladder. Furacilin is injected into it using a catheter to avoid accidental injuries to neighboring organs and to facilitate insertion of the trocar.

A small incision is made on the patient's skin through which a trocar is inserted. The stylet part of the instrument is removed and a Foley catheter is inserted in its place. Then the trocar itself is removed, leaving the catheter in the bladder cavity. The drainage is fixed to the skin using several sutures.

Postoperative period

Epicystostomy requires regular and careful care. At least twice a week, it is necessary to rinse the bladder with an antiseptic solution in order to prevent stagnation of urine and salt deposits. An inexpensive and effective drug is furatsilin. Pharmacies sell ready-made solutions, which eliminates the need to prepare the washing liquid yourself.

An important component when caring for a cystostomy is the hygienic component. A set of measures aimed at minimizing the risk of infection includes regular care of the components of the catheter and the area of ​​skin adjacent to the drainage. The place where the cystostomy enters the abdominal cavity is washed daily with warm soapy water or sanitary napkins. The catheter is washed with smooth longitudinal movements at least once a day. When emptying the urinal (carried out when it is half full), it is necessary to prevent all contact of its surface with the surface of the toilet.

In the postoperative period, changing the cystostomy is allowed 6 weeks after its installation. In the future, drainage replacement should be carried out at least once a month.

With high-quality surgery, the risk of complications is low. To avoid suppuration and inflammatory processes, the operation should be carried out under completely sterile conditions and include antibacterial therapy. If the patient is individually intolerant to the antiseptic, an allergic reaction may occur. The presence of blood in the urine, its cloudiness and lack of discharge are alarming symptoms and require a routine medical examination.

Bladder drainage is the creation of conditions for the outflow of urine from it. Drainage can be carried out by catheterization, that is, by passing a catheter through the urethra or by applying a cystostomy - a drainage tube extending from the bladder to the anterior wall of the abdomen.

Drainage of the bladder cavity can be achieved:

• insertion of a rubber catheter through the urethra for a certain period of time;
• surgically through the external peritoneal part of the anterior wall.

The first has limited use for special indications. A high section of the bladder is used for the purpose of longer temporary or permanent diversion of urine from the bladder when there is an obstacle to the outflow of urine through the urethra and in case of injuries to the bladder or urethra. In case of external peritoneal ruptures of the bladder of traumatic or gunshot origin, especially if they are accompanied by a fracture of the pelvic bones and leakage of urine into the lower parts of the peri-vesical tissue, drainage of the bladder and pelvic tissue is necessary as early as possible from the moment of injury.

For diseases and injuries of the spinal cord, accompanied by urination disorders, long-term drainage of the bladder according to Monroe is used, the essence of which is to create a constantly operating siphon system that allows you to alternate between filling the bladder and emptying it. In addition to flushing the bladder to fight infection, the Monroe Method helps restore the urination reflex.

In cases where there is no need to rinse the bladder, it is convenient to drain it using a double-lumen Foley catheter connected through an intermediate tube to a urine collection.

The catheter can be connected to a soft graduated collection suspended from the bed with a capacity of 100 to 2000 ml, which has an additional drain tube with a clamp. The advantage of such a drainage system is the ability to constantly maintain its sterility.

For drainage of the bladder, capitate catheters of numbers 12-40 on the Charrière scale are also used. Catheter length 30-40 cm.

After some gynecological operations, with strictures of the urethra, prostate adenoma and in some other cases, it is convenient to use closed drainage systems for suprapubic drainage of the bladder. When using such a system, a perforated silicone rubber film with a catheter retainer attached to it is glued to the skin of the patient’s abdomen. Through the central hole of the film, the abdominal wall is punctured in the suprapubic region with a special trocar with a plastic cannula, through which, after removing the trocar from it, a catheter made of soft siliconized elastomer is inserted into the bladder. The main advantage of such a system compared to drainage through the urethra is that it ensures earlier development of spontaneous emptying of the bladder and reduces the risk of infection. The presence of a three-way tap in the system makes it possible to rinse the bladder without disconnecting it.