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PubMedDate not supplied

Caprine obstructive urolithiasis: requirement for 2nd surgical intervention and mortality after percutaneous tube cystostomy, surgical tube cystostomy, or urinary bladder marsupialization.

OBJECTIVES: To determine the requirement for 2nd surgical interventions and mortality after 3 different surgical techniques (percutaneous tube cystostomy [10 goats], surgical tube cystostomy [25 goats], urinary bladder marsupialization [10 goats]) for caprine obstructive urolithiasis, and to determine whether pre- or 24-hour postoperative physical examination findings or serum chemistry results could be used as predictors of mortality. STUDY DESIGN: Retrospective study. ANIMALS: Male goats (45) with obstructive urolithiasis. METHODS: Medical records for all male goats admitted and operated for obstructive urolithiasis between 1993 and 2003 were reviewed. Data retrieved included signalment, pre- and 24-hour postoperative values for temperature, pulse, respiratory rate, packed cell volume, serum K(+), serum creatinine, and blood urea nitrogen [BUN]. The type of initial surgical procedure, time to 2nd surgical intervention, time to death, and duration and cost of hospitalization were also obtained. RESULTS: Percutaneous tube cystostomy was associated with a significantly increased requirement for (5.6-fold increased hazard) and decreased time to a 2nd intervention (P=.002). There were no differences between the 3 procedures for time to mortality. Increased BUN and respiratory rate at admission were associated with increased mortality (hazards ratio of 4.8 and 5.0, respectively). Urinary bladder marsupialization was associated with significantly decreased hospitalization time (P=.02) and cost (P=.04) compared with surgical tube cystostomy and percutaneous tube cystostomy. CONCLUSION: Surgical tube cystostomy and bladder marsupialization are both acceptable surgical methods for treatment of caprine obstructive urolithiasis. Each procedure has inherent complications that should be discussed with the owner before choosing the surgical treatment. CLINICAL RELEVANCE: There are acceptable options for treatment of caprine obstructive urolithiasis; however, percutaneous tube cystostomy should be avoided.

Animals↗
PubMed1993

Fluoroscopically guided percutaneous suprapubic cystostomy for long-term bladder drainage: an alternative to surgical cystostomy.

Percutaneous large-bore suprapubic cystostomy catheters were placed under fluoroscopic guidance in 60 patients as an alternative to surgical cystostomy. Foley catheters (16-20 F) were placed in 57 of the patients in a one-stage procedure. Ten-French catheters were initially placed in three patients because of difficulty in dilating percutaneous tracks because of obesity (one patient) or dense scar tissue (two patients). Three weeks later, 18-F Foley catheters were placed in these three patients when mature tracks had developed, making dilation easier. Minor complications occurred in three patients, including superficial track bleeding in two and urosepsis in one. Fifteen patients were lost to follow-up. Suprapubic catheters provided excellent long-term drainage (range, 0.5-36 months; mean, 16 months; median, 18 months) in the remaining 45 patients. The authors conclude that percutaneous suprapubic catheter placement is a safe and effective procedure that provides excellent long-term bladder drainage.

Adult↗
PubMed2000

Is suprapubic cystostomy an optimal urinary management in high quadriplegics?. A comparative study of suprapubic cystostomy and clean intermittent catheterization.

INTRODUCTION: Long-term outcome of spinal cord injury (SCI) patients was compared between those managed by suprapubic cystostomy (SPC) and clean intermittent catheterization (CIC) with particular emphasis on an incidence of urinary tract complications and patients perception for urinary management. MATERIALS AND METHODS: The study comprised 61 SCI patients; 34 patients managed with SPC (group A), while 27 with CIC (group B). After stabilization of their condition, all were followed annually on an outpatient basis with clinical history, urinalysis, urinary imaging and renal function studies. Mean follow-up periods were 8.6 and 9.9 years for groups A and B, respectively. Between groups, a comparative study was performed on the incidence of urinary complications such as renal dysfunction, hydronephrosis, vesicoureteral reflux, symptomatic genitourinary infection and urinary stone. Satisfaction with urinary management was also estimated using the questionnaires during follow-up. RESULTS: Renal dysfunction, hydronephrosis and vesicoureteral reflux were not found in either group. Symptomatic genitourinary infection was seen in 4 (12%) of group A and 7 (26%) of group B, respectively. The incidence of renal stone was 3 (9%) in group A and 1 (4%) in group B. A significant difference was not found between two groups in these urinary complications. On the contrary, bladder stone was seen more frequently in group A (65%) than in group B (30%) with a significant difference (p<0.001). The degrees of incontinence, bother score of daily activities, and overall satisfaction showed no significant difference between the two groups. CONCLUSION: Except for bladder stones, SPC is a valuable option of urinary management for quadriplegic patients, the results of which were comparable to paraplegic SCI patients managed with CIC.

Adolescent↗
PubMedDate not supplied

Fluoroscopically guided suprapubic cystostomy in complex urologic cases.

PURPOSE: To evaluate the efficacy of percutaneous suprapubic cystostomies performed by the interventional radiologist for complex urologic cases. MATERIALS AND METHODS: A retrospective analysis was done of the 25 cases referred to the radiology department for suprapubic cystostomies. The patients were referred because of unsuccessful placement or malposition of a suprapubic cystostomy tube. The procedure was performed with the Seldinger technique by using a 21-gauge needle for initial antegrade puncture and subsequent tract dilation and placement of 10-24-F catheters. RESULTS: In 24 of 25 cases (96%) the suprapubic cystostomy was successfully performed. After suprapubic cystostomy, eight patients (32%) underwent additional ancillary procedures by urologists through the suprapubic tract. The only major complication was perivesical fluid collection in one patient (4%), which was subsequently drained. Seventeen patients (68%) had transient hematuria. CONCLUSION: Percutaneous suprapubic cystostomy performed under fluoroscopic control is an effective and safe procedure ideally suited for the interventional radiologist, especially in complex urologic cases.

Adolescent↗
PubMed2006

Short- and long-term outcome and factors predicting survival after surgical tube cystostomy for treatment of obstructive urolithiasis in small ruminants.

OBJECTIVE: To evaluate outcome of small ruminants after tube cystostomy without urethral flushing. STUDY DESIGN: Retrospective clinical study. ANIMALS: Small ruminants (n=63; 50 goats, 13 sheep). METHODS: Medical records (January 1996-October 2003) for all small ruminants undergoing tube cystostomy were analyzed. Signalment, laboratory data, intraoperative findings, urolith type, and postoperative outcome were compared. Long-term follow-up was obtained at 6 and > or= 12 months postoperatively. RESULTS: Most animals were castrated males. Pygmy goats were overrepresented. Mean time to normal urination after tube cystostomy was 11 days, and mean hospitalization was 14 days. Seventy-six percent of animals were successfully treated with tube cystostomy (90% of those discharged from hospital). Short- and long-term survival was good for those animals with follow-up data. Reobstruction occurred in <20% of animals at 6 and 12 months. Goats, castrated males, and animals with normal serum potassium, no fluid in the abdomen, or no urethral process amputation were more likely to survive. Stone type, bladder appearance, and age at castration were not associated with outcome. CONCLUSION: Surgical tube cystostomy without urethral flushing is an effective technique for resolution of obstructive urolithiasis in small ruminants. CLINICAL RELEVANCE: Goats, small ruminants with an intact urethral process, absence of abdominal fluid, and serum potassium concentration <5.2 mEq/L at admission were all associated with survival after tube cystostomy. Castrated males may also be more likely to survive. These factors should be considered in management of small ruminants with urolithiasis.

Animals↗
PubMed2004

Ultrasound-guided suprapubic cystostomy catheter placement in the emergency department.

The purpose of this article is to describe a series of patients undergoing ultrasound-guided suprapubic cystostomy catheter placement in the Emergency Department. A series of 17 consecutive patients who underwent emergent real-time ultrasound-guided suprapubic cystostomy in the ED over a 2-year period is reported. The procedure was facilitated by direct ultrasound imaging of the bladder using a Digital Sonoace 5500 machine. Procedural notes and follow-up records were analyzed for efficacy, safety, and complications. The results demonstrated that trans-abdominal ultrasound confirmed urinary retention before drainage in each of the 17 cases enrolled. Each patient required emergent suprapubic cystostomy catheter placement for acute urinary outflow obstruction because urethral bladder catheterization was not possible or was contraindicated. Continuous real-time ultrasound-guided percutaneous suprapubic cystostomy placement and decompression of the bladder was successful in all 17 (100%, 90-100% CI: 95%) cases. There were no complications reported. In conclusion, real-time ultrasound imaging of the bladder was successful for the purpose of aiding the guidance of a suprapubic cystostomy catheter placement in the ED and might represent an improvement from the standard blind method presently used.

Adult↗
PubMed2006

Hair as the nidus for bladder calculi formation complicating suprapubic cystostomy catheterization: a case report.

Neurogenic bladder is a familiar sequel to spinal cord injury, and bladder calculi is a common complication of neurogenic bladder. We report a case of a 25-year-old man with spinal cord injury resulting in neurogenic bladder. Permanent cystostomy was performed, and, for 4 years, the patient received periodic replacement of a cystostomy catheter. Bladder calculi were found on follow-up radiography. Cystoscopic lithotripsy was done, and it was noted that a hair was the nidus of a calculus. The hair could have been introduced into the bladder accidentally during the cystostomy catheter replacement. We suggest routine pubic hair care, even shaving, for patients suffering from neurogenic bladder with cystostomy. In addition, patients and caregivers should take care not to introduce pubic hair into the bladder while changing cystostomy catheters.

Adult↗
PubMed1999

Squamous cell carcinoma of suprapubic cystostomy tract without bladder involvement.

This report describes a third case of squamous cell carcinoma of the suprapubic cystostomy tract. The first case reported in 1993 concerned a squamous cell carcinoma arising adjacent to the suprapubic cystostomy site and extending anteriorly to the abdominal wall in a 80-year-old man, 5 years after suprapubic urinary diversion for urethral stricture. A second case published in 1995 described a 50-year-old paraplegic man (T11-T12 spinal cord injury) in whom a suprapubic cystostomy tract squamous cell carcinoma developed after 25 years of urinary diversion. The tumour involved the cystostomy tract primarily with extension into the bladder but did not penetrate the bladder wall muscle. Our patient is in fact the second one to have a suprapubic cystostomy tract squamous carcinoma not involving the bladder.

Abdominal Neoplasms↗
PubMed1997

Mucinous adenocarcinoma arising from a suprapubic cystostomy site without bladder involvement.

Carcinoma arising from a suprapubic cystostomy site in patients with spinal cord injury has been infrequently described. In all previously reported cases, they have been squamous cell carcinomas. Our patient is a 68 year old male with T10 complete thoracic paraplegia who presented with an exophytic mass extending from his suprapubic cystostomy tract. Biopsy revealed mucinous adenocarcinoma. Carcinoma of the suprapubic cystostomy tract should be considered in those patients who present with bloody drainage and/or masses arising from the suprapubic cystostomy site.

Adenocarcinoma, Mucinous↗
PubMed1994

Long-term follow-up of transvaginal urethral closure and suprapubic cystostomy for urinary incontinence in women with multiple sclerosis.

OBJECTIVE: To assess the long-term success, in terms of continence and patient satisfaction, of transvaginal urethral closure and suprapubic cystostomy in women with multiple sclerosis and urinary incontinence. PATIENTS AND METHODS: The group under study comprised 50 severely disabled women with multiple sclerosis who were undergoing suprapubic cystostomy and transvaginal urethral closure to manage urinary incontinence refractory to conservative measures and urethral catheterization. Follow-up was by patient interview and Catheter Change Clinic records. RESULTS: An initial continence rate of 78% was achieved and secondary revision was attempted in 10%. Urinary diversion was performed in 4% and a return to urethral catheterization in 2%. Long-term follow-up (mean length 6.5 years) showed that 79% of patients remained completely dry and were managed by regular catheter change. Six per cent of women with continued leakage around the suprapubic site were managed by conservative local methods. The major complications of urethral closure and suprapubic cystostomy (recurrent calculi and encrustation blockage) related to the presence of the catheter. CONCLUSIONS: The lack of major complications associated with transvaginal urethral closure and suprapubic cystostomy, and the high rates of continence and patient satisfaction suggest that this technique could be more widely used. Particularly, it could be employed at an earlier stage in multiple sclerosis and thus offer patients a better quality of life for a longer period of time. Modifications in catheter design may overcome problems of calculi and encrustation blockage.

Cystostomy↗
PubMedDate not supplied

Tube cystostomy for treatment of obstructive urolithiasis in small ruminants.

Tube cystostomy was used to treat 13 goats and two sheep with obstructive urolithiasis. The cystostomy tube was intermittently occluded 3 to 4 days after placement to determine if urine could be voided through the urethra. If the animal showed no discomfort during urination after the cystostomy tube had been occluded for several days, the tube was removed. This procedure was successful in relieving urethral obstruction in 12 animals. The mean time until the animal could urinate freely and until the cystostomy tube was removed was 11.5 and 14.4 days respectively. Follow-up was available for 10 animals; seven were alive with no recurrence of urinary obstruction. One goat died from unrelated to urinary obstruction 1 year postoperatively. One goat died from unknown causes, and one goat died after urinary obstruction recurred.

Animals↗
PubMed2000

Long-term analysis of suprapubic cystostomy drainage in patients with neurogenic bladder.

OBJECTIVE: We assessed the roles of suprapubic cystostomy in patients with neurogenic bladder and analyzed the complications and their courses. PATIENTS AND METHODS: We reviewed 118 patients with neurogenic bladder managed with suprapubic cystostomy. The original diseases were spinal cord injury in 90, degenerative disease of the central nervous system in 15, spina bifida in 6, cerebral palsy in 3, pontine bleeding in 1, Parkinson's disease in 1, brain tumor in 1, and dysgenesis of the external sphincter in 1. Fifty-six (62.2%) of spinal cord-injured patients demonstrated cervical damage. Renal function, urinary pH and white blood cell values were measured and evaluated after insertion. The stone-free rate after insertion was estimated by the Kaplan-Meier method. RESULTS: Indications for cystostomy were failure of clean intermittent catheterization in 62 (52.5%) and Credé's maneuver in 2, severe urethral damage in 30 (25.4%), replacement of urethral catheter in 3, worsening of the original disease in 15 (12.7%), deterioration of the general condition in 2, mental retardation in 2, and traumatic vesical rupture in 1. Frequent complications were formation of the bladder calculi in 30 (25%) and urinary leakage through the urethra in 11 (10%). No fatal complications occurred. The stone-free rates 5 and 10 years after insertion were 77 and 64%, respectively. The urinary pH of the stone-forming group was significantly higher than that of the stone-free group. The high urinary pH group (>7.24) had a higher risk of stone formation. CONCLUSIONS: Although continuous cystostomy drainage is not considered to be ideal management for bladder emptying, some patients with neurogenic bladder may benefit from this procedure.

Adult↗
PubMed1989

Percutaneous, large-bore, suprapubic cystostomy: technique and results.

A technique to insert large-bore suprapubic cystostomy catheters (18-French or larger) percutaneously, under radiologic imaging guidance, is described in 15 men who required long-term drainage of the bladder. This single-stage procedure is carried out under local anesthesia with optional IV sedation. It consists of rapid enlargement of the percutaneous track by means of a balloon dilatation catheter followed by insertion of a self-retaining Foley cystostomy catheter through a peel-away sheath. No complications associated with the placement of the catheters occurred, and long-term patient compliance has been satisfactory. Our results suggest that percutaneous, large-bore suprapubic cystostomy may be a preferred alternative to surgical cystostomy.

Adult↗
PubMed2002

Percutaneous tube cystostomy and vesicular irrigation for treatment of obstructive urolithiasis in a goat.

Treatment of a 3-month-old male goat with obstructive urolithiasis by means of percutaneous tube cystostomy and vesicular irrigation with a chemolysis solution is described. The cystostomy tube was inserted percutaneously with ultrasonographic guidance. Patency of the urethra was reestablished with no clinical evidence of urethral stricture or recurrence of obstruction during the following 12 months. Results in this goat suggest that percutaneous tube cystostomy may be an economical alternative to surgical cystostomy tube placement. Chemical dissolution of calcium phosphate uroliths with a commercially available compound appears to be feasible in goats.

Animals↗
PubMed1993

Vesicoureteral reflux and lower urinary tract injury: the possible role of suprapubic cystostomy.

Incidental vesicoureteral reflux was noted frequently during routine cystographic evaluation of patients who suffered vesicourethral trauma and who were managed by suprapubic cystostomy. Based on this observation we designed a retrospective study to document the prevalence of vesicoureteral reflux among 30 consecutive patients following vesicourethral trauma. In 9 patients drainage was instituted by urethral catheter and in 21 by suprapubic cystostomy. Of the latter 21 patients 10 (47.6%) had evidence of vesicoureteral reflux on cystography, which was associated with complete rupture of the urethra in 9 (90%). No patient who was treated initially with a urethral catheter had evidence of vesicoureteral reflux on cystography. We conclude that the prevalence of vesicoureteral reflux is significantly affected by the coexistence of severe vesicourethral injury and the presence of suprapubic cystostomy. The significance of this observation is in the potential risk of ascending upper urinary tract infections due to the hazardous combination of vesicoureteral reflux and frequent recurrent lower urinary tract infections. Presence of vesicoureteral reflux in these patients may necessitate a prophylactic antibiotic regimen. The specific mechanisms that lead to increased prevalence of vesicoureteral reflux in patients following severe vesicourethral injury are not defined by our results. However, we propose a multifactorial concept that may explain our observation.

Adult↗
PubMed2003

Clinical use of low-profile cystostomy tubes in four dogs and a cat.

Traditional cystostomy tubes (used for temporary or permanent diversion of urine in dogs and cats) are long (> or = 22 cm) and cumbersome to stabilize, requiring sutures or bandages to hold the tube against the body. Use of a low-profile gastrostomy port system as a low-profile cystostomy tube (LPCT) in 4 dogs and a cat was investigated; owner satisfaction with the device was assessed. Technical difficulty associated with placement and management of LPCTs was similar to that for traditional cystostomy tubes; with LPCTs, activity and mobility of pets was not compromised, and bandaging was not required. Complications included lower urinary tract infection, mild peristomal leakage of urine and leakage from components of the system, and subcutaneous peristomal infection. Four of 5 owners considered the tube to be easy to use; all owners said they would be comfortable repeating their decision to use the LPCT in their pet.

Animals↗
PubMed2002

Suprapubic cystostomy: urinary tract infection and other short term complications.

AIMS: To evaluate the frequency of urinary tract infection in patients with suprapubic cystostomy and other complications of the procedure within 30 days of placement. METHODS: Patients characteristics, indication and types of cystostomy and short term (within 30 days); complications were analyzed in 91 patients. Urine analysis and culture was done in all patients to exclude those with urinary tract infection. After 15 and 30 days of the procedure, urine analysis and culture was repeated to evaluate the frequency of urinary tract infection. The prevalence of symptomatic bacteriuria with its organisms was assessed. Antibiotics were given to the postoperative and symptomatic patients and the relationship of antibiotics on the prevention of urinary tract infection was determined. RESULTS: Of the 91 cases 88 were males and 3 females. The mean age was 40.52 +/- 18.95 with a range of 15 to 82 years. Obstructive uropathy of lower urinary tract.was present in 81% cases and 17 (18.6%) had history of trauma to urethra. All these cases had per-urethral bleeding on examination while x-ray urethrogram showed grade II or grade III injury of urethra. Eighty two of the procedures were performed per-cutaneously and 7 were converted to open cystostomies due to failure of per-cutaneous approach. Nine patients had exploratory laparotomy. Duration of catheterization was the leading risk factor for urinary tract infection found in 24.1% at 15 days and 97.8% at 30 days. There was low prevalence of symptomatic urinary tract infection. E.Coli was the prevalent organism. Antibiotics did not play a significant role in controlling catheter associated urinary tract infection. Blockage and macroscopic hematuria (self limiting) were the predominant complications encountered. CONCLUSION: Duration of catheterization is the leading risk factor for the development of urinary tract infections. Catheter-associated bacteriuria are usually asymptomatic. Macroscopic hematuria and blockage of catheter are frequent which can be managed promptly without surgical intervention.

Cystostomy↗
PubMed1992

[Circumvallate nephro-cystostomy].

Circumvallate nephro-cystostomy (CNC) provides a subcutaneous connection of a nephrostomy and a cystostomy catheter thus allowing spontaneous micturition. This procedure is suitable for those patients affected by an obstructive nephropathy where it was not possible to insert a double "J" stent or where surgical treatment was not allowed. Patients affected by debilitating disease benefit from these procedure by avoiding problems connected with daily handling of catheter, examples are medications at the insertion site or possible dislodgement of a nephrostomy catheter added to the psychological problems related to carry the urine collection bag. A number of 13 patients have been treated with this method, 5 had monolateral CNC, 8 had bilateral CNC for a total of 21 procedures. All but one cause of ureteral obstruction were neoplastic, the exception being a patient with necrosis of the ureter subsequent to major vascular surgery. CNC had a residence time ranging from 1, 5 to 25 months with an average of 9.8 months. Only in 2 cases it was necessary to remove CNC due to recurrent cystitis and orchitis due to bladder irritation by a cystostomy catheter and for an obstruction which could not be remedied in a patient with necrosis of the ureter. The most important complication, i.e. obstruction, occurred in 4 cases. In the above mentioned case CNC was removed after 9 months of proper performance. In the other 3 cases obstruction occurred after 2, 3, 18 months and in all this cases obstruction was easily removed. Besides obstruction only minor malfunctions were experienced and the procedure was very well tolerated by all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Colorectal Neoplasms↗