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Suprapubic Cystostomy

(Cystostomy, Suprapubic)

Pronounced: sup-ra-pyoo-bik sis-tos-toe-me
by Deanna M. Neff, MPH

Definition

Suprapubic cystostomy is a procedure to help drain the bladder (organ that collects and holds urine). A tube called a catheter, which leads out of the lower abdomen, is inserted to drain the bladder.

Bladder and Urethra (Female)

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Reasons for Procedure

This procedure is done if you cannot urinate and a catheter cannot be passed through your urethra to help you urinate. The urethra is where urine passes out of the body from the bladder. Urine may not be able pass through the urethra due to:

  • Narrowing of the urethra
  • Other blockage due to:
    • Kidney stones
    • Inflammation
    • Infection
    • Injury
    • Prostate disease (in men)

The procedure may also be done if you need to:

  • Avoid damaging the urethra
  • Have surgery on the urethra or nearby structures
  • Have a catheter in your body long-term

Possible Complications    TOP

Complications are rare, but no procedure is completely free of risk. Your doctor will review a list of possible complications, which may include:

  • Damage to the bowel or other surrounding structures
  • Need for a repeat procedure
  • Infection
  • Bleeding
  • Blood clots
  • Anesthesia reaction

Factors that may increase the risk of complications include:

  • Bleeding disorders
  • Medicines that reduce blood clotting
  • Obesity
  • Smoking
  • Previous abdominal surgery
  • Bladder cancer

Discuss these risks with your doctor before the procedure.

What to Expect    TOP

Prior to Procedure

Your doctor may do the following:

  • Physical exam
  • Imaging, blood, and urine tests
  • Talk about the anesthesia being used and the potential risks

You should also talk to your doctor about your medicines. If this is not an emergency situation, you may be asked to stop taking some medicines up to one week before the procedure. These medicines may include:

  • Aspirin or other anti-inflammatory drugs
  • Blood thinners, like warfarin (Coumadin)
  • Clopidogrel (Plavix)

Your doctor may ask you to take certain medicines before surgery.

In the days before the surgery:

  • Arrange for a ride home from the hospital.
  • You may need to avoid eating for eight hours before the surgery.
  • If instructed by your doctor, drink only clear liquids (eg, water, clear juices, tea). You may be asked to drink extra fluids to fill the bladder.

Note: These steps may not be possible in an emergency situation.

Anesthesia

Local anesthesia may be used with or without sedation. You will not have any pain during the procedure.

Description of the Procedure

After anesthesia has numbed the area, the doctor will locate the bladder using imaging tools such as ultrasound if needed. Next, a needle will be inserted through your lower abdomen and into your bladder. A wire will then be guided through the needle into the bladder to prepare the site for a catheter. A special catheter will be placed into the bladder over the wire. The catheter will be sutured in place. A balloon may be inflated to keep the catheter in place. Afterward, the opening made in the skin (called a stoma) will be covered with gauze.

How Long Will It Take?

10-45 minutes

How Much Will It Hurt?

Anesthesia prevents pain during the procedure. You will be given pain medicine to ease pain and soreness after the surgery.

Average Hospital Stay

You will either stay in the hospital overnight or go home the same day.

Post-procedure Care

At the Hospital

The hospital staff will:

  • Monitor your recovery
  • Help you to eat and move around again
  • Give you pain medicine
  • Teach you how to care for your catheter

At Home

When you return home, do the following to help ensure a smooth recovery:

  • Take medicines as directed.
  • Avoid lifting heavy objects for two weeks.
  • Drink plenty of fluids (8-10 glasses per day).
  • Do not drive or have sex until your doctor tells you that it is safe to do so.
  • Follow the guidelines for changing the catheter and collection bag.
  • Keep the stoma site clean and dry:
    • Cleaning the incision site as directed.
    • Using a soft wash cloth to gently wipe the incision area.
    • Changing dressings daily, or more as directed.
    • Asking your doctor when it is safe to shower, bathe, or soak in water.
  • Be sure to follow your doctor’s instructions.

Call Your Doctor    TOP

After you leave the hospital, call your doctor if any of the following occurs:

  • Pain or cramps
  • Redness or soreness around the catheter site
  • Catheter fails to drain
  • Catheter falls outs
  • Changes in frequency, odor, appearance, or volume of urine
  • Signs of infection, including fever or chills
  • Bloody urine

In case of an emergency, call for medical help right away.

RESOURCES:

American Urological Association Foundation
http://www.urologyhealth.org
National Institute of Diabetes and Digestive and Kidney Diseases
http://www2.niddk.nih.gov/

CANADIAN RESOURCES:

Canadian Urological Association
http://www.cua.org/
Health Canada
http://www.hc-sc.gc.ca

References:

Aguilera PA, Choi T, Durham BA. Ultrasound-guided suprapubic cystostomy catheter placement in the emergency department. J Emerg Med . 2004;26(3):319-21.
Care of a suprapubic cystostomy. Danbury Hospital Patient Education website. Available at: http://www.danbury... . Accessed October 19, 2012.
How to care for a suprapubic catheter. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated September 26, 2012. Accessed October 19, 2012.
Percutaneous suprapubic cystostomy. In: Roberts: Clinical Procedures in Emergency Medicine . 5th ed. Philadelphia, PA: Saunders Elsevier; 2009:chap 55.
Last reviewed March 2013 by Adrienne Carmack, MD
Last Updated: 03/15/2013