Albert Linardy

DefinitionA surgery procedure to make urine diversion

on supra pubic area either by open or closed technique

Troicart / closed

cystostomy

Open cystostomy

Cystostomy

Anatomy of the Bladder

General IndicationsAll patient with:

Catheterization failureSuspicious of urethral ruptureUrine diversion for:

Stricture of urethra BOO

General ContraindicationsAll patient with:

Suspicious of bladder malignancyUnclear cause of gross haematuria

Troicart IndicationUrine retention when:Catheterization was failed :

Anterior urethral strictureAnterior urethral ruptureImpacted urethral stone

Open Cystostomy IndicationsUrine retention:If failed to perform troicart cystostomyEvidence of abnormal anatomy of bladder

(operation scars, high riding of prostate)Posterior urethral rupture or stricture

Tools1. Sterile scrubs2. Sterile gauze3. Sterile linen4. Desinfectant (povidone iodium 10%)5. Spuit sterile 5 cc dan 10 cc6. Lidokain 2%7. Scalpel and blade8. Dissecting pincer9. Dissecting forcep10.Troicart (if closed cystostomy)11.Foley catheter12.Urobag13.Sterile water14.Yarn operation (plain catgut 3-0, silk 3-0)

Troicart

a. Slot catheterb. Sheathc. Obturator d. A,b,c

Preparations1. Informed concent2. Make sure the patient is still in urine retention

condition3. Foley catheter :

Size : compare with the troicart and catheter sheath size

Baloon catheter on normal function.

4. Troicart : Complete set Normally lock on and lock off functions

5. All of the instruments needed are ready6. There are assistant who ready to support

Procedures 1. Desinfection and demarkation of operation

field2. Infiltration of local anaesthesia (lidokain

2%) around the operation field3. Make vertical incision (midline), 2 finger

suprasymphisis, around 1 cm in length and dissect layer by layer until the anterior rectus abdominal muscle fascia

4. Aspiration the bladder with syringe 5 cc if urine, then bladder is identified

5. Insert troicart to the bladder caudally

If succesfull : There are no

retention when troichart inserted

Come out urine from the canula

6. Open the obturator and sheath, and leave the catheter slot . And than insert foley catheter and attach the urobag

7. Fill the baloon catheter with sterile water until fixed

8. Pull out the slot catheter

9. Fixate the catheter on the skin and closed with sterile gauze

The proceduresDesinfection and demarkation operation field and place the sterile linen

Infiltration with lidocaine 2 %

Make vertical incision 2 finger suprasymphisis around 3- 5 cm

Open layer by layer until fascia of rectus abdomen

Make incision on fascia and widen the incision with scissor to cranial and caudal

Split the muscles with blunt dissection

separate the muscles with double langenback

Set aside the prevesical fat to cranial

Make two fixation on central area of bladderAspirate the bladder with 5 cc syringe until the urine come outMake incision to bladder with no.11 blade and widen the incision bluntly

Place double langenback to open the bladder

Insert the catheter, and fill the baloon catheter

Suture the two layer of bladder and fixate the catheter on bladder

Close the operation field and fixate the catheter on the skin

Close the wound with sterile gauze

ComplicationsBleeding InfectionFalse route to the peritoneal cavityPeritonitis because solid or hollow organ

rupture

Post surgical careRemove the suture on skin at day 5-7.Change or remove the catheter depend on

indications and type of catheter