Download - Cystostomy New
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Albert Linardy
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DefinitionA surgery procedure to make urine diversion
on supra pubic area either by open or closed technique
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Troicart / closed
cystostomy
Open cystostomy
Cystostomy
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Anatomy of the Bladder
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General IndicationsAll patient with:
Catheterization failureSuspicious of urethral ruptureUrine diversion for:
Stricture of urethra BOO
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General ContraindicationsAll patient with:
Suspicious of bladder malignancyUnclear cause of gross haematuria
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Troicart IndicationUrine retention when:Catheterization was failed :
Anterior urethral strictureAnterior urethral ruptureImpacted urethral stone
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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
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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)
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Troicart
a. Slot catheterb. Sheathc. Obturator d. A,b,c
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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
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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
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5. Insert troicart to the bladder caudally
If succesfull : There are no
retention when troichart inserted
Come out urine from the canula
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6. Open the obturator and sheath, and leave the catheter slot . And than insert foley catheter and attach the urobag
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7. Fill the baloon catheter with sterile water until fixed
8. Pull out the slot catheter
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9. Fixate the catheter on the skin and closed with sterile gauze
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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
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Open layer by layer until fascia of rectus abdomen
Make incision on fascia and widen the incision with scissor to cranial and caudal
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Split the muscles with blunt dissection
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separate the muscles with double langenback
Set aside the prevesical fat to cranial
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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
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Place double langenback to open the bladder
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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
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ComplicationsBleeding InfectionFalse route to the peritoneal cavityPeritonitis because solid or hollow organ
rupture
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Post surgical careRemove the suture on skin at day 5-7.Change or remove the catheter depend on
indications and type of catheter
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