Cystotomy

Cystotomy

1. cystotomy Presented by---- Mrs. Usha Rani Kandula , MSc.Nursing , Assistant professor, Department of Adult Health Nursing, College of Health Sciences, Arsi University, Asella , Ethiopia.

2. DEFINITION -An opening made into the urinary bladder for the management of urinary problems.

3. Perform suprapubic incision - An incision into the urinary bladder through a suprapubic incision.

4. Purpose of cystotomy - cystotomy may be performed to repair ( cystoplasty ) -a bladder laceration or rupture as a result of trauma or a defect in the bladder wall.

5. Indications of cystotomy To perform urinary diversion To relieve an urinary obstruction To “protect” the site of a surgical procedure (e.g., vesico -urethral anastomosis ).

6. Procedure - A low vertical or transverse incision is used. -The urinary bladder is distended using a urethral catheter (e.g., Foley) when there is no obstruction.

7. Incision of the urinary bladder - The dome of the urinary bladder is incised, - Pezzer or Malecot catheter is inserted into the incision. - The catheter is secured with absorbable sutures.

8. -The wound is closed in layers; -Additional drainage is optional.

9. Surgical catheters -“Tube cystostomy ” (i.e., catheter cystostomy ) - A urethral catheter, e.g., Foley is usually placed until the cystostomy tract matures to minimize leakage.

10. Preparation of the Patient -Application of Anti embolitic hose -Administration of regional or general anesthesia, -patient is instructed for supine position;

11. Provide comfort of the patient -A pad may be placed under the lumbar spine. -A pillow may be placed under the knees (to avoid straining back muscles and for comfort).

12. Table- Trendelenburg position The arms may be extended on padded arm boards. - Padded shoulder braces are secured to the table; -The table may be placed in Trendelenburg position to facilitate exposure.

13. Prevention of neurovascular pressure - All bony prominences and areas vulnerable to skin and neurovascular pressure or trauma are padded.

14. Insertion of foleys catheter - Check with the surgeon regarding the insertion of a Foley catheter.

15. Skin Preparation Males. -A Foley catheter should be inserted prior to the skin preparation. -Skin preparation extending from the nipples to the lower thighs and the genitalia are included.

16. Females. -Foley catheter should be inserted. -A Foley catheter may be inserted following the vaginal preparation, - Both vaginal and the abdominal skin preparations are required; -use two preparation sets separately.

17. Draping -Folded towels and a laparotomy sheet Equipment -Padded shoulder braces -ESU (electronic surgical unit) -Suction catheters

18. Instrumentation -Major procedures tray -Long instruments tray - Trocar , catheter stylet , and urethral sounds (e.g., filaform ), available - Ligating clip appliers, e.g., Hemoclip appliers (assorted sizes and lengths)

19. Supplies -Anti embolitic hose -Foley catheter and sealed drainage unit -Basin set -surgical Blades, (2) #10, (1) #15, and (1) # 11

20. -Electrosurgical pencil and cord with scraper - Suction tubing -Irrigation solution (e.g., 1.5% glycine or sorbitol ) and - asepto syringe

21. Electrosurgical pencil -It is a Cautery   Pencil.   - is a medical device used for -to fulgurate, - coagulate , cut or dissect biological tissue by the applying electric current.

22. Asepto Syringe -Is an instrument for introducing fluids into or withdrawing them from the body. - Compression of the bulb creates a vacuum for gentle suction of small amounts of bodily drainage, - such as oral and nasal secretions.

23. - Ligating clips, e.g., Hemoclips (small, medium, large) - Cystostomy catheter (e.g., Pezzer , Malecot ) and sealed drainage unit.

24. Malecot catheter -The   Malecot   catheter  has been routinely  used  as a self-retaining tube in the drainage of different body fluids, e.g. urine, bile, pus. - It was originally described for  use  in suprapubic cystostomy , which required the  use  of a needle with the  catheter .

25. Special Notes -Apply Special Notes from Cystoscopy , as indicated. -The circulator may be requested to unclamp urethral catheter when the bladder is incised. Thanking you .