Felis ISSN 2398-2950

Cystostomy: tube

Synonym(s): Prepubic (suprapubic catheterization, prepubic urine drainage

Contributor(s): Rosa Ragni, Daniel Smeak

Introduction

  • A cystostomy tube permits drainage of urine from the bladder directly through the abdominal wall.
  • Cystostomy tubes are considered when other less invasive means of obstruction relief or urinary diversion are not possible (eg transurethral catheterization, intermittent cystocentesis), or when more radical surgical procedures are not feasible to relieve distal urinary tract obstructions (eg in case of invasive neoplasia).
  • Cystostomy tubes provide a practical, relatively simple avenue of temporary or long-term urinary diversion for dogs and cats with outflow obstruction of the bladder or urethra, or disruption of the urethra.
  • Placement of cystostomy tubes does not require specialized equipment, and can be performed either at the time of primary surgical treatment of the urinary obstruction or trauma, or as an emergency procedure to help stabilize an obstructed uremic patient.
  • There are a number of potential complications, most of which are avoided with proper surgical and aseptic technique during placement. Technical details for successful placement and management of tube cystotstomies are described below.

Uses

  • Cystostomy tubes are indicated for urinary diversion in dogs and cats with either functional or mechanical obstruction of the bladder or urethra   Urethra: obstruction  , distal urinary tract disruption, or neurologic or idiopathic bladder atony. Common causes of obstruction in small animals include trauma   Bladder: trauma rupture      Urethra: rupture  , inflammatory disorders, urinary calculi   Urolithiasis  , and neoplasia   Bladder: neoplasia      Urethra: neoplasia  .
  • These tubes can be used for short-term diversion to help stabilize patients until primary relief of the obstruction or repair of a traumatic urinary tract disruption is performed.
  • In addition, cystostomy tubes may be helpful for management of permanent or slowly responsive neurological or detrusor dysfunction conditions of the bladder (causing urine retention), or as palliative treatment for nonresectable tumors of the bladder or urethra when other successful treatments are not available or possible.

Advantages

  • Cystostomy tube placement is relatively quick and easy to perform. The procedure does not require specialized equipment, although special catheters (ports) may be preferred for long-term or permanent diversion in selected patients.

Disadvantages

  • This invasive procedure carries with it the expense, and all the inherent risks associated with transabdominal wall catheter placement such as leakage, infection, dehiscence, irritation of the stoma site, tube obstruction, and accidental dislodgement.
  • Proper management requires careful monitoring and handling of the tube, and draining of the bladder at least 3-4 times daily. Good owner and patient compliance is necessary for success of this diversion technique.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • The prognosis is highly dependent on the primary disease process that required urinary diversion. Temporary tube cystostomy is easily managed and well tolerated. With more chronic diversion, urinary tract infection is inevitable and this usually requires intermittent antibiotic treatment when clinical signs occur.

Further Reading

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