The purpose of cystostomy is to drain the bladder. It is a mode of external derivation of the bladder reservoir whose technical aspects differ according to its temporary or definitive character. The drainage path is always suprapubic. You can also click here for more info on rhinoplasty in las vegas if you are looking for a nose job, sometimes called a nose surgery.
Temporary drainage of the bladder is accomplished by placing a suprapubic catheter percutaneously. This minimal gesture can be facilitated by the use of ultrasound which allows the bladder to be punctured without the risk of injuring the small intestine or the pre-medical vessels, the lesion of which may be responsible for a hematoma in the space of Retzius , Sometimes voluminous. The indications are as follows:
– removal of acute or chronic bladder retention when urethral sounding is impossible or dangerous (stenosis or false urethral route, urethral trauma).
– temporary resting of the urethra after reconstructive surgery.
The injection of contrast medium by the cystostomy catheters naturally allows cystography to be performed.
The final cystostomy has become exceptional. It consists of a tubular vesical flap creating a canal coming to the skin and ensuring the drainage of the urine. Sometimes when the neo-canal is a continent, regular self-sounding allows the bladder to evacuate. This technique is mainly used in neurological bladders.
The trans-appendicular cystostomy according to Mitrofanoff uses the appendix caecal. It is implanted in the bladder with a submucosal tunnel, which is antireflux, and terminated at the skin at the other end. It is a continental bypass, requiring autosondage but whose comfort seems appreciated by the patients.
It is often associated with a gesture of bladder enlargement by a digestive segment (enteroplasty) to obtain a bladder at low pressure. Its indication remains rare (some neurological bladders of the child).
THE VESICO-URETERAL REFLUX
The treatment of reflux involves two types of techniques: on the one hand the classic surgical treatment, ie the uretero-vesical reimplantation, and on the other hand the endoscopic treatment.
Endoscopic treatment involves creating a solid posterior wall in the ureteral bladder pathway to restore the uretero-vesical antireflux valve (Figure 4-117). For this purpose, a biomaterial 2 mm or 3 mm below the corresponding ureteral orifice is injected under visual control, so as to raise it without causing obstruction (Figs 4-117, 4-118). Various biomaterials can be used for this purpose (Teflon, collagen, macroplastic). The advantage of this technique lies in its simplicity and its relative absence of complication. These are mainly ureteral obstruction (to be detected by ultrasound) and by the failure of the treatment (reflux objectified on a retrograde control cystography). However, the questions raised by this technique (particle migration in the organism, long-term outcome, more difficult secondary surgery) mean that it has not formally replaced the conventional surgical technique.