Name of the Procedure:

Change of Cystostomy Tube; Complicated
Also known as: Exchange of Suprapubic Catheter, Complicated

Summary

Changing a cystostomy tube, particularly when it's complicated, involves replacing a catheter that drains urine from the bladder through an incision in the abdomen. It's considered complicated when there are additional challenges, such as blockage, infection, or anatomical difficulties.

Purpose

This procedure addresses issues with urinary bladder drainage due to catheter malfunction, blockages, infections, or improper initial placement. The goal is to ensure effective urine drainage, prevent urinary tract infections, and manage any difficulties associated with the cystostomy tube.

Indications

• Blocked or clogged catheter.
• Persistent urinary tract infections (UTIs).
• Discomfort or pain due to catheter displacement.
• Leakage around the catheter insertion site.
• Inability to properly drain urine from the bladder.

Preparation

• Patients may need to fast for a few hours before the procedure, especially if anesthesia is required.
• Current medications should be reviewed, and adjustments may be needed.
• Diagnostic tests like ultrasounds or urine cultures may be conducted to assess the condition of the bladder and presence of infection.

Procedure Description

1. Anesthesia: Depending on the complexity, local, regional, or general anesthesia may be administered.
2. Incision: The existing cystostomy site is cleaned and, if necessary, a small incision around the area is made.
3. Tube Removal: The old catheter is carefully removed.
4. Inspection and Cleaning: The site is inspected for signs of infection or blockages and appropriately cleaned and treated.
5. New Tube Insertion: A new catheter is inserted through the existing stoma into the bladder.
6. Confirmation: Proper placement is confirmed by visual inspection and sometimes imaging.
7. Securing the Catheter: The new catheter is secured in place to prevent displacement.

Tools used typically include catheters, antiseptic solutions, sterile gloves, and surgical instruments.

Duration

The procedure typically takes between 30 minutes to an hour, depending on the complexity.

Setting

It is usually performed in a hospital setting, outpatient clinic, or surgical center.

Personnel

• A urologist or general surgeon performs the procedure.
• Assistance from nurses and, if necessary, an anesthesiologist.

Risks and Complications

• Common risks: Pain, bleeding, infection at the insertion site, or blockage.
• Rare risks: Injury to the bladder or surrounding organs, severe infection, or allergic reactions to anesthesia.

Benefits

• Effective urine drainage.
• Reduced risk of UTIs.
• Improved comfort and quality of life.
• Results are noticeable almost immediately after recovery from the procedure.

Recovery

• Patients might experience mild discomfort, which can be managed with prescribed pain relief.
• Regular cleaning and care of the site are essential.
• Usually, light activities can be resumed within a few days, while full recovery might take a week.
• Follow-up appointments are necessary to monitor healing and catheter function.

Alternatives

• Intermittent catheterization: Regularly inserting and removing a catheter to drain the bladder.
• Indwelling urethral catheter: A catheter that remains in the urethra instead of through the abdomen.
• Bladder reconstruction surgery: For patients with chronic issues.

Each alternative has its own risks and benefits, which should be discussed with a healthcare provider.

Patient Experience

During the procedure, under anesthesia, the patient will not feel pain but may experience a sensation of pressure. Post-procedure, mild discomfort and tenderness around the insertion site are common. Pain management strategies, like analgesics and local care instructions, help ensure patient comfort during recovery.