Trocar epicystostomy is positioned as an effective tool aimed at helping people who are unable to independently control the withdrawal of urine in a natural way.
The technique got its name thanks to the epicystostomy - a special catheter. It is injected into the bladder through an abdominal incision. The main task of such a medical capacity is the collection of waste urine.
Externally, the urinal is a rubber tube that is connected at one end to a container for collecting the processed liquid. Doctors are forced to resort to such a measure when the victim is unable for some reason to monitor the flow of urine. Moreover, the procedure can be assigned both to people for a temporary solution to the issue, for example, if their condition is especially difficult, and on an ongoing basis. The technique of operation remains almost identical.
How is the intervention
Emergency introduction of a special catheter into the bladder is often aimed not only at leveling the factors of discomfort for the patient, but at saving his life. An urgent measure is prescribed in situations when it is not possible to install the urinal with standard approaches through the urethra. Due to the need for the implementation of the plan to make an incision in the abdominal part of the body, some doctors call the method an artificial fistula.
In addition to the ability to divert accumulated liquid waste materials this way, the tube will turn out to be used to introduce a contrast medium. Advanced functionality allows the use of manipulation not only as a postoperative stage for some especially severe patients. It is actively used to prepare for surgical intervention according to indications, as well as to diagnose certain pathologies. Often, doctors use a proven method to facilitate the fulfillment of the natural needs of people who move in a wheelchair. Control of the process due to epicystostomy greatly facilitates urination.
The mechanism for conducting a trocar operation covers several stages. But it is recommended to carry them out as planned after studying the patient’s medical history from his medical record. Also, for the final decision in favor of the intervention, the victim will have to undergo an additional examination. A separately treating doctor will take into account the current state of the ward. Based on all the information collected, it will be possible to determine how long the catheter needs to be mounted.
The step-by-step execution algorithm includes the following phases:
- The notch. It is made in the suprapubic part slightly below the location of the navel. The incision should not exceed 1 cm.
- Holding a trocar. It is carried out between the muscle fibers to get to the affected organ and pierce its walls.
- The introduction of the drainage tube. This should be done strictly along the side wall in order to direct the second end of the tube into the free cavity.
- The reverse process. At this stage, the surgeon sews all previously cut tissues in the reverse order of the layers. For reliability, the catheter will need to be fixed with a couple of additional sutures, fixing it to the front wall of the abdominal cavity.
- The application of a sterile dressing.
To increase the accuracy of actions, as well as to be able to control the course of manipulation in real time, the surgeon involves a cystoscope. It transfers all the data to the monitor so that the trocar drainage passes without consequences for the surrounding healthy tissues.
The price of an epicystostomy usually does not have fixed boundaries, since here you also have to take into account the costs of the restoration phase. Separately, you will need to calculate how much a set of anesthetics can cost. Also, the pricing policy will vary depending on the type of urinal selected. Here you will have to include in the budget the need to periodically replace the worn-out tank and spend money on care products.
Indications and Contraindications
Trocar technique is a fairly popular type of help in modern operational urology. This increased popularity is explained by the huge list of medical indications for its purpose.
Among them are:
- the complex clinical condition of the patient, when the bladder emptying in a natural way can not be made;
- delayed removal of processed fluid due to nervous shock;
- the formation of bloody clots or the presence of purulent inclusions;
- mechanical injury to the bladder;
- advanced stage of diagnosed prostate adenoma;
- damage to the urinary canal;
- bladder pathology;
- the need for emergency washing, or the introduction of therapeutic solutions;
- a number of gynecological interventions;
- diagnosis of anomalies.
Despite the fact that for some injuries of the bladder epicycostomy cannot be dispensed with, it is they that sometimes become the main contraindication for the intervention. It is worth considering each clinical case individually, relying on the primary source of the problem and the nature of the particular lesion in order to find the optimal solution.
Also, experts identify two more contraindications, which include the acute format of the course of urethritis, as well as the reduced sphincter.
When trocar epicystostomy is necessary
If initially the technique was considered as an effective tool to help patients on a temporary basis, today its application has somewhat expanded to include the complete absence of time restrictions.
People who receive palliative care while suffering from acute urinary retention are unlikely to benefit from anything better than installing a catheter. This is done in a hospital inpatient setting. Often the primary source of such a need is the advanced stage of adenoma, or a malignant cancer with localization in the prostate gland.
A little less often the source of the problem is the obstructive process, which started on the site of the cervical-urethral segment.
The modern equipment used for this kind of operation helps to simplify the procedure itself, as well as to defeat in a number of indicators the classic superposition of the suprapubic urinary fistula.
This is supported by the results of a statistical study, which states that using the trocar approach, it was possible to reduce the likelihood of death among victims of prostate adenoma by approximately 5%. We are talking about victims who, according to vital signs, had to give consent to the installation of an urinal.
Thanks to the proven technique, surgeons can conduct a detailed examination and preoperative preparation before directly conducting a delayed adenectomy. If you use this option, you can eliminate the need for a permanent catheter. But it is he who is fraught with danger regarding the imperceptible development of urethritis. It can also be a catalyst for triggering the urethral fever mechanism.
To prevent exacerbation of the chronic course of pyelonephritis during delayed adenectomy, it will be much more effective to take advantage of the capabilities of a trocar technique. She will prevent the aggravation of renal failure.
One of the most important advantages of the technique is the operative formation of an artificial fistula, which will not bring cicatricial deformities with localization at the site of the cut. But about the traditional imposition of suprapubic urinary fistula such good things can not be said. Having even a slight scar in the indicated area, subsequent adenomectomy is complicated.
Among other positive aspects that are characteristic of a progressive urinary diversion, the ability to not limit a person's physical activity is highlighted.
This possibility reduces the incidence of thromboembolic complications by an order of magnitude, which improves cardiovascular activity. This nuance has a beneficial effect on the functioning of the respiratory system as a whole.
Disadvantages of the procedure
Despite the fact that trocar-type epicystostomy often saves the lives of patients, it still has a number of disadvantages. The most pronounced of them is the increased sensitivity of the skin in the area around the catheter.
Doctors note that in most cases the victim is to blame here, who did not take enough care of the affected area, even allowing a minor inflammatory process.
Usually, after a while, the hypersensitivity syndrome goes away on its own.
Occasionally, the opposite effect occurs when, after surgery, a peculiar territory forms at the exit site of the tube with numbness of the skin. The former sensitivity is restored only after the epicystostomy is removed back after the time allotted by the doctor.
Obesity of the victim can add to the difficulties, which will become a serious obstacle to the introduction of the tube with the urinal because of the need to get through a large amount of fatty tissue.
You will also have to come to terms with the fact that in the first few days after installation, urine almost always leaks, even if the installation was performed by experienced medical personnel. To neutralize the negative consequences of such a development of events, it is enough to just change the dressings to clean and dry on time.
It will take a couple of weeks to put up with this drawback. But if, after the specified time, the dressings have to be changed all the same often, then it would be more logical to insist on a second intervention. It will aim to replace the catheter with a thicker diameter index to eliminate the risks of extensive leakage.
No less often, patients have to face the occurrence of infectious lesions, which then lead to an extensive inflammatory process. Researchers confirm the existence of such a problem, warning that with periodic self-catering, such risks are much lower. The same thing happens when using a special penis clamp in men. But alternative methods can not be used for all diagnoses, hence the justified inconvenience.
The final difficulty that all victims will have to put up with is the periodic failure of the drainage system. This is explained by the fact that the passage will be regularly polluted by the natural:
In this situation, urine cannot pass through the tube, which contributes to its further accumulation in the bladder. If you ignore the problem, a person in the near future will have to face unpleasant symptoms:
- the development of infection;
- the rapid development of pyelonephritis, indicating inflammation of the kidneys.
Here you can not do without consulting a doctor.
To facilitate the understanding that something is wrong with the victim, doctors have developed a kind of protocol for alarming symptoms. If at least one dangerous sign is found in yourself, this turns into an occasion to seek help from a treating doctor. The list includes the following items:
- pain syndrome;
- turbidity of the effluent;
- unpleasant odor;
- discomfort in the abdomen;
- redness of the skin of the abdomen around the catheter;
- hot skin near the incision;
- purulent or mucous discharge from the hole;
- the presence of bloody discharge or immediately whole clots from the hole;
- catheter prolapse;
- lack of urine in the urinal for a long time.
A situation is considered separately when part of the urine passes by a catheter. Usually this phenomenon is within normal limits, if before that the device was just replaced. But just in case, it is better to consult a specialist.
Frequent Patient Mistakes
Many patients are interested in whether to wash their catheter at least periodically. Some people use Furacilin, saline, or generally any available antiseptic fluids to carry out their plans. But urologists categorically forbid doing such experiments.
The reason for such firm categorization is the increased likelihood of infection. If you inject liquid into the bladder under pressure using a Janet syringe or other similar instruments, it will only allow you to flush various substances from the inner walls of the catheter. This is about:
- bacterial films.
All of the above goes through the bladder above to the kidneys. With their weakened protection, a person, instead of benefit, will only harm himself. With the most serious scenario, the patient is threatened with urosepsis. This is called the spread of infection with subsequent inflammation, which often ends in death, even with an emergency response.
Another frequently asked question on the topic is the need to use antibiotics. There is no unambiguously accurate answer, since one has to take into account the presence of signs of an inflammatory process. We are talking about elevated temperature, turbid effluent, as well as pain in the lower abdomen and lower back.
If the victim does not have all of the above, and the doctor approves the rejection of the antibiotic program, then there is no reason to take them. You will not even have to include uroseptics in the therapeutic regimen.
Instead, it is better to pay attention to the rule of heavy drinking and following the basics of a therapeutic diet. The menu for her provides for the restriction of a number of familiar dishes, and the need to constantly take herbal preparations. It will be useful to consult on the use of a decoction of the diuretic spectrum of action.
The urologist will tell you which pharmacy fee is suitable for a particular ward, he will write down the rules for admission and a specific dosage.
After the epicystostomy has been successfully implemented, an extremely important moment comes, which will show how productive the help will be. The body itself will perceive the drainage as a foreign body, even if it is made of the most inert materials.
This composition is used to reduce the percentage probability of system rejection, or the development of an allergic reaction with anaphylactic shock to complete the picture. Today, some manufacturers offer potential consumers models that are equipped with an antibacterial coating. It is designed to reduce the risks of infection. But even with the purchase of innovative specimens, one cannot ignore the rules of personal hygiene.
The most common consequence of installing a discharge tube is a urinary tract infection. To protect the body from pathogens, you will have to devote time to individual hygiene, following simple covenants:
- You should always wash your hands not only after the completion of manipulation with the catheter, but also before that.They need to be washed even before and after emptying the bladder, if the patient was transferred to a training regimen for testing the bladder before removing the unit.
- Carefully monitor the occupancy rate. You do not have to reach the time when the liquid in the urinal reaches the very top. Ideally, the collected urine should be poured after half the capacity has accumulated or a little more.
- Do not place the urinal on the floor or other potentially dirty surfaces. The rule in public toilets is especially relevant.
- Treat the place of discharge with an antiseptic. For these purposes, medical alcohol is well suited for which you need to wipe the indicated part of the mechanism before connecting to the catheter.
- Wash skin near the hole in the morning and evening. Disinfection will require ordinary warm water and soap.
But to constantly apply a bandage after completely tightening the wound surface - an extra manipulation. The dressing is useful only if leakage is detected after changing the catheter to a new one. Then a replacement is required after each wet.
In rare cases, doctors fix in the wards excessive growth of the skin. This is considered a normal body response. Thus, the body tries to get rid of the external stimulus - the tube. Nothing can be done independently to eliminate the defect. It is better to report the situation to the attending doctor.
Despite the fact that it is generally not forbidden to take a bath with installed drainage, experts still recommend limiting oneself to a shower. You also need to make sure that the makeup products for the hole do not have any pronounced perfume components.
They usually act as a catalyst for the development of an allergic reaction.
The final helpful tip is to always have one spare catheter on hand. This will allow you to quickly help yourself in an emergency, as it happens when the old device suddenly falls out. After reinstallation, you must immediately go to the hospital.
How to live after epicystostomy
Even a lifelong drainage installation after an epicystostomy should not interfere with a person's active endeavors. After the body gets used to a foreign body, the victim may gradually return to his usual life. He just needs to follow a few simple instructions. So, you have to regularly monitor fluid intake. The specific daily volume is calculated individually, based on body weight.
The absorbed water helps prevent stagnation in the bladder, helping to accelerate the elimination of all harmful and unnecessary components like salt residues, mucous accumulations, bacteria.
But for such purposes, irritating liquids are not suitable, the list of which includes strong tea, coffee, tonics and various carbonated drinks. An individual ban on the consumption of alcoholic beverages will also have to be imposed.
Separately, you need to work on changing the standard menu. It is necessary to exclude salty foods, as well as acidic foods and spicy foods from the diet. This will help not only the normal generation of urine, but also will prevent frequent constipation. But it is they who often provoke various complications after even a successful operation. Therefore, it is so important to empty the intestines in time, following the prescribed therapeutic diet.
If any abnormalities are found, including pain in the problem area, you must immediately go to the hospital. A timely response to poor health will protect yourself from serious complications.