Tuesday, June 9, 2015

Study group discussion: Suprapubic cystostomy experience

So last night, in the emergency department, comes a 65 yr old male complaining of difficulty in passing urine.
On examination: His lower abdomen is distended. A pyriform shaped swelling reaching the umbilicus.

He was having acute retention of urine. Tried introducing a 16 fr catheter. But failed. Next step?

You try intorducing a 10 fr paediatric catheter.

But we didn't have one to our dispense. So we did supra pubic.

What is the procedure?
Palpate and percuss first. Then insert the catheter directly at 90 degree.

The moment I did.. The patient heaved a sigh of relief. On further work up, it was a case of BPH.

How do you make sure you don't injure inferior epigastric vessels?

Midline 4 cm above pubic symphysis. Inferior epigastric vessels are more lateral.

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