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Suprapubic Cystostomy Medication

  • Author: Seth A Cohen, MD; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Mar 27, 2014
 

Medication Summary

The goals of pharmacotherapy are to minimize pain, reduce morbidity, and prevent complications.

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Anesthetics, Local Anesthetics, Amides

Class Summary

The anesthesia should be used for a percutaneous suprapubic cystostomy. Local anesthetics block the initiation and conduction of nerve impulses.

Lidocaine (Xylocaine)

 

Lidocaine inhibits depolarization of type C sensory neurons by blocking sodium channels. An example of an appropriate preparation would be a 1:1 formulation of 5 mL of lidocaine 1% and 5 mL of bupivacaine 0.25%, for a total of 10 mL. Many other formulation compositions would serve equally well as a local anesthetic. With a 22-gauge needle tip, infiltrate the superficial and subcutaneous tissue down to the fascia, approximately 2 fingerbreadths above the pubic symphysis. Fill a 10-mL Luer-Lok syringe with 5 mL of 1% lidocaine and 5 mL of 0.25% bupivacaine. Attach the syringe to a 22-gauge, 7.75-cm spinal needle. Raise a skin wheal at the marked site, and infiltrate the anesthetic into the subcutaneous tissue and rectus abdominis muscle fascia, aiming the needle at a 10-20° angle toward the pelvis. Advance the needle in this direction, while aspirating the syringe; urine should be easily aspirated when the bladder is entered.

Bupivacaine (Marcaine)

 

Bupivacaine decreases the permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses. An example of an appropriate preparation would be a 1:1 formulation of 5 mL of lidocaine 1% and 5 mL of bupivacaine 0.25%, for a total of 10 mL. Fill a 10-mL Luer-Lok syringe. Attach the syringe to a 22-gauge, 7.75-cm spinal needle. Raise a skin wheal at the marked site, and infiltrate the anesthetic into the subcutaneous tissue and rectus abdominis muscle fascia, aiming the needle at a 10-20° angle toward the pelvis. Advance the needle in this direction, while aspirating the syringe; urine should be easily aspirated when the bladder is entered.

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Contributor Information and Disclosures
Author

Seth A Cohen, MD Fellow, Female Pelvic Medicine and Reconstructive Surgery, Department of Urology, University of California, Los Angeles, David Geffen School of Medicine

Seth A Cohen, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, American Urogynecologic Society, International Continence Society

Disclosure: Nothing to disclose.

Coauthor(s)

Charles M Lakin, MD Associate Clinical Professor, Department of Surgery, Division of Urology, University of California, San Diego School of Medicine; Staff Physician, Veterans Affairs Medical Center of San Diego

Charles M Lakin, MD is a member of the following medical societies: American Medical Association, American Urological Association, California Medical Association, Chicago Medical Society, Illinois State Medical Society, American Association of Clinical Urologists

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Acknowledgements

Mary L Windle, PharmD

Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Acknowledgments

The authors of this article would also like to extend a sincere thank you to the faculty and residents of the Department of Urology, University of California, San Diego Health System, for their invaluable input and contributions.

References
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  13. Khan AA, Mathur S, Feneley R, Timoney AG. Developing a strategy to reduce the high morbidity of patients with long-term urinary catheters: the BioMed catheter research clinic. BJU Int. 2007 Dec. 100(6):1298-301. [Medline].

 
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Suprapubic cystostomy placement under cystoscopic guidance.
An example of the Cook Peel-Away Sheath set.
An example of the Stamey percutaneous cystostomy set.
Algorithm for managing difficult-to-catheterize patient. Arrows indicate next reasonable step; horizontal lines indicate that either option is reasonable.
Erosion of ventral surface of penis. Foley catheter has eroded glans, penile skin, and almost entire penile urethra. (Reprinted from Vaidyanathan S, Soni BM, Hughes PL, et al. Severe ventral erosion of penis caused by indwelling urethral catheter and inflation of Foley balloon in urethra. Adv Urol. 2010; 461539.)
Gross anatomy of the bladder.
 
 
 
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