Medication Summary
The goals of pharmacotherapy are to minimize pain, reduce morbidity, and prevent complications.
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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Suprapubic cystostomy placement under cystoscopic guidance.
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An example of the Cook Peel-Away Sheath set.
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An example of the Stamey percutaneous cystostomy set.
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Algorithm for managing difficult-to-catheterize patient. Arrows indicate next reasonable step; horizontal lines indicate that either option is reasonable.
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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.)
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Gross anatomy of the bladder.
