Supra-Pubic Catheter

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Invasive placement of a silicone tube in a percutaneous supra-pubic puncture site. This is secured inside the bladder (with a balloon) and attached to a drainage bag on the outside, in order to drain an obstructed bladder.

Why is it done?

  • This can be placed as an emergency for patients in acute urinary retention
  • Patients requiring long term catheterization especially spinal cord injury patients
  • Failed urethral catheterization
  • Severe prostate obstruction
  • Urethral strictures
  • Severe sepsis of the urogenital area where diverting urine away from the area is advisable
  • Urethral catheterization impossible

 

How is it done?

  • Usually done under general anesthesia.
  • This is done as a sterile procedure; therefore, the genital area and suprapubic area will be cleaned with a non-abrasive dis-infectant.
  • A flexible cystoscopy will be placed to inspect the bladder, allow filling with saline and visualize the puncture with a cannula from the skin (outside)
  • A 1cm incision is then made in the midline of the lower abdomen, approximately 2cm above the pubic bone
  • An appropriate size catheter (14-16Fr) will be inserted using a trocar method
  • Correct placement is confirmed with the cystoscopy (direct vision)
  • An anchoring balloon will be inflated with 10cc of sterile water.
  • A drainage urine bag will be attached
  • The catheter will be secured to your leg. (check that this is always secured)

 

Complications

  • Side effects from a general anesthetic.
  • Bleeding from the wound site. (Anti-coagulants should have been ceased a week prior)
  • Depending on the size of your bladder a possible bowel injury could occur, the odds of this happing will be discussed with you prior to your procedure.

 

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Wes Catheters Suprapubic Catheter CHANGE

Copyright 2019 Dr Jo Schoeman

Trans-Urethral Cauterization of Bladder Bleeders + Evacuation Clots

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 Why is it done?

Primary management of:

  • Continuous or intermittent bleeding from bladder vessels
  • More prominent after radiation therapy with neo-vascularisation
  • Induced or aggravated by blood thinning and anti-platelet therapy

 

Risk factors:

  • Anti-coagulation therapy: Warfarin, Xaralto etc
  • Anti-platelet therapy
  • Radiation to bladder prostate or bowel
  • These need to be stopped prior to the procedure

 

How is it done?

  • This is done under General anaesthesia.
  • A cystoscopy is performed by placing a camera in the urethra with the help of a lubricant gel and saline irrigation.
  • The bladder is then distended with saline.
  • Clots are evacuated with an evacuator
  • A resectoscope is then placed.
  • I use Bi-polar resection, thus using Saline as irrigation.
  • The offending bleeding vessels are cauterized and sealed
  • A 3-way catheter is placed with continuous saline irrigation until your urine is clear
  • Antibiotics may be given to prevent infection.

 

Complications

Side–effects

  • You may have a 22 –24 French (thick) 3-way urethral catheter placed through your urethra.
  • It does have a channel for placement of constant saline irrigation and another for the drainage of the blood-stained urine.
  • The Continuous bladder irrigation will continue until your urine is clear approximately 24-48hrs.
  • This can also be remedied by drinking plenty of fluids until it clears.
  • As soon as the colour of your urine is satisfactory, your catheter will be removed.

 

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Wes TU cauterisation of bladder bleeders

Copyright 2019 Dr Jo Schoeman

Trans-Urethral Resection of Bladder Tumour – TURBT

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Trans Urethral resection of bladder tumour with/without MMC

An endoscopic procedure where bladder tumours are excised via the urethra.

Why is it done?

Primary management of:

  • Resect a bladder lesion suspicious of bladder cancer
  • Three Types of bladder cancer:
    • Urothelial Carcinoma (85%)
    • Squamous Cell carcinoma
    • Adeno carcinoma
  • Metastatic cancer to the bladder – i.e. Breast, Cervical, Adeno carcinoma of bowel.
  • Other space occupying lesions in the bladder: infection granulomas, abscess from diverticulitis etc.
  • Abnormal cells suggestive of urothelial carcinoma, on urine cytology.

Risk factors:

  • Strong family history of bladder cancer.
  • Smokers or passive smokers.
  • Factory workers: dyes, paints, etc.
  • Exposure to Schistosoma (Bilharzia).
  • Renal stone disease, bladder stones.

How is it done?

  • This is done under General anesthesia.
  • A cystoscopy is performed by placing a camera in the urethra with the help of a lubricant gel and saline irrigation.
  • The bladder is then distended with saline.
  • A resectoscope is then placed.
  • I use Bi-polar resection, thus using saline as irrigation.
  • The tumour or tumours are resected as complete as possible.
  • Deep resection of the tumour base is done to exclude deep muscle invasive tumours.
  • In tumours where it is clearly muscle-invasive, less extensive surgery is done, as this patient may benefit from a cystectomy.
  • 40mg of Intravesical Mitomycin C is routinely placed inside your bladder for an hour after the surgery.
  • A 3-way catheter is placed with continuous saline irrigation until your urine is clear.
  • Antibiotics may be given to prevent infection.

Mitomycin C

Chemotherapeutic agent providing 40% lower incidence of Urothelial Cancer recurrence if placed within 6-8 hours inside the bladder after a TURBT.

What to expect after the procedure?

  • Blood stained urine.
  • Lower abdominal discomfort which will persist for a few days.
  • Catheter induced discomfort.
  • NB! Each person is unique and for this reason symptoms vary.
  • Small risk (<1%) of bladder perforation, causing you to have a laparoscopy with repair of bladder and wash-out of peritoneal cavity with Sterile Water.

What next?

  • You may have a 22 French (thick) 3-way urethral catheter placed through your urethra.
  • It does have a channel for placement of constant saline irrigation and another for the drainage of the blood-stained urine.
  • The continuous bladder irrigation will continue until your urine is clear approximately 24-48hrs.
  •  This can also be remedied by drinking plenty of fluids until it clears.
  • As soon as the colour of your urine is satisfactory, your catheter will be removed.
  • Staging of your cancer will be arranged to be reviewed on your review appointment.
  • A ward prescription will be issued to patients on discharge, for own collection at any pharmacy.
  • Patients should schedule a follow-up appointment within 7-14 days.
  • Please don’t hesitate to direct all further queries to Jo.
  • REMEMBER: THOSE WHO SUFFER IN SILENCE, SUFFER ALONE!

Staging

  • CT IVP.
  • CT Chest.
  • Bone scan.
  • Renal Function and Liver Function Tests.
  • MRI where an allergy to Iodine or Renal Impairment.

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Wes TURBT