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

Urethral Dilatation

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Dilatation of urethral stricture. Dine in combination with urethroscopy and placement of IDC is advocated on daily basis at home as management of urethral stricture.

Why is it done?

  • To treat a narrowing in the urethra which has formed due to previous damage/injury to the urethra.
  • Causes: after bypass surgery where a drop in blood pressure has caused an area of low blood supply to the urethra; trauma to the urethra (pelvic fractures/ urethral instrumentation); and sexually transmitted diseases.
  • The procedure placing a dilator un your urethra on a daily basis.
  • It aids in keeping your urethra open and prevents eventual kidney damage / failure.

How is it done?

  • Patients will receive a local anesthetic.
  • A urethroscopy is performed by placing a flexible camera in the urethra, with the help of a lubricant jelly and an irrigate (fluid), to identify the stricture.
  • A guidewire is slipped through the opening of the narrowing.
  • The camera is removed.
  • The stricture is dilated using a graduated S dilators over the guide wire.
  • Prophylactic antibiotics may be given to prevent infection.

What to expect after the procedure?

  • It may be slightly uncomfortable, please don’t hesitate to tell jo and request sedation if required.
  • A catheter will be inserted in the urethra and bladder. This will remain in the bladder for 3 days.
  • Catheters can be very irritating and cause some discomfort.
  • Blood stained urine will be present.
  • Lower abdominal discomfort will persist for a few days.
  • NB! Each person is unique and for this reason symptoms may vary!

 

What next?

  • Patients will be sent home with a catheter for 3 days after receiving thorough catheter care instructions.
  • Arrangements will be made to remove the catheter on day 3.
  • There may be some blood in the urine. This can be remedied by drinking plenty of fluids until it clears.
  • A referral will be done to BlueCare Nurses, who will assess you to instruct you on daily self-dilatation.
  • PLEASE CONTACT THE HOSPITAL WITH ANY POST-OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS.

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Wes Urethroscopy & Urethral Dilatation

Urethrectomy

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Removal of urethra. Usually in adjunct to a radical cystectomy. Occasionally done some time after a cystectomy where recurrences occur in urethra.

 

Why is it done?

  • As part of the treatment for aggressive localized Urothelial carcinoma of the bladder.
  • T1G3, > T2 disease.
  • Primary Urethral disease with:
    • Urothelial Carcinoma.
    • Squamous cell carcinoma.
    • Secondary metastatic disease to Urethra: Melanoma, Lung cancer, Breast cancer (all these are rare).
  • Advanced disease may involve a penectomy.
  • The procedure is part of the radical cystectomy, radical cysto-prostatectomy or could be and adjunct later on when recurrences are found with surveillance.
  • Part of a necrotic inflammatory condition ie: Fourniers Gangrene.

How is it done?

  • This procedure is done under general anesthetic.
  • Legs are placed in a lithotomy position.
  • A single incision is made on the midline raphe on the perineum (area between scrotum and anus). Sutures will be dissolvable.
  • The Corpora Spongiosum with the urethra inside it is mobilized off the Corpora Cavernosa.
  • Urethral meatus is removed distal and glans is closed.
  • Proximally the urethra is taken up to the sphincter and freed.
  • You will have already had a diversion of the urine with an ileostomy, or this will be done with your cystectomy part of the operation.
  • A drain will be left for 24-48 hours to prevent the collection of serous fluids.
  • A dressing is then applied, which should be removed after 72 hours.

What to expect after the procedure?

  • Any anesthetic has its risks, and the anesthetist will explain all such risks.
  • If this is the only operation you have undergone, you will be sent home as soon as the drain is removed on D2 or D3.
  • Swelling is a common complication.
  • A hematoma (blood collection under the skin) may form and needs to be reviewed by Dr Schoeman as soon as possible. Bruising is normal.
  • An infection of the wound may occur and requires immediate attention.
  • Owing to the area of the surgery the wound should be kept clean and dry.
  • DANGER SIGNS: A wound that swells immediately, fever, or puss. Please contact Dr Schoeman or the hospital immediately as this may occur in up to 15 % of all cases.

What next?

  • The dressing should be kept dry for the initial 72 hours after surgery and then soaked in a bath until it comes off easily.
  • The dressing may sometimes adhere to the wound causing slight bleeding on removal. Don’t panic, the bleeding will stop.
  • On discharge a prescription may be issued for patients to collect.
  • There will be signs of bruising for at least 10 days.
  • The suture-line will be hard and indurated for at least 8-10 weeks.
  • PLEASE CONTACT THE HOSPITAL DIRECTLY WITH ANY POST-OPERATIVE CONCERNS AND RETURN TO THE HOSPITAL IMMEDIATELY SHOULD THERE BE ANY SIGNS OF SEPSIS.

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Wes Urethrectomy

UROLUME / Memocath Urethral Stent

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Minimal invasive management for the relief of lower urinary tract symptoms (LUTS) or urinary retention caused by a urethral stricture

Why is it done?

  • This procedure is performed when concentric scarring in the urethra causes LUTS and /or Urinary Retention
  • Symptoms include: a weak stream, nightly urination, frequent urination, inability to urinate, (LUTS) and Urinary Retention
  • This is alternative to an invasive procedure where long periods of anesthetic are contraindicated.
  • Usually for chronically sick patients who cannot undergo surgery yet are active enough not to want a permanent catheter.
  • Patients who don’t want to / cannot do intermittent self-dilatation of these strictures
  • Don’t want a permanent Indwelling Catheter

How is it done?

  • Patients will receive sedation with local anesthetic gel placed in the urethra.
  • A cystoscopy is performed by placing a camera in the urethra with the help of a lubricant jelly and an irrigate (fluid).
  • The measurements of the urethral are taken (length)
  • Appropriate length coil is chosen.
  • The device is placed through the cystoscopy sheath, to sit snug in the prostate urethra stretching over the length of the stricture
  • Prophylactic antibiotics will be given to prevent any infections.

 

Complications

Side–effects

  • Persistent pain in penile shaft
  • Pain in Perineum when seated
  • Migration of the device
  • Erosion of device
  • Possible infection
  • Long term yields the risk for encrustation and recurrent infections
  • NB! Each person is unique and for this reason, symptoms vary!

 

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Wes UROLUME Urethral Stent

Copyright 2019 Dr Jo Schoeman