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      Suprapubic Cystostomy: Risk Analysis of Possible Bowel Interposition Through the Percutaneous Tract by Computed Tomography

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          Abstract

          Purpose

          The most serious complication of suprapubic cystostomy is bowel injury. By computed tomography (CT), we investigated the risk factors of possible bowel interposition through the percutaneous suprapubic cystostomy tract.

          Materials and Methods

          From September to October 2009, we consecutively reviewed 795 abdominopelvic CT scans of adult patients performed for various reasons in our hospital. From these scans, we selected the films wherein the urinary bladder was distended more than 6 cm above the symphysis pubis. We then determined whether the bowel was interposed between the bladder and the skin at the routine puncture site of suprapubic cystostomy (the midline of the abdomen 3 cm above the upper margin of the symphysis pubis). We analyzed which factors influenced the possibility of the bowel being interposed between the bladder and the skin at the suprapubic puncture site.

          Results

          A total of 226 CT (148 males, 78 females) scans were selected. The mean patient age was 63 years (range, 26-84 years). The mean distance between the upper margin of the symphysis pubis and the umbilicus was 14.4 cm (range, 7.2-21.0 cm). In the multivariate analysis, obesity, a positive history of radical pelvic surgery, and a short distance (≤11 cm) between the symphysis pubis and the umbilicus had significant correlations with bowel interposition in the assumed tract.

          Conclusions

          When performing a suprapubic cystostomy, extreme caution is needed to avoid possible bowel injury in patients who are obese, had a previous radical pelvic operation, or have a short distance between the upper margin of the symphysis pubis and the umbilicus.

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          Most cited references13

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          An unusual cause of small bowel obstruction: the misplaced suprapubic catheter.

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            An unusual cause of volvulus: the misplaced suprapubic catheter.

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              Percutaneous endoscopic cystostomy for bladder localization and exact placement of a suprapubic tube.

              We describe a new technique for exact positioning and placement of a suprapubic tube. The bladder dome and its relative position on the lower abdomen are localized using a flexible cystoscope, light source and abdominal palpation. The technique has been successfully used in patients who require long-term urinary drainage. Percutaneous endoscopic cystostomy is simple, effective and easily performed and it simplifies the placement of a suprapubic tube in the difficult to localize bladder.
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                Author and article information

                Journal
                Korean J Urol
                KJU
                Korean Journal of Urology
                The Korean Urological Association
                2005-6737
                2005-6745
                October 2010
                21 October 2010
                : 51
                : 10
                : 709-712
                Affiliations
                Department of Urology, Soonchunhyang University College of Medicine, Seoul, Korea.
                Author notes
                Corresponding Author: Won Jae Yang. Department of Urology, Soonchunhyang University Seoul Hospital, 22, Daesagwan-gil, Hannam-dong, Seoul 140-743, Korea. TEL: +82-2-709-9376, FAX: +82-2-709-9378, wonjya@ 123456schmc.ac.kr
                Article
                10.4111/kju.2010.51.10.709
                2963785
                21031092
                d9cd9be3-7bb2-4b86-a623-4e2165ceee44
                Copyright © The Korean Urological Association, 2010

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 26 August 2010
                : 17 September 2010
                Categories
                Original Article
                Endourology

                Urology
                complications,punctures,cystostomy
                Urology
                complications, punctures, cystostomy

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