A cystostomy is a medical procedure creating a surgical opening (stoma) directly into the bladder. This opening is typically made through the lower abdominal wall, just above the pubic bone, for the placement of a drainage tube. The device inserted is commonly referred to as a suprapubic catheter (SPC). This procedure provides an alternative path for urine when normal urinary tract function is compromised.
What a Cystostomy Is and Why It Is Necessary
The primary purpose of a cystostomy is to divert the flow of urine away from the urethra, the tube that normally carries urine out of the body. By bypassing the urethra, the suprapubic catheter offers a stable and often more comfortable route for long-term bladder drainage. The catheter is secured inside the bladder, usually by a small, inflatable balloon, to ensure continuous drainage into an external collection bag.
A cystostomy becomes necessary when standard urethral catheterization is not possible, poorly tolerated, or medically contraindicated. One of the most frequent reasons is the presence of urethral trauma or chronic blockages, such as severe urethral strictures or significant enlargement of the prostate gland. These conditions prevent a catheter from being safely or successfully passed through the natural channel.
The procedure is also indicated for individuals requiring long-term bladder management, such as those with a neurogenic bladder due to spinal cord injury or multiple sclerosis. For these patients, a suprapubic catheter reduces the risk of urethral complications, including irritation, infection, and skin breakdown, often associated with extended urethral catheter use. Furthermore, a cystostomy may be created temporarily following complex surgeries on the urethra or surrounding pelvic structures to allow the area to heal.
The Procedure for Catheter Placement
The initial placement of a suprapubic catheter is an invasive procedure performed in a hospital setting under local anesthesia with sedation, or under general anesthesia. Prior to the procedure, the bladder is filled with fluid to ensure it is distended and easily located, which helps prevent injury to surrounding organs like the bowel. The surgeon cleanses the lower abdomen with an antiseptic solution and then makes a small incision, typically one to two finger-breadths above the pubic bone.
The catheter is then guided into the bladder through this small opening, either using a specialized insertion kit or by an open surgical technique. To ensure precise placement and minimize risks, the process is often guided by imaging technology, such as ultrasound, or by visualizing the bladder’s interior using a camera passed through the urethra (cystoscopy). Once the catheter tip is positioned within the bladder, a small balloon at the tip is inflated with sterile water to anchor it securely in place.
Following the insertion, the catheter is connected to a closed drainage system, and the insertion site is dressed to protect the new stoma. The catheter may be temporarily secured to the skin with a stitch or tape to prevent accidental movement while the new tract begins to form. The procedure is usually quick, often taking less than 20 minutes, though the overall time depends on the complexity of the patient’s anatomy and the technique used.
Daily Care and Maintenance of the Site
Proper daily care of the suprapubic catheter site minimizes the risk of infection and skin irritation. The skin around the insertion point should be cleaned at least once daily using mild soap and water, gently removing any crusting or drainage. After cleaning, the area must be patted completely dry, and users should avoid applying lotions, powders, or scented soaps near the stoma.
Managing the drainage system requires vigilance to ensure continuous flow and prevent backflow of urine into the bladder. The collection bag must always be kept positioned below the level of the bladder, and the tubing should be checked regularly for any kinks or twists that could obstruct the drainage. The drainage bag itself needs to be emptied several times a day and should be replaced with a clean one approximately once a week.
Users should monitor the insertion site daily for signs of complication, such as increasing redness, swelling, tenderness, or pus-like drainage, which indicates an infection. Other concerns include a sudden cessation of urine drainage or leakage around the catheter, which may signal a blockage or bladder spasm. Suprapubic catheters must be replaced periodically, typically every four to eight weeks, a procedure performed by a healthcare professional to ensure sterility and proper technique.