A cystostomy tube is a medical device that helps the bladder drain urine when the usual urinary pathway is blocked or compromised. This tube provides an alternate route for urine to exit the body for individuals who cannot urinate naturally.
Understanding Cystostomy Tubes
A cystostomy tube, also known as a suprapubic catheter, is a thin, flexible tube surgically inserted directly into the bladder through the lower abdominal wall, typically just above the pubic bone. This connection between the bladder and the skin allows urine to drain externally.
This type of catheter is used for various medical conditions, including chronic bladder outlet obstruction, which can be caused by an enlarged prostate (benign prostatic hyperplasia), or urethral strictures, which are narrowings of the urethra. It is also used for neurogenic bladder, a condition where nerve damage affects bladder function, and in cases of severe urethral trauma. Additionally, a cystostomy tube may be a temporary measure after certain surgeries or for complicated lower genitourinary infections.
A difference between a cystostomy tube and a standard urethral catheter is the insertion site. A urethral catheter is inserted through the urethra. In contrast, a cystostomy tube bypasses the urethra entirely by creating a new opening in the abdomen. This can be beneficial for long-term bladder management, potentially reducing the risk of certain infections and preserving sexual function in male patients.
How a Cystostomy Tube is Placed and Removed
The placement of a cystostomy tube is a surgical procedure. It is usually done under local anesthesia, though general anesthesia or sedation may also be used. The area above the pubic bone is prepared by shaving and cleaning the skin, then numbed with anesthetic.
Imaging guidance, such as ultrasound, is often used to ensure correct placement of the tube into the bladder. A small incision is made in the lower abdomen. The tube is then inserted into the bladder, and its position is often confirmed by aspirating urine. Once inside the bladder, the tube is secured, commonly by inflating a small balloon at its tip with sterile water or by using sutures. The entire placement procedure can take between 10 to 45 minutes.
Removing a cystostomy tube is a straightforward process. The balloon holding the tube in place within the bladder is deflated by withdrawing the sterile water. Once deflated, the tube can be gently pulled out. The small opening in the skin where the tube was inserted closes and heals naturally over time. The first tube change occurs 4-6 weeks after initial placement to allow a tract to form, with subsequent changes happening monthly for long-term use.
Daily Life and Care with a Cystostomy Tube
Living with a cystostomy tube requires daily care to prevent complications and maintain hygiene. The insertion site, also known as a stoma, needs to be cleaned daily with soap and water or an antiseptic solution like chlorhexidine. After cleaning, the area should be thoroughly dried, and a new sterile gauze dressing may be applied. Hands should be washed thoroughly before and after performing any care.
The drainage bag attached to the tube must be emptied regularly, typically when it is one-half to two-thirds full, or at least every 8 hours. Smaller leg bags may need emptying every 3 to 4 hours. When emptying, the drain spout should not touch anything, and its tip should be cleaned with alcohol. The drainage bag itself can be cleaned with a solution of two parts vinegar to three parts water to reduce odor, allowing it to air dry between uses. The tube should always be kept below the waist to prevent urine backflow and kinks in the tubing.
Despite careful management, some common issues can arise. Leakage around the tube can occur, which may be managed with dressings. Pain around the site is also possible, and minor bleeding may be observed, especially after initial placement or changes.
Signs of infection include redness, swelling, pus, tenderness around the stoma, fever, or cloudy and foul-smelling urine. Tube blockages can happen due to mucus or debris. If blockage is suspected, flushing the tube with sterile saline as advised by a healthcare professional may be necessary.
Certain symptoms or situations warrant immediate medical attention. These include severe pain, a high fever, or if no urine is draining into the bag. If the tube becomes dislodged, it is important to seek medical care promptly, as the tract can close quickly, requiring re-insertion of the tube. Persistent leakage, significant blood in the urine, or any signs of a worsening infection also require consultation with a healthcare provider.
Regarding lifestyle, individuals with a cystostomy tube can shower, but bathing or swimming is often discouraged to prevent infection, unless specifically advised otherwise by a doctor. Loose-fitting clothing is more comfortable and helps prevent tugging on the tube. Physical activity can be resumed based on medical advice, ensuring the tube is secured to prevent dislodgement or excessive movement, which can cause irritation or damage to the tract.