Simplified percutaneous large bore suprapubic cystostomy for acute urinary retention—A cost saving procedure

Introduction and objectivesCommercial cystostomy kits/trocars are not always readily available in regions with insufficient funding. Open suprapubic cystostomy procedures are yet prevalent. This paper presents a simplified percutaneous suprapubic cystostomy technique that utilizes specially selected surgical blades in the place of commercial trocars.Subjects and methodsEighty-nine male patients with acute urinary retention underwent puncturing of the visibly and palpably distended bladder with surgical blade size 20 (7 mm diameter), 21 or 22 (9 mm diameter) to allow resistance-free placement of Foley catheter size 18 Fr (maximum diameter of 6 mm) or size 20 (maximum diameter of 6.7 mm) respectively under local anesthesia along the mid abdominal line in a sagittal direction – two finger breadths above the pubic symphysis. The main outcome measures were to determine the success rate and the encountered complications.ResultsSuccessful bladder puncture and insertion of the Foley catheter of choice was possible in all cases. There was no mortality and no adjacent visceral injury. There were two cases of catheter blockage with clots that were easily flushed out.ConclusionsEmergency cystostomy can be safely achieved through direct puncture of the visibly and palpably distended bladder with appropriately selected surgical blades that will subsequently allow resistance-free placement of sizable Foley catheters.