Korean J Urol.  2010 Oct;51(10):709-712.

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

• Cho KH
• Doo SW
• Yang WJ
• Song YS
• Lee KH

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 (< or =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.

Keyword

Complications; Cystostomy; Punctures

MeSH Terms

Abdomen
Adult
Cystostomy
Humans
Male
Multivariate Analysis
Obesity
Punctures
Risk Factors
Skin
Umbilicus
Urinary Bladder

Figure

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  FIG. 1 Computed tomography scan showing the bowel interposed between the urinary bladder and the skin at a point along the midline of the abdomen, 3 cm above the upper margin of the symphysis pubis.

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