EMERGENCY PERCUTANEOUS INSERTION OF HEMATURIA CATHETERS A. S. ADAMSON, M.B., F.R.C.S. R. O’N. WITHEROW, M.S., ER.C.S.
From the Department London. England
of Urology, St Mar\r’s Hospital.
Chin alnd Short’s recent article* highlighted a problem that occasionally faces the urologist. Of the currently available commercial kits for suprapubic drainage, none allows placement of large-caliber catheters. The utilization of the balloon dilator to place such a catheter is certainly noteworthy. In our experience, however, the most common indication for passing a large-diameter catheter is in acute clot retention. While passage of a urethral catheter in this scenario is ideal, on occasion it is impossible to instrument the urethra, and suprapubic drainage with a hematuria catheter is indicated. Balloon dilatation of the suprapubic cystostomy may be valuable in elective or semielective procedures, but in the situation outlined above we recommend a quick and reliable alternative method. Technique Following preparation of the suprapubic region with antiseptic, the skin, rectus sheath,
L
Ciatheter
‘\----/\Bladder FIGUHE 2.
Diagrammatic
wprmmtution
of rathe
trr insertion.
and bladder wall are infiltrated with local anesthetic. A positive bladder tap is then obtained with a 21-gauge needle and syringe. Using a no. 11 blade a stab wound is made through the skin and rectus, thus facilitating subsequent catheter insertion. A trocar from a 24 F chest drain is then inserted through the distal drainage hole of the desired catheter to abut on the inside of the catheter tip. The body of the catheter is then held firmly against the trocar (Fig. 1). Using the left hand as a guard to prevent overinsertion of the trocar, the bladder is entered through the stab wound (Fig. 2). Puncture of the bladder is confirmed by a definite “give.” Removal of the trocar is facilitated by inflation of the retaining balloon prior to its extraction, The catheter is secured with a suture. London
MT3 lfi’~’ England (MR. ADAMSON)
From the Department London. England
of Urology, St Mar\r’s Hospital.
Chin alnd Short’s recent article* highlighted a problem that occasionally faces the urologist. Of the currently available commercial kits for suprapubic drainage, none allows placement of large-caliber catheters. The utilization of the balloon dilator to place such a catheter is certainly noteworthy. In our experience, however, the most common indication for passing a large-diameter catheter is in acute clot retention. While passage of a urethral catheter in this scenario is ideal, on occasion it is impossible to instrument the urethra, and suprapubic drainage with a hematuria catheter is indicated. Balloon dilatation of the suprapubic cystostomy may be valuable in elective or semielective procedures, but in the situation outlined above we recommend a quick and reliable alternative method. Technique Following preparation of the suprapubic region with antiseptic, the skin, rectus sheath,
L
Ciatheter
‘\----/\Bladder FIGUHE 2.
Diagrammatic
wprmmtution
of rathe
trr insertion.
and bladder wall are infiltrated with local anesthetic. A positive bladder tap is then obtained with a 21-gauge needle and syringe. Using a no. 11 blade a stab wound is made through the skin and rectus, thus facilitating subsequent catheter insertion. A trocar from a 24 F chest drain is then inserted through the distal drainage hole of the desired catheter to abut on the inside of the catheter tip. The body of the catheter is then held firmly against the trocar (Fig. 1). Using the left hand as a guard to prevent overinsertion of the trocar, the bladder is entered through the stab wound (Fig. 2). Puncture of the bladder is confirmed by a definite “give.” Removal of the trocar is facilitated by inflation of the retaining balloon prior to its extraction, The catheter is secured with a suture. London
MT3 lfi’~’ England (MR. ADAMSON)
