Anatomical Basis and Clinical Relevance of Suprapubic Cystostomy

Introduction

Suprapubic cystostomy is a surgical procedure used for urinary drainage when urethral catheterization is contraindicated or ineffective.

Indications for Suprapubic Cystostomy

• Urethral obstruction due to trauma, stricture, or malignancy
• Neurogenic bladder dysfunction
• Post-surgical urinary retention
• Long-term bladder drainage needs

Procedural Technique

The procedure involves percutaneous insertion of a catheter through the anterior abdominal wall into the bladder.

Step-by-step Guide

1. Identify the anatomical landmarks—midline superior to the pubic symphysis.
2. Administer local anesthesia.
3. Use ultrasound guidance to locate the bladder.
4. Introduce a catheter using the Seldinger technique.
5. Secure the catheter to prevent displacement.

Anatomical Landmarks

Key structures involved:

• Rectus abdominis muscle
• Prevesical space (Retzius space)
• Bladder dome

Potential Complications

Despite being a minimally invasive procedure, complications can occur:

• Bladder perforation
• Infection (urinary tract infection, peritonitis)
• Catheter misplacement
• Hematuria

Conclusion

Suprapubic cystostomy is an essential urological intervention with well-defined indications and technique. Proper understanding of anatomical landmarks minimizes complications.