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Objectives: Low-profile cystostomy tubes provide an alternative to conventional cystostomy tubes with external tubing. Previously, these have been placed surgically involving coeliotomy, cystotomy and cystopexy, or have been used as replacement tubes in existing stoma sites. The purpose of this study is to describe a technique for, and the outcomes of, single-step, non-surgical low-profile cystostomy tube placement., Materials and Methods: All cases that had single-step, non-surgical placement of low-profile cystotomy tube attempted at the authors' institutions were included in this study. Data, including success rates, outcomes and complications, were extracted from the medical records., Results: Ten client-owned dogs were inclided. Single-step, non-surgical placement was successful in eight out of 10 dogs, with placement being unsuccessful in two thus necessitating coeliotomy. The median duration that low-profile cystostomy tubes were in place was 7.0 months (range 4 days to 38 months). Seven of the eight dogs required replacement of their cystostomy tube. Mean time until first tube replacement was 103 days (range 13 to 363 days)., Clinical Significance: Single-step, non-surgical placement of a low-profile cystostomy tube is a viable alternative to surgical placement. Lack of cystopexy does not appear to result in complications. Conversion to coeliotomy might be required if tube placement is not successful with this technique. Complications seen with non-surgical tube placement such as inadvertent tube removal were similar to those previously reported for surgically placed tubes., (© 2024 The Authors. Journal of Small Animal Practice published by John Wiley & Sons Ltd on behalf of British Small Animal Veterinary Association.)

Objective: To compare two techniques-trocar and Seldinger-for performing percutaneous suprapubic cystostomy., Materials and Methods: 125 patients, mean age 71.8 ± 16.5 years (range, 15-102 years), underwent primary suprapubic cystostomy from January 2013 to December 2018. Trocar access (N = 60) was performed as a single step using a puncture cannula without guidewire access. Seldinger access (N = 65) involved needle puncture, guidewire placement, and serial dilation. A retrospective review of patient records was conducted., Results: All procedures were technically successful. Mean catheter size was 13.1 ± 2.0 and 13.9 ± 2.0 French for trocar and Seldinger, respectively (P = .044). Mean procedure time was significantly reduced using trocar technique, 12.4 ± 7.7 versus 25.7 ± 12.1 minutes (P <.001), and was associated with lower anxiolytic dose, 1.2 ± 0.8 versus 1.9 ± 1.1 mg midazolam (P = .003), and less radiation exposure, 20.2 ± 59.5 versus 100.7 ± 98.5 mGy (P <.001). Catheter occlusion was the most common complication (28.8%), followed by UTI (13.6%) and bladder spasm (8.0%). All but 2 complications were classified as Clavien-Dindo grade I or II. Catheter occlusion was more frequent in the trocar group (41.7% vs 16.9%, P = .003), while bladder spasms were more frequent in the Seldinger group (13.8% vs 1.7%, P = .018)., Conclusion: Suprapubic cystostomy via trocar is associated with faster procedure time, lower anxiolytic dose, and less radiation. While major complications are rare, catheter occlusion is a common occurrence that may be overlooked. Although we detected more occlusions with trocar technique, this may be confounded by a catheter-tract size discrepancy., (Published by Elsevier Inc.)

Objectives: To evaluate the MIC-KEY button vesicostomy as an alternative to indwelling suprapubic catheters (SPCs) for bladder drainage in adults., Patients and Methods: Phase II pilot study prospectively evaluating patients with indwelling SPCs that were converted to MIC-KEY buttons, or cystoscopic-guided de novo insertion, between November 2014 and February 2019. In all, 15 patients (14 female, one male) had indwelling SPCs that had conversion or attempted conversion to MIC-KEY button, and one (male) had a cystoscopic-guided de novo insertion with a history of previous suprapubic catheterisation. The mean (range) age was 44.2 (13-73) years. Catheter-related quality-of-life (C-IQoL) questionnaire data were collected at baseline and 3 months., Results: Two patients had attempted conversion but were abandoned perioperatively due to sizing issues and insertion difficulties, respectively. Three patients were subsequently converted back to a SPC; due to button sizing (18 days), leaking (3 months), and recurrent infection (13 months). The remaining 11 patients have remained well with continued drainage via the MIC-KEY button; mean (range) duration since conversion was 34.2 (5-105) months. The C-IQoL score improved 3 months after insertion, from 50.0 to 75.4. Changes were performed dependent on patient's personalised management, typically every 3 months, under local or general anaesthetic., Conclusion: The MIC-KEY button is a safe alternative to SPC drainage in adults in the short- to medium-term, in a selected cohort., (© 2019 The Authors BJU International © 2019 BJU International Published by John Wiley & Sons Ltd.)

Purpose: The vesicostomy button has been shown to be a safe and effective bladder management strategy for short- or medium-term use when CIC cannot be instituted. This study reports our use with the vesicostomy button, highlighting the pros and cons of its use and complications. We then compared the quality or life in patients with vesicostomy button to those performing clean intermittent catheterization., Materials and Methods: Retrospective chart review was conducted on children who had a vesicostomy button placed between 2011 and 2015. Placement was through existing vesicostomy, open or endoscopically. We then evaluated placement procedure and complications. A validated quality of life questionnaire was given to patients with vesicostomy button and to a matched cohort of patients performing clean intermittent catheterization., Results: Thirteen children have had a vesicostomy button placed at our institution in the 4 year period, ages 7 months to 18 years. Indications for placement included neurogenic bladder (5), non-neurogenic neurogenic bladder (3), and valve bladders (5). Five out of 7 placed via existing vesicostomy had leakage around button. None of the endoscopically placed buttons had leakage. Complications were minor including UTI (3), wound infection (1), and button malfunction/leakage (3). QOL was equal and preserved in patients living with vesicostomy buttons when compared to CIC., Conclusion: The vesicostomy button is an acceptable alternative to traditional vesicostomy and CIC. The morbidity of the button is quite low. Endoscopic insertion is the optimal technique. QOL is equivalent in patients with vesicostomy button and those who perform CIC., Competing Interests: None declared., (Copyright® by the International Brazilian Journal of Urology.)

Background: Circumstances such as the inability to pass a retrograde urinary catheter or a lack of surgeon availability may prevent immediate relief of urethral obstruction in dogs. In such situations, a cystostomy tube may be placed with ultrasound guidance to allow urinary diversion until further treatment is possible., Key Findings: A case of a 5-year-old male neutered Swiss Mountain dog with an obstructive urolith at the level of the os penis is used to describe the technique. Multiple attempts to pass a urinary catheter under sedation were unsuccessful. A pigtail cystostomy tube was placed with ultrasound guidance to allow urinary diversion. The dog was discharged from the hospital within 2 days after scrotal urethrostomy and the dog made a full recovery. Ultrasound-guided placement of a pigtail cystostomy tube was straightforward and without complications., Significance: Ultrasound-guided placement of a pigtail cystostomy tube may be beneficial as it is not technically challenging, can be performed rapidly, and may avoid the need for general anesthesia. Additionally, ultrasound is readily available and an inexperienced ultrasonographer can easily locate the urinary bladder. This report serves to provide a detailed technique of ultrasound-guided placement of a pigtail cystostomy tube in dogs for emergency urinary diversion., (© Veterinary Emergency and Critical Care Society 2019.)

Objectives: Minimally invasive paracentetic suprapubic cystostomy is a technique that should be learned by all surgical trainees and residents. This study aimed to develop a self-made training model for paracentetic suprapubic cystostomy and placement of the suprapubic catheter and then to evaluate its effectiveness in training fourth-year medical students., Methods: Medical students were divided into an experimental group receiving comprehensive training involving literature, video, and model use and a control group receiving all the same training protocols as the experimental group except without hands-on practice using the model. Each student's performance was video-recorded, followed by subjective and objective evaluations by urology experts and statistical analysis., Results: All students completed the surgical procedures successfully. The experimental group's performance scores were significantly higher than those of the control group (median final performance scores of 91.0 vs. 86.8, respectively). Excellent scores were achieved by more students in the experimental group than in the control group (55% vs. 20%), and fewer poor scores were observed in the experimental group than in the control group (5% vs. 30%)., Conclusions: Based on its cost-effectiveness, reusability, and training effectiveness, this paracentetic suprapubic cystostomy training model is able to achieve goals in teaching practice quickly and easily. Use of the model should be encouraged for training senior medical students and resident physicians who may be expected to perform emergent suprapubic catheter insertion at some time.

Competing Interests: Competing interests: None declared.

Purpose: Precise preoperative characterization of urethral stricture is important for surgical planning. A period of urethral rest by a suprapubic cystostomy tube may aid in stricture characterization and affect the surgical approach. In this study fellowship trained reconstructive urologists compared the radiographic characterization of anterior urethral strictures before and after a period of urethral rest. We then determined how this changed the planned operative approach., Materials and Methods: We queried our prospectively maintained urethroplasty database at our institution for men with an anterior urethral stricture who underwent retrograde urethrogram and voiding cystourethrogram before and after preoperative suprapubic cystostomy tube placement. A total of 29 men were identified for analysis. To minimize responder fatigue 20 pairs of radiographs were selected at random. All images before and after suprapubic tube placement were interpreted in random order by 11 fellowship trained reconstructive urologists. Interpretation included stricture length, diameter, location and surgeon operative plan. Preplacement and post-placement results were compared. Post-placement stricture length was also compared to intraoperative length. ICC was used to evaluate homogeneity among the urologists. Linear regression analysis was performed to determine the association of post-radiographic length after tube placement with intraoperative stricture length., Results: Imaging agreement among interpreting urologists was satisfactory (ICC 0.72). There was no statistically significant difference in stricture length before vs after suprapubic tube placement. Of the images 23% were considered obliterative before tube placement while 58% were obliterative after placement (p = 0.0005). Mean ± SD post-placement radiographic and intraoperative stricture length was 3.0 ± 2.6 and 3.8 ± 3.3 cm, respectively (p <0.0001). Deviation between the radiographic and intraoperative lengths increased with stricture length (slope 0.26, p = 0.0023). The surgeon operative plan changed 47% of the time, including to an excision approach in 37% of cases., Conclusions: Despite optimal urethral imaging with a suprapubic tube in men with high grade stricture reconstructive urologists underestimated length by an average of almost 1 cm. This underestimation was less for shorter strictures and it increased with stricture length. In addition, a period of urethral rest resulted in more frequent stricture obliteration, which was associated with a change in the planned operative approach about half of the time. If urologists do not place a suprapubic cystostomy tube prior to urethroplasty for high grade stricture, the operative plan should account for the stricture being tighter than it may appear., (Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: To place a suprapubic tube without using specialized instruments. Suprapubic cystostomy is a straightforward urological procedure, which nevertheless may become complicated if the equipment needed to perform the operation is unavailable. Nowadays, in most operating rooms, control of urological instruments has been taken away from a small cadre of dedicated urology nurses, and instead is delegated to a central sterilization department or is even outsourced, leading to an increased rate of instrument misplacement or breakage. Disposable kits are useful, but may not be stocked at all facilities. Hence, the tools needed by the urologist to perform suprapubic cystostomy may not be readily available when they are needed. This reality was the impetus for the development of the following technique for suprapubic tube placement, which relies only upon ordinary instruments., Methods: A simple method is described for placing a suprapubic catheter using a curved Van Buren sound, a cystoscope, and a minor surgical set., Results: Not only is the operation is easy to do, but is also advantageous in that the catheter may be exchanged over a wire, if necessary, before the establishment of a suprapubic tract. The technique depends on the presence of an intact urethra; therefore, it is contraindicated in the setting of pelvic trauma., Conclusion: This suprapubic cystostomy method may be used either as a primary technique or as a back-up procedure if the urologist's preferred instrumentation is not available., (Copyright © 2018 Elsevier Inc. All rights reserved.)

An 82-year-old male with multiple comorbidities, including previous laparotomies, had a suprapubic catheter (SPC) inserted under guidance with ultrasound and a flexible cystoscope. Three months following the procedure, having returned for a flexible cystoscopy for ongoing bladder pain syndrome, he became peritonitic postoperatively.A CT scan and subsequent laparotomy confirmed the SPC to be passing through a section of terminal ileum. The bowel was resected and he recovered well after a long hospital admission. A literature search found this delayed presentation of bowel perforation following SPC insertion to be rare, with only a few other cases reported. In particular, previous abdominal surgery increases the risk of this complication. This case serves as a reminder of the rare but potentially significant risk of SPC insertion and unusually highlights that this may not present immediately., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Competing Interests: Interessenkonflikt: Beratungstätigkeit: Dr. Pfleger, Pfizer; Vortragstätigkeit: Allergan, AMS Deutschland, Astellas, Berlin-Chemie, Janssen, Lilly Deutschland, Dr. Pfleger, Pfizer, Pohl-Boskamp; Studienfinanzierung: AMS Deutschland

A new mouldable seal, Brava® Protective Seal, was evaluated by patients on aspects related to residue, durability, and preference. A total of 135 patients from four countries participated (Denmark, Germany, Japan and the USA) and the new product was compared to the patients' usual pouching systems. Less residue and easier skin cleansing was observed, which may benefit patient quality of life. The possible benefits of less residue for peristomal skin health need further investigation.

A 35 years old man presented with retention of urine secondary to meatal stenosis with bulbar urethral stricture. He had a distended, palpable, tender urinary bladder. Urethral catheterization and dilatation was tried but failed. A trocar cystostomy was performed under local anaesthesia, which led to the injury to the small bowel when least expected. This is a rare but well recognized complication of small bowel injury following blind trocar suprapubic cystostomy when it was least expected and as such had a significant bearing on its management. We discuss its subsequent management and possible mechanism underlying this unexpected and unfortunate complication in the given circumstances.

Background: Urine leakage is a common complication in patients with bladder cancer after radical cystectomy and neobladder reconstruction., Objective: The aim of this study was to evaluate the clinical value of the use of urostomy bags in the management of urine leakage in patients with bladder cancer after radical cystectomy., Methods: Urine leakage during the perioperative period was retrospectively analyzed in 483 patients with bladder cancer who underwent radical cystectomy from 2004 to 2010. Before 2008, all patients with urine leakages were treated by routine dressing changes (group A). After 2008, the leakages were managed with urostomy bags (group B). The perioperative quality of life (EQ-5D) and cost for urine leakage for both groups were compared in this controlled study., Results: The average cost in management of preoperative urine leakage was significantly higher in group A than in group B as well as the patients with extravasations of urine or lymphoceles. Patients in group B had an overall better perioperative life quality compared with group A. In particular, the score for pain/discomfort was significantly higher in group A than in group B., Conclusions: The management of perioperative urine leakage with urostomy bags avoided constant body wetness and significantly increased the quality of life and reduced the special costs of urine leakage in patients with bladder cancer after cystectomy., Implications for Practice: Early use of urostomy bag is a good choice for perioperative urine leakage in patients with bladder cancer after radical cystectomy and neobladder reconstruction.

Introduction: Over recent years the button vesicostomy has become an alternative management option in children with poor bladder emptying, when clean intermittent catheterisation (CIC) cannot be initiated for reasons of age, sensation, or urethral anatomy. This study reviews recent experience of this technique and evaluates its use., Methods: Retrospective review of patients who had a button vesicostomy to permit bladder drainage between 1998 and 2011., Results: Thirty children underwent button vesicostomy insertion aged between 4 days and 16 years. Indications were neuropathic bladders (n = 15), congenital hypotonic bladders (n = 6), functional bladder disorders (n = 5), and post-obstruction bladders (n = 4). The median length of use was 11 months; however, 7 patients still have the button in situ. Minor complications (n = 12) included transient leakage, wound infection, and overgranulation. Major complications included 2 UTIs, 1 device failure, and 2 significant leaks, requiring revision of the tract and removal of the button., Conclusion: The button vesicostomy is a suitable and safe technique for use in the short- and medium-term. The procedure has minimal morbidity and therefore is acceptable to families. It has a wide scope, including patients with a neuropathic bladder as an alternative to CIC and where temporary drainage is required until bladder function can recover., (Copyright © 2013 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Introduction: To describe a novel technique using extracorporeal tailoring and an inverted ureteral nipple to perform laparoscopic transperitoneal ureteral reimplantation for adult obstructed megaureter and our initial experience with 10 patients., Technical Considerations: Ten patients (mean age 39.2 years [range, 21-62]) with adult obstructed megaureter underwent transperitoneal laparoscopic ureteral reimplantation by a 3- or 4-port technique. In each case, the affected ureter was freed and delivered out of the peritoneal cavity through the ipsilateral 12-mm port. The lower end of the ureter was tailored by approximately 6 cm, and the tip was folded back onto itself and secured with absorbable sutures to form a nipple. A double-J stent was placed, the entire assembly was carefully replaced into the abdomen, and the ureter was reimplanted into the posterolateral wall of the bladder., Conclusion: Surgery was successful in all the 10 patients without the need for open conversion. At a mean follow-up of 17 months, all patients were asymptomatic, and hydronephrosis was relieved in 9 cases. Laparoscopic ureteral reimplantation with extracorporeal tailoring and direct nipple ureteroneocystostomy is an easy, safe, and effective procedure for adult obstructed megaureter., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background and Purpose: Current methods of suprapubic cystostomy (SPC) catheter insertion may be difficult for patients in poor health and can result in significant morbidity and mortality. These include a highly invasive open procedure, as well as the use of the percutaneous trocar punch methods, commonly associated with short-term SPC. We present the first human experience with the Transurethral Suprapubic endo-Cystostomy (T-SPeC(®)) device, a novel disposable device used for introducing a suprapubic catheter via a retrourethral (inside-to-out) approach similar to the Lowsley technique., Patients and Methods: Four men at St. Mary's General Hospital in Kitchener Ontario, Canada, received the T-SPeC device (model T7) under general anesthesia., Results: Patients had no complications from catheterization using the T-SPeC T7 Surgical System. The mean surgical time of the four procedures was 9.7 minutes, with a range of 7.9 to 13.5 minutes, including instrument preparation and cystoscopy. All four procedures were highly accurate and rapid. There were no complications and minimal blood loss from the procedure., Conclusions: We found that the T-SPeC device allows for efficient and safe insertion of a suprapubic catheter in an outpatient setting and may be a useful addition to the urologic armamentarium. The T-SPeC Surgical System facilitates rapid and precise suprapubic catheter placement.

Complications associated with the Stamey percutaneous loop cystostomy catheter (Cook Medical), including exposure of the most proximal side-hole and leakage of urine from the bladder, were encountered following percutaneous placement in three cats. In all cats, surgical exploration for removal of the catheter was performed.

In situations at the interface of urology and geriatric medicine the palliative management of geriatric patients with urinary incontinence of voiding dysfunction occupies a central position. Influencing factors that need to be considered by the surgically active urologist are not only the high age and the thus associated vulnerability of the geriatric patient but also other aspects such as the patient's wishes, the expectations of care-giving relatives and the sexual situation. In this light a strict and individually adapted indication for placing a palliative indwelling catheter is mandatory. First of all, all other treatment options should be explored, for the placement itself particularly sparing and low-risk procedures such as suprapubic catheter placement in nephrostomy technique should be employed. After placement of the catheter special attention must be paid to the hygienic care of the deviation in order to avoid complications and subsequent diseases., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: We describe our technique of percutaneous suprapubic catheter insertion with special reference to steps that help to avoid common complications of haematuria and catheter misplacement., Methods: The procedure is performed using a stainless steel reusable trocar under local infiltrative anaesthesia, usually at the bedside. After clinical confirmation of a full bladder, the trocar is advanced into the bladder through a skin incision. Once the bladder is entered, the obturator is removed and the assistant inserts a Foley catheter followed by rapid balloon inflation. Slight traction is applied to the catheter for about five minutes. Patients with previous lower abdominal surgery, an inadequately distended bladder or acute pelvic trauma do not undergo suprapubic catheterisation using this method., Results: The procedure was performed in 72 men (mean age: 42.4 years, range: 18-78 years) with urinary retention with a palpable bladder. The average duration of the procedure was less than five minutes. No complications were noted in any of the patients., Conclusions: Trocar suprapubic catheter insertion is a safe and effective bedside procedure for emergency bladder drainage and can be performed by resident surgeons. The common complications associated with the procedure can be avoided with a few careful steps.

Percutaneous suprapubic catheterization is an alternative when placement of a urethral catheter is contraindicated or unsuccessful. We report the case of a 3-day-old newborn, who presented anuric acute renal failure secondary to placement of a suprapubic catheter. An excessive length of catheter had been inserted into the bladder and was obstructing the vesicoureteral junctions. Several measures can be taken to prevent this complication, such as systematic measurement of the length inserted into the bladder, use of a catheter with 1cm gradations or recourse to radiopaque material., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Aim: The aim of this study is to define which children could benefit from a button cystostomy. We describe a safe way to perform the insertion of a button cystostomy for urinary diversion and provide more precise instructions concerning the best indications for this device., Materials and Methods: We analyzed several criteria of the follow-up of all the patients who had a button cystostomy since 2007 including indications, age, urodynamic variables, and complications., Results: Twenty-one patients underwent a button cystostomy. A group of young children was included in the study (mean age, 2 years), in which most of the failed procedures were observed, whereas we had better results with the second group of older children (mean age, 12 years)., Conclusions: The analysis of indications and, more particularly, urodynamic variables regarding the quality of the results allows us to clearly define which children can benefit from this procedure with a good chance of success and low risk of complications., (Copyright © 2012 Elsevier Inc. All rights reserved.)

The increasing experience obtained through laparoscopy has resulted in the evolution of ablative and reconstructive procedures in the field of paediatric urology. Apart from the established methods of laparoscopic nephrectomy and orchidopexy, nowadays laparoscopic hemi-nephrectomy and pyeloplasty have become standard therapeutic surgical alternatives. Nevertheless, many of these procedures require a high level of experience in laparoscopic preparation and stitching techniques and are thus performed in institutions with greater laparoscopic experience. With the introduction and evolution of the robotic-assisted technique and the availability of smaller instruments and ports (8 and 5 mm), there has been an evolution in the spectrum of complex ablative and reconstructive procedures in the field of paediatric urology as well. Nevertheless, there is a lack of randomised trails and the literature available in this area consists manly of case reports. The purpose of this article is to present the current status and perspectives of robotic-assisted surgery in the field of paediatric urology.

Objective: To describe a laparoscopic technique for percutaneous tube cystostomy in dogs., Design: Prospective cohort study., Animals: 8 healthy mixed-breed dogs., Procedures: A laparoscope portal and 2 instrumental portals were created in the abdomen of anesthetized dogs that were in dorsal recumbency. Intracorporeal suturing was performed to place 2 simple interrupted sutures between the ventral body wall and urinary bladder. A purse-string suture was placed in the urinary bladder wall approximately 1 cm cranial to the 2 simple interrupted sutures. A stab incision was made into the urinary bladder in the middle of the purse-string suture; an 8F Foley catheter was inserted through the stab incision and into the urinary bladder. Two other sutures were placed between the ventral body wall and bladder 1 cm cranial to the Foley catheter to create a cystopexy. The Foley catheter was secured to the skin with a finger-trap suture and was attached to a closed urine collection bag. All dogs underwent follow-up laparoscopy 1 month later., Results: Median time for laparoscopic percutaneous tube cystostomy was 85 minutes (range, 72 to 103 minutes); there were no major intraoperative or postoperative complications. On follow-up laparoscopy, focal fibrous adhesions between the ventral body wall and bladder were observed in all dogs and omentum attached to the cystopexy site was observed in 2 dogs., Conclusions and Clinical Relevance: In this study, a laparoscopic percutaneous tube cystostomy was accomplished in healthy dogs by use of a 3-portal technique and appeared to be an effective and safe procedure.

Purpose: The "button" enteral feeding systems are widely used as a gastrostomy. We describe our use of this device to facilitate bladder drainage in children., Materials and Methods: We prospectively reviewed all patients who underwent insertion of a cystostomy button between 2002 and 2005. Indications and complications were analyzed., Results: A total of 17 children (8 female, 9 male) with a mean age of 7.1 years underwent insertion of a cystostomy button during the 4-year period. Mean followup was 16 months (range 2 to 40). Cases selected included those with a neuropathic bladder, prune belly syndrome, previous major bladder neck surgery and those unsuitable for Mitrofanoff stoma formation. Complications included 1 wound infection treated with antibiotics. Four children had leakage from the cystostomy site that was successfully treated with a change in button size, and 14 buttons remain in situ., Conclusions: Button cystostomy is a safe and effective form of bladder drainage in children. It is a good alternative to standard suprapubic drainage and it gives children an improved quality of life.

Suprapubic cystostomy is recommended to patients with neuropathic bladder to prevent complications of long-term urethral catheter drainage. We present a 50-year-old male patient with tetraplegia who had long-term urethral catheter drainage. Following flexible cystoscopy, he developed a urine leak from the right side of the scrotum. Suprapubic cystostomy was performed. After suprapubic cystostomy, the urinary fistula healed completely. A follow-up cystourethrogram confirmed an intact urethra with no leak of contrast. Six weeks later, this patient presented with a hole below the suprapubic cystostomy through which a small amount of urine was leaking. A keyhole dressing had been applied around the suprapubic catheter and the catheter was hanging loosely, thus permitting traction on the catheter, especially when the urine bag was full. Computerised tomography of the pelvis showed extrusion of the Foley balloon from the urinary bladder, but the tip of the catheter was still located within the bladder. The extruded catheter was removed and a Foley catheter was inserted, ensuring that the balloon was inflated within the urinary bladder. The suprapubic catheter was secured firmly to the anterior abdominal wall with a BioDerm Tube Holder, thus preventing any traction on the catheter or Foley balloon. The urine leak through the hole below the suprapubic cystostomy stopped and the sinus healed. This case illustrates the need to anchor the suprapubic catheter securely to the anterior abdominal wall with adhesive tape or BioDerm Tube Holder to prevent traction and consequent displacement of the catheter or Foley balloon.

Objectives: To assess the efficacy, reliability, and performance of the LapraTy clip (LTc) as a substitute for knot tying during reconstructive surgery in a porcine model., Methods: Twenty-four farm pigs were divided in two groups, each undergoing two surgical procedures: group A, transperitoneal laparoscopic cavotomy and small-bowel enterotomy with repair, and group B, laparoscopic partial nephrectomy and cystotomy with repair. In all animals LTc were used to replace knot tying. Tissue specimens were harvested and examined at 2, 4, and 8 weeks postoperatively to assess success of reconstruction and tissue reaction., Results: There were no major complications. Animals in group A showed no clinical signs of caval obstruction. No intraperitoneal collections or significant narrowing were noted at the enterotomy sites. Animals in group B showed no evidence of fluid collections around the partially resected kidneys or the cystotomy sites, and all repairs were intact. Pathologic examination revealed that all LTc were encapsulated by fibroblasts and giant cells typical of a foreign body-type granulomatous reaction. No evidence of clip migration into the epithelium was noted in any of the tissues examined., Conclusions: In an animal model, the LTc is a safe and efficient alternative to knot tying during laparoscopic reconstructive surgery. We are currently evaluating the clinical applicability of the LTc in a variety of urologic conditions. We believe that other surgical specialties should evaluate this device as well.

We report a rare case of spontaneous catheter knotting in the setting of a suprapubic cystostomy and also review previous reports and the rationale behind this event.

Urinary bladder stones have played a role in medicine for ages. Many examples of this disease can be found in Dutch history. The need to cure this ailment led to the development of extremely painful interventions, for which self-appointed specialists very soon came forward and were then employed in this capacity in the cities. The various interventions were: perineal lithotomy using either the 'apparatus minor' or the 'apparatus major', lateral lithotomy, cutting for stone 'in two trips', suprapubic cystotomy, and ultimately lithotripsy. Bladder stones have largely disappeared from contemporary medicine and now represent only 5% of all urinary-tract stones, the main groups at risk being men with prostate hypertrophy, whether or not surgically treated, and women previously operated on for incontinence. Bladder stones are now seen mainly in developing countries. The dangerous operations via an extravesicular route have now been replaced by transurethral procedures in which the stone is disintegrated with the aid of an electric charge, shock waves or ultrasound. In an early stage, this ailment was the incentive for the development of a separate medical specialty: urology.

Context: EUS-guided transmural drainage of pancreatic pseudocyst has been reported using a linear array echoendoscope; however, placement of large 10 French stent was not feasible because of the limited diameter of the working channel. Recently linear array echoendoscopes with large working channel (3.7 to 3.8 mm) and newer accessories for pancreatic cyst puncture have become available; however, clinical data on their efficacy and safety in pancreatic pseudocyst drainage is not available., Objective: To evaluate efficacy and safety of a one-step real time EUS-guided pancreatic pseudocyst drainage approach using a 3.8 mm channel linear array echoendoscope and cystotome., Design: Prospective case series., Setting: Tertiary care hospital endoscopy unit., Patients and Interventions: A total of 12 EUS-guided pancreatic pseudocyst drainage procedures were performed in 11 patients with symptomatic pancreatic pseudocyst using a 3.8 mm channel linear array echoendoscope and cystotome., Main Outcome Measurements: Complete resolution of pancreatic pseudocyst on imaging., Results: Successful puncture of pancreatic pseudocyst and placement of 1 or 2 stents (10 Fr) was successful in all patients who were considered eligible for EUS-guided pancreatic pseudocyst drainage. Overall 9 patients out of a total of 11 (82%) were managed successfully with EUS-guided pseudocyst drainage. Two recurrences were noted over a mean follow-up period of 4 months (range 3-6 months). One patient underwent successful repeat drainage and the other patient was managed with surgical cystogastrostomy because of infected cyst contents. No major complication occurred., Limitations: Uncontrolled, small sample size., Conclusions: A single-step approach using a large channel (3.8 mm) linear array echoendoscope and cystotome appears feasible. This approach appears safe and effective in managing selected patients with symptomatic pancreatic pseudocysts.

Purpose: We evaluated the postoperative morbidity and technical complications of a new handmade catheter used for suprapubic prostatectomy., Materials and Methods: A total of 146 patients with lower urinary tract symptoms who had indications for open prostatectomy were enrolled in the study from January 2003 to August 2004. Of the patients 96 were treated with a novel technique without a urethral catheter but with a special handmade cystostomy catheter, while the other 50 underwent the traditional procedure using cystostomy and a urethral catheter. The same surgical team operated on the 2 groups. Clot retention episodes, hemoglobin decreases, irritative symptoms, voiding status after cystostomy removal and incontinence were evaluated postoperatively. Three months later we followed the patients with symptom score, maximum flow rate and cystoscopic examination., Results: Preoperatively mean International Prostate Symptom Score was 31.6 in each group. Postoperatively none of the patients with the novel catheter complained of significant irritative urinary symptoms, clot retention and true or stress urinary incontinence. Of the cohorts 94% were satisfied with voiding but 86% of controls were satisfied. There was no report of urinary tract infection or epididymo-orchitis in the cohorts, while we found epididymo-orchitis in 4 controls (8%). Three months after the operation the mean International Prostate Symptom Score was 4.4 (range 1 to 7) and the mean maximum flow rate was 22.6 ml per second (range 14 to 25) in patients with the novel catheter, and 4.2 (range 1 to 7) and 22.5 ml per second (range 15 to 25), respectively, in those with the traditional catheter. At followup there was no bladder neck contracture but 4 patients (4.1%) showed some degree of membranous urethral stricture. We also noted 7 controls (14%) with urethral stricture., Conclusions: Transurethral prostate resection has been introduced as the surgical treatment of choice in patients with benign prostatic hyperplasia. However, open adenomectomy still has a place. Urethral catheter-free suprapubic prostatectomy can be safely applied with a low postoperative risk of infection, incontinence and stricture formation.

The Protractor is a self-retaining ring retractor used mainly for minilaparotomies in adults. We report our positive results of using this retractor in pediatric surgery. We performed surgery with the aid of the Protractor in 57 pediatric patients aged from 1 day old to 16 years old. The Protractor allowed a wide operative view and did not cause any major complications. It was especially useful for Kasai's portoenterostomies and ureteroneocystostomy (Cohen's repair). In neonatal surgery, the Protractor not only provided a wide operative view, but also prevented the washing fluid from overflowing onto the covering sheet. In appendectomy, the Protractor protected the surgical wound from contaminated ascites and the appendix. The Protractor is a very useful tool for assisting with various abdominal operations in infants and children.

The author describes his first-hand experience of a technique to keep patients with a suprapubic catheter free from urine leakage. He modified a suprapubic catheter by adding an external phalange to secure the catheter and balloon placement within the bladder. To date, this modification has prevented leakage around the catheter site for all patients in which it was used. In a followup article, the author will explain how he obtained a patent for the new design and worked with companies to manufacture the new product.

The role of suprapubic catheters in traumatic bladder injuries is not well defined. Current literature suggests that suprapubic catheters are only necessary with large intraperitoneal bladder ruptures. The purpose of this study is to show that all bladder injuries can be managed with transurethral catheterization alone with a similar leak rate, morbidity, and healing time. Retrospective analysis was done of all patients with traumatic bladder injuries at a level I urban trauma center from June 1992 through June 2003. Medical records were reviewed and data analyzed according to type of bladder catheterization (i.e., transurethral or suprapubic). All patients with urethral injuries were excluded. Fifty-six patients met inclusion criteria. Twenty-seven patients suffered penetrating bladder injuries, and 29 bladder injuries were secondary to blunt trauma. Forty-seven patients were treated with transurethral catheter drainage, two were treated with suprapubic catheters, and seven were treated with both transurethral and suprapubic catheters. Forty patients had follow-up cystograms prior to catheter removal. Of the 47 patients treated with transurethral drainage alone, 3 (6%) developed urinary leaks. Of the 9 patients with suprapubic catheters, 2 (22%) developed urinary leaks. The mean time to removal of transurethral catheters was 15 days. The mean time to removal of suprapubic tubes was also 15 days. All study patients successfully healed their bladder injuries regardless of catheterization method. Suprapubic catheter drainage may increase morbidity without improving healing time. These results effectively support the decision to use transurethral catheter drainage alone in all patients with traumatic bladder injuries.

A patient with urethral stricture presented to us with acute retention. Sequential dilatation over a guidewire was done and a suprapubic catheter was placed percutaneously. Guide wire broke during the procedure, which came to our notice on micturating urethrogram. Laser core through for the stricture and endoscopic removal of the guidewire were done.

Background: The role of suprapubic catheterization after repair of intraperitoneal bladder injury is controversial and has been found to be superfluous in retrospective studies. We sought to evaluate bladder drainage prospectively., Methods: Patients were prospectively enrolled and were assigned to suprapubic catheter drain after bladder repair or urethral catheter alone determined by the unit admitting the patient. Factors that were evaluated were associated injuries, hospital stay, duration of catheterization, and catheter-related complications., Results: There were 42 patients: there were 39 male patients, and the mean age was 29.6 years. The patients were matched for age and associated injuries. The morbidity (p = 0.004) and hospital stay (p = 0.028) were significantly higher in the suprapubic drainage group., Conclusion: Urethral catheterization is adequate to effect bladder drainage after intraperitoneal bladder injury. In addition, it is associated with a shorter hospital stay and lower morbidity.

Traditional cystostomy tubes (used for temporary or permanent diversion of urine in dogs and cats) are long (> or = 22 cm) and cumbersome to stabilize, requiring sutures or bandages to hold the tube against the body. Use of a low-profile gastrostomy port system as a low-profile cystostomy tube (LPCT) in 4 dogs and a cat was investigated; owner satisfaction with the device was assessed. Technical difficulty associated with placement and management of LPCTs was similar to that for traditional cystostomy tubes; with LPCTs, activity and mobility of pets was not compromised, and bandaging was not required. Complications included lower urinary tract infection, mild peristomal leakage of urine and leakage from components of the system, and subcutaneous peristomal infection. Four of 5 owners considered the tube to be easy to use; all owners said they would be comfortable repeating their decision to use the LPCT in their pet.

A 10-year-old, spayed female Dalmatian was diagnosed with granulomatous urethritis causing urethral obstruction. Due to the extensive involvement of the urethra, a urethrostomy was not possible. A commercially available, silicone, low-profile gastrostomy tube was placed as a prepubic cystostomy tube to achieve urinary diversion. This tube is easy to use, has a one-way valve, and lies flush with the skin margin, thereby decreasing the likelihood of inadvertent removal. This tube should be considered to achieve long-term urinary diversion when urethral involvement is extensive.

Aims: To evaluate the frequency of urinary tract infection in patients with suprapubic cystostomy and other complications of the procedure within 30 days of placement., Methods: Patients characteristics, indication and types of cystostomy and short term (within 30 days); complications were analyzed in 91 patients. Urine analysis and culture was done in all patients to exclude those with urinary tract infection. After 15 and 30 days of the procedure, urine analysis and culture was repeated to evaluate the frequency of urinary tract infection. The prevalence of symptomatic bacteriuria with its organisms was assessed. Antibiotics were given to the postoperative and symptomatic patients and the relationship of antibiotics on the prevention of urinary tract infection was determined., Results: Of the 91 cases 88 were males and 3 females. The mean age was 40.52 +/- 18.95 with a range of 15 to 82 years. Obstructive uropathy of lower urinary tract.was present in 81% cases and 17 (18.6%) had history of trauma to urethra. All these cases had per-urethral bleeding on examination while x-ray urethrogram showed grade II or grade III injury of urethra. Eighty two of the procedures were performed per-cutaneously and 7 were converted to open cystostomies due to failure of per-cutaneous approach. Nine patients had exploratory laparotomy. Duration of catheterization was the leading risk factor for urinary tract infection found in 24.1% at 15 days and 97.8% at 30 days. There was low prevalence of symptomatic urinary tract infection. E.Coli was the prevalent organism. Antibiotics did not play a significant role in controlling catheter associated urinary tract infection. Blockage and macroscopic hematuria (self limiting) were the predominant complications encountered., Conclusion: Duration of catheterization is the leading risk factor for the development of urinary tract infections. Catheter-associated bacteriuria are usually asymptomatic. Macroscopic hematuria and blockage of catheter are frequent which can be managed promptly without surgical intervention.