Clinical Significance of Suprapubic Cystostomy in the Treatments of Patients with Voiding Difficulty / 대한비뇨기과학회지

ABSTRACT

PURPOSE: We assessed the clinical significance of a suprapubic cystostomy for the treatment of patients with voiding difficulties, and analyzed the related courses and complications. PATIENTS AND METHODS: A review of 55 patients managed with suprapubic cystostomy was undertaken. The changes in the serum Cr, urinary pH and white blood cell values, after a suprapubic cystostomy, were analyzed. The stone-free rate after insertion of a suprapubic catheter was estimated by the Kaplan-Meier method. RESULTS: The original diseases included spinal cord injury in 20 (36.3%), inoperable benign prostatic hyperplasia in 12 (21.8%), cerebrovascular accident in 10 (18.2%), diabetic cystopathy in 4 (7.3%), recurrent urethral stricture in 3 (5.5%), spinal stenosis in 2 (3.6%), prostatic cancer in 2 (3.6%) and 1 (1.18%) each of Parkinson's disease and multiple sclerosis. The indications for the need for a cystostomy were poor hand function in 35 (64%), patient request in 8, worsening of the original disease in 6, vesicoureteral reflux in 3, severe urethral damage in 2 and a recurrent urinary tract infection in 1. The most common complication was the formation of bladder calculi, which occurred in 9 (16%). There were no serious complications associated with the procedure. The mean serum creatinine levels changed from 1.01+/-0.09mg/ml to 0.90 +/-0.09mg/ml, but with no statistical significance. The stone-free rates at 1 and 5 years after the procedure were 91.9 and 61.6%, respectively. The urinary pH of the stone-forming group was significantly higher than that of the stone-free group (p<0.05). CONCLUSIONS: Although continuous cystostomy drainage is not considered an ideal management for bladder emptying, the long-term uses of suprapubic catheters are well tolerated by patients, despite the frequent catheter-related complications. Therefore, a suprapubic cystostomy, as a management, may be indicated in some patients with severe urethral damage and limited activity of the upper extremities.