TsISTOSTOMYYa (Greek kystis bladder + stoma of companies, opening, pass; a synonym an epicystostomy) — surgery of creation of an outside vesical fistula.
C. apply hl. obr. for temporary or constant removal of urine at disturbance of passability of an urethra owing to its damage, a prelum by a tumor or adenoma of a prostate, at strictures of various origin, reconstructive
urethra operations in time and after operation, and in some cases — during a preparation for surgery. C. for the purpose of drainage of a bladder make also at bladder operations, at operational treatment of vaginovesical and puzyrnopryamokishechny fistulas, at for
a derzhka of urine as a result of neurogenic dysfunction of a bladder (see the Bladder, a neurogenic bladder).
It is accepted to distinguish suprapubic and puncture (trocar) Ts.
Naiboley the C is widespread suprapubic. Before an opa
the radio set on an urethra enter a catheter into a bladder; the exception is made by patients with injuries of an urethra, at to-rykh catheterization is contraindicated or impossible. Operation is carried out under local, epidural anesthesia or under anesthetic. Position of the patient during back operation with the raised basin.
After a nizhnesredinny section of a front abdominal wall make typical suprapubic vnebryu-tire vesicotomy (see). After bladder emptying on depth of 2 — 2,5 cm enter a drainage tube into its gleam, rubber or polyethylene, with two side openings, to-ruyu fix to a wall of a bladder catgut seams. Operation is finished with sewing up of a wound to a drainage. The drainage tube is in addition fixed two silk seams to skin. In the postoperative period the tube is washed out for prevention of its obstruction by clots and slime. After need for a tsistostoma disappears, the drainage tube is deleted. Fistula is closed spontaneously during 1 — 2 days.
Complications at suprapubic C. are noted seldom. Refer uric infiltration of a wound, discrepancy of vesical seams to them, it is long not closed fistulas. Prevention of complications consists in careful sewing up of a wound of a bladder, drainage of prevesical cellulose.
In recent years as a measure of preliminary removal of urine at it hron. to a delay at patients with adenoma of a prostate gained distribution puncture (trocar) C. Unlike suprapubic puncture C. is one of means of temporary removal of urine and assumes further operational treatment. As contraindications to it serve unions in prevesical space after the operations undergone earlier, stones, big diverticulums, an injury, wrinkling of a bladder, a hamaturia, inguinoscrotal hernia.
Before performance trocar C. enter 300 — 400 ml of antiseptic solution (at an acute ischuria filling of a bladder is not made) into a bladder. Then in position of the patient on spin under a local infiltration anesthesia on the centerline by 1 — 2 cm higher than a pubis do a small section of skin (1 cm), hypodermic cellulose and make cuts an aponeurosis. A special trocar catheter (see. Urological tools), advancing it strictly vertically, puncture soft tissues and get into a cavity of a bladder; mandrin is deleted, and on a catheter urine or the liquid entered into a bladder begins to follow. The trocar catheter is fixed in a gleam of a bubble by inflating of a cylinder on its end which is in a gleam of a bladder. Leaving for tsistostomichesky drenazhy same, as behind a drainage tube at suprapubic Ts.
Oslozhneniyami puncture C. damage of a transitional s'kladka of a peritoneum, loops of a gut with development of peritonitis at excessively high puncture or the small sizes of a bladder can be, and also bleeding at wound a trocar catheter of a back wall of a bladder.
Bibliography: M. A frost. Troakar-dre-
foot tube, Klin, hir., M 9, page 65, 1979; Operational surgery, under the editorship of Y. Littmann, the lane with Wenger., page 749, Budapest, 1981; Portnoya. Page igrod-zovskayaf. JI. Cancer and adenoma of a prostate, L., 1984; The Guide to clinical urology, under the editorship of A. Ya. Py-tel, page 62, 238, M., 1970; H at x r and e the Tax Code about D. P. and Lyulkoa. B. The atlas of operations on bodies of urinogenital system, page 132, M., 1972; Benign prostatic hypertrophy, ed. by F. Hinman, N. Y. a. o., 1983; Smith D. R. General urology, p. 141, Los Altos, 1984. V. V. Borisov.