Bleeding is the most common (up to 80%) complication of kidney cancer. Usually hematuria occurs without warning and occurs without pain. Blood clots, passing through the ureter, acquire a worm-like shape and can clog its lumen, which is clinically manifested by lower back pain and attacks of renal colic.
To clarify the source of bleeding, it is necessary to perform cystoscopy and chromocystoscopy during hematuria.
Emergency therapeutic cystoscopy is aimed at eliminating tamponade Bladder. The catheterization of the ureter performed in this case eliminates blood clots, restoring the passage of urine. If cystoscopy is ineffective, a cystostomy is necessary to remove blood clots and drain urine from the upper urinary tract.
With bladder cancer, massive bleeding lasting from several hours to a day is often observed. Sometimes even small benign papillomas serve as a source of massive, life-threatening bleeding. Continued hematuria leads to a serious complication such as bladder tamponade. Hematuria manifests itself as pain over the womb and urine stained with blood. The resulting blood clots cause painful dysuria or urinary retention.
The main diagnostic method for hematuria and bladder tamponade is cystoscopy. It allows you to determine the presence of a tumor, its growth, location, extent, and source of bleeding.
Emergency medical care
In this situation, emergency treatment measures include transurethral electrocoagulation of the source of bleeding, destruction and removal of blood clots and accumulated urine through the natural urinary tract. If it is impossible to carry out the above measures due to difficult access to the tumor, its decay or large size, transvesical electrocoagulation, suturing of the bleeding area or electroresection of the bladder wall with the mandatory use of a hemostatic therapy complex is indicated.
Disturbance of urine outflow in bladder cancer, it is caused by compression of the ureteral orifice by the growing tumor. Clinically, this is expressed by attacks of renal colic, a feeling of tension and heaviness in the lumbar region. When the tumor is localized in the neck of the bladder, the internal opening of the urethra becomes “jammed,” which is accompanied by attacks of radiating pain in the perineum.
Emergency care is aimed at diverting urine from the upper urinary tract through ureteral catheterization or nephrostomy.
Violation of the outflow of venous blood and lymph from the lower extremities occurs as a result of germination or compression of vascular formations in the paravesical region. These disorders are further aggravated by metastases to intrapelvic regional lymph nodes and are clinically manifested by edema of the lower extremities, pain in the pelvis and perineum. A vesicovaginal or vesico-rectal fistula is formed when bladder cancer grows into neighboring organs. This complication is accompanied by the release of feces from the vagina or liquid feces through natural routes and the development of an ascending infection of the urinary system. With fistulas, the injected dye (methylene blue) is released from the rectum or vagina. Emergency care in these cases is aimed at alleviating the patient’s condition. For excruciating pain, in addition to analgesics (narcotics), novocaine blockade through the obturator foramen, epidural anesthesia or presacral anesthesia are used. A sigmostoma is applied to drain feces in case of intestinal fistulas and internal interorgan fistulas. The bladder is constantly washed with antiseptic solutions. With ascites, fluid evacuation from the abdominal cavity is required.
Bladder bleeding is most often observed after open adenomectomy or TUR of prostate adenoma.
Blood intensively entering the lumen of the bladder after adenomectomy or TUR of the prostate due to inadequate hemostasis leads to the formation of a blood clot in the bladder. The clinical picture of bladder tamponade develops.
Most common cause bleeding from the adenoma bed is incomplete removal of adenomatous tissue, damage to the bladder neck or adenoma capsule. The cause of bleeding may also be a blood clotting disorder, therefore, if bleeding occurs after adenomectomy, a coagulogram must be performed and the concentration of D-dimers in the blood serum must be determined.
Blood clots clog the lumen of the drainage tubes, urine flow through them stops, and bladder tamponade develops. Patients complain of severe pain above the pubis and a painful urge to urinate. A sharply painful bladder is palpated above the pubis. A blood test shows a decrease in the number of red blood cells and hemoglobin. An ultrasound can confirm the presence of blood clots in the bladder.
If bladder tamponade with blood clots is diagnosed, an attempt should be made to evacuate them with an evacuation catheter. If it is possible to evacuate blood clots from the bladder, then it is necessary to drain the bladder with a Foley catheter through the urethra, the catheter balloon is filled with 40 ml of solution and a rod is attached to the catheter, which allows you to press the neck of the bladder and stop the flow of blood from the adenoma bed into its lumen. It is necessary to establish constant rinsing of the bladder with an antiseptic solution and carry out hemostatic and antibacterial therapy. The tension on the catheter is released after 24 hours; the bladder flushing system should function for 3–5 days.
If the evacuation catheter fails to remove blood clots from the bladder, then a cystotomy must be performed. Blood clots are removed and the source of bleeding is determined. When blood enters from the adenoma bed, a digital inspection is performed. The remaining fragments of the adenoma lobes are removed. A Foley catheter is passed through the urethra into the bladder and its balloon is inflated in the bed of the adenoma until blood flow into the bladder stops. After surgery, constant rinsing of the bladder with furatsilin is necessary.
If intense bleeding after adenomectomy is not accompanied by the formation of blood clots, then this is a sign of coagulopathic bleeding and the development of DIC syndrome. The fight against such bleeding is carried out under the control of coagulogram parameters and D-dimers (for details on hemostatic measures for DIC syndrome, see “Acute pyelonephritis”).
Bleeding after TUR of prostate adenoma is also clinically manifested by bladder tamponade. Blood clots are removed using an evacuation catheter. Then a resectoscope tube is passed through the urethra to examine the area of the resected adenoma in order to search for a bleeding vessel and coagulate it. After good hemostasis is achieved, the bladder is drained with a Foley catheter and continuous lavage of the bladder is established.
Classification:
Unilateral: for chronic pyelonephritis, renal artery stenosis, long-term thrombosis of the renal veins. The differential diagnosis takes into account renal hypoplasia.
Double sided: when chronic glomerulonephritis, diabetic nephropathy, nephrosclerosis, other systemic diseases: less often with bilateral chronic pyelonephritis.
Clinical manifestations: end-stage chronic nephritis with renal failure; rapid fatigue, poor exercise tolerance, shortness of breath with pleural effusion and edema, anemia are often observed. With bilateral atrophy, hemodialysis is necessary.
Diagnostics:
Anamnesis.
Laboratory tests: simple general analysis blood; urine culture and microscopy of urinary sediment, 24-hour urine analysis, blood creatinine level; determination of creatinine clearance.
Ultrasonography. > Ultrasound data:
Disproportionately small kidney sizes. (When one kidney atrophies, as a rule, there is a compensatory increase in the opposite kidney.)
Thinning of the parenchyma.
Increased echogenicity of the parenchyma.
Blurred contours of the organ. Sometimes the kidney can only be visualized due to the presence of cortical cysts (cystic degeneration of the medullary pyramids or secondary retention cysts).
Accuracy of ultrasound diagnostics: The diagnosis can be made if the kidney is visualized and is disproportionately small. At the final stage of the disease, there is no need for histological confirmation of the diagnosis and, therefore, for percutaneous biopsy.
Bladder tamponade
Clinical manifestations: anuria, possible pain and tenderness in the lower abdomen. With prolonged tamponade with stagnation of urine, colicky pain occurs. Diagnostics:
History and examination: palpable mass in the lower abdomen (full bladder). The patient is asked about a possible inciting event (renal biopsy, bladder aspiration, etc.).
Ultrasound: Can also be used to guide percutaneous aspiration.
Cystoscopy. Ultrasound data:
Full bladder.
High-intensity internal echoes from clotted blood (eg, bladder aspiration, catheterization), debris, stone, or tumor are often detected.
Ultrasound diagnostic accuracy: Ultrasound can reliably diagnose bladder tamponade. The use of other diagnostic methods is required only to determine the cause of tamponade.
Situations requiring urgent intervention occur quite often in urological practice. These include renal colic, acute pyelonephritis, urinary retention, gross hematuria. Rapid recognition and differentiated treatment of these conditions reduces the likelihood of complications and increases the duration of the effect of the therapy.
Clinical picture and diagnostic criteria
Patients suffer from bladder overflow: painful and fruitless attempts to urinate, pain in the suprapubic region; The patients' behavior is characterized as extremely restless. Patients with central diseases react differently. nervous system and spinal cord, which are usually immobilized and do not experience severe pain. When examined in the suprapubic region, a characteristic bulge is determined, caused by an overfilled bladder (“vesical ball”), which upon percussion produces a dull sound.
In order to provide the patient with timely and qualified assistance, it is necessary to clearly understand the mechanism of development of acute urinary retention in each individual case. In case of acute urinary retention, it is necessary to urgently evacuate urine from the bladder. Considering the danger of urinary tract infection in the absence of a pronounced urge to urinate, it is better to perform catheterization in a hospital setting. Expressed pain syndrome, caused by overdistension of the bladder, is an indication for catheterization at the prehospital stage.
Bladder catheterization should be treated as a serious procedure, equating it to surgery. In patients without anatomical changes in the lower urinary tract (with diseases of the central nervous system and spinal cord, postoperative ischuria, etc.), catheterization of the bladder usually does not present any difficulties. For this purpose, various rubber and silicone catheters are used.
The greatest difficulty is catheterization in patients with benign prostatic hyperplasia (BPH). With BPH, the posterior urethra lengthens and the angle between its prostatic and bulbous sections increases. Given these changes in the urethra, it is advisable to use catheters with Tieman or Mercier curvature. With rough and violent insertion of a catheter, serious complications are possible: the formation of a false passage in the urethra and prostate gland, urethrorrhagia, urethral fever. Prevention of these complications is careful adherence to asepsis and catheterization techniques.
The need for catheterization often arises in elderly patients, as well as in persons with severe concomitant pathologies, including diabetes mellitus, circulatory disorders, etc. In such cases, taking into account the lack of sterile conditions in the ambulance, catheterization must be carried out antibiotic prophylaxis of urinary tract infections (UTIs).
The main causative agent of uncomplicated UTI infections is E. coli- 80 - 90%, much less often - S. saprophyticus (3-5%), Klebsiella spp., P. mirabilis etc. Fluoroquinolones (ciprofloxacin, pefloxacin, ofloxacin, etc.) are most active against these pathogens, the level of resistance of which is less than 3%.
As an alternative, you can use amoxicillin/clavulanate or cephalosporins II - III generations (cefuroxime axetil, cefaclor, cefixime, ceftibuten).
For preventive purposes, these antibacterial drugs can be used orally.
In acute prostatitis (especially those resulting in an abscess), acute urinary retention occurs due to deviation and compression of the urethra by the inflammatory infiltrate and swelling of its mucosa. Bladder catheterization is contraindicated in this disease. Acute urinary retention is one of the leading symptoms in patients with urethral trauma. In this case, catheterization of the bladder with diagnostic or therapeutic purpose also unacceptable.
Acute urinary retention due to stones in the bladder occurs when a stone wedges into the neck of the bladder or obstructs the urethra in its various parts. Palpation of the urethra helps diagnose stones. For urethral strictures that lead to urinary retention, an attempt to catheterize the bladder with a thin elastic catheter is possible.
The cause of acute urinary retention in elderly and senile women may be uterine prolapse. In these cases, it is necessary to restore the normal anatomical position of the internal genital organs, and urination is also restored (usually without prior catheterization of the bladder).
Casuistic cases of acute urinary retention include foreign bodies in the bladder and urethra, which injure or obstruct the lower urinary tract. Emergency care involves removing the foreign body; however, this manipulation can only be performed in a hospital setting.
In case of reflex urinary retention (for example, with postpartum, postoperative ischuria), you can try to induce urination by irrigating the external genitalia warm water, by pouring water from one vessel to another (the sound of a falling stream of water can reflexively cause urination); if these methods are ineffective and there are no contraindications, inject 1 ml of a 1% solution of pilocarpine or 1 ml of a 0.05% solution of prozerin subcutaneously; if ineffective, bladder catheterization is indicated.
Indications for hospitalization. Patients with acute urinary retention are subject to emergency hospitalization.
Gross hematuria
Definition. Hematuria - the appearance of blood in the urine - is one of the characteristic symptoms many urological diseases. There are microscopic and macroscopic hematuria; the occurrence of intense gross hematuria often requires emergency care.
Etiology and pathogenesis. Possible reasons hematuria are presented in.
Clinical picture and classification. The appearance of red blood cells in the urine gives it a cloudy appearance and a pink, brown-red or reddish-black color, depending on the degree of hematuria.
Macrohematuria can be of three types: 1) initial (initial), when only the first portion of urine is colored with blood, the remaining portions are of normal color; 2) terminal (final), in which no blood admixture is visually detected in the first portion of urine and only the last portions of urine contain blood; H) total, when urine in all portions is equally colored with blood. Possible causes of gross hematuria are presented in.
Often macrohematuria is accompanied by an attack of pain in the kidney area, since a clot formed in the ureter disrupts the outflow of urine from the kidney. With a kidney tumor, bleeding precedes pain (“asymptomatic hematuria”), while with urolithiasis, pain appears before the onset of hematuria. Localization of pain during hematuria also allows us to clarify the localization of the pathological process. Thus, pain in the lumbar region is characteristic of kidney diseases, and in the suprapubic region - for lesions of the bladder. The presence of dysuria simultaneously with hematuria is observed when the prostate gland, bladder or posterior urethra is affected. The shape of blood clots also allows us to determine the localization of the pathological process. Worm-shaped clots that form as blood passes through the ureter indicate a disease of the upper urinary tract. Shapeless clots are more typical for bleeding from the bladder, although they can form in the bladder when blood is released from the kidney.
With profuse total hematuria, the bladder is often filled with blood clots and independent urination becomes impossible. Bladder tamponade occurs. Patients develop painful tenesmus and may develop a collapsoid state. Bladder tamponade requires immediate treatment.
Main directions of therapy. With the development of hypovolemia and a drop in blood pressure, restoration of circulating blood volume is indicated - intravenous administration of crystalloid and colloid solutions. Hemostatic agents are not used.
Indications for hospitalization. If gross hematuria occurs, immediate hospitalization to the urology department of the hospital is indicated.
Acute pyelonephritis
Definition. Pyelonephritis is a nonspecific infectious and inflammatory process with predominant damage to the interstitial tissue of the kidneys and its pyelocaliceal system.
Etiology and pathogenesis. The causative agents of pyelonephritis can be Escherichia coli, less often - other gram-negative bacteria (for example, Pseudomonas aeruginosa), staphylococci, enterococci, etc. Possible ways kidney infections - ascending (urinogenic), hematogenous (in this case, the source of infection can be any purulent-inflammatory process in the body - otitis media, tonsillitis, mastitis, pneumonia, sepsis, etc.). Predisposing factors - immunodeficiency, obstruction of the urinary tract (urolithiasis, various anomalies of the kidneys and urinary tract, strictures of the ureter and urethra, prostate adenoma, etc.), instrumental studies of the urinary tract, pregnancy, diabetes mellitus, old age, etc. According to the conditions occurrences are distinguished between primary pyelonephritis (without any previous disorders of the kidneys and urinary tract) and secondary (arising on the basis of organic or functional processes in the kidneys and urinary tract, reducing the resistance of the kidney tissue to infection and disrupting the outflow of urine). In general, pyelonephritis develops more often in women, especially at a young age, which is associated with anatomical, physiological and hormonal characteristics female body. In old age, the disease is more common in men due to the development of prostate adenoma.
The classification of acute pyelonephritis is presented in.
Clinical picture. The symptoms of acute pyelonephritis consist of general and local signs of the disease. Initially, acute pyelonephritis is clinically manifested by signs infectious disease, which often causes diagnostic errors.
General symptoms: increased body temperature, severe chills followed by profuse sweating, nausea, vomiting, inflammatory changes in blood tests.
Local symptoms: pain and muscle tension in the lumbar region on the affected side, sometimes dysuria, cloudy urine with flakes, polyuria, nocturia, pain when tapping the lower back.
During acute pyelonephritis, the stages of serous and purulent inflammation are distinguished. Purulent forms develop in 25 - 30% of patients. These include apostematous (pustular) pyelonephritis, carbuncle and kidney abscess.
Treatment algorithm for acute pyelonephritis
Full treatment is possible only in a hospital setting; at the prehospital stage, only symptomatic therapy is possible, implying the use of non-steroidal anti-inflammatory drugs and antispasmodics (see section Renal colic).
Prescribing antibacterial drugs wide range actions without clarifying the state of urodynamics of the upper urinary tract and restoring urine passage leads to the development of an extremely serious complication - bacteriotoxic shock, the mortality rate of which is 50 - 80%.
Indications for hospitalization. Patients with acute pyelonephritis require urgent hospitalization for a detailed examination and determination of further treatment tactics.
D. Yu. Pushkar, Doctor of Medical Sciences, Professor
A. V. Zaitsev, Doctor of Medical Sciences, Professor
L. A. Aleksanyan, Doctor of Medical Sciences, Professor
A. V. Topolyansky, Candidate of Medical Sciences
P. B. Nosovitsky
MGMSU, NNPO emergency medical care, Moscow
Note!
- The effectiveness of treatment for patients with acute urological diseases depends on two factors: the quality of a set of measures aimed at normalizing vital functions, and timely delivery of the patient to a specialized hospital.
- Renal colic is a symptom complex that occurs when there is an acute (sudden) disruption of the outflow of urine from the kidney, which leads to the development of pyelocaliceal hypertension, reflex spasm of the arterial renal vessels, venous stasis and edema of the parenchyma, its hypoxia and overstretching of the fibrous capsule.
- In acute prostatitis (especially those resulting in an abscess), acute urinary retention occurs due to deviation and compression of the urethra by the inflammatory infiltrate and swelling of its mucosa.
Bladder tamponade can be a consequence of diseases genitourinary system, as well as the result of injuries. The main reasons are:
- upper urinary tract injuries;
- neoplasms of the upper urinary tract;
- bladder neoplasms;
- varicose veins of the urinary reservoir and prostate gland;
- damage to the prostate capsule due to the capsule rupturing.
Bladder cancer is a common cause
Development mechanism
How the process develops largely depends on the origin of the pathology. For example, with a sudden rupture of the prostate capsule, the process proceeds as follows. Rupture and tension of the capsule occurs due to the growth of the prostate gland and obstruction in it.
There is constant pressure on the muscle that relaxes the bladder, as well as on the neck of the bladder. It is formed due to the fact that it is necessary to overcome infravesicular blockage. Changes in pressure inside the bladder and a large volume of the prostate gland create conditions that lead to capsule rupture. As a result, hematuria occurs.
What are the reasons for incomplete emptying of the bladder?
Incomplete emptying of the bladder is felt mainly in diseases of the lower parts of not only the urinary but also the reproductive system in women and men.
Frequent urination in men should not always be considered normal. Even if the frequent urge to empty the bladder is not accompanied by discomfort, discharge and other alarming symptoms, the patient should consult a specialist.
Causes
All reasons frequent urination in men can be divided into 2 groups. The first includes physiological ones, in most cases associated with errors in diet or stress. The second group includes pathological causes associated with various diseases organs of the genitourinary and other systems.
Bladder cystostomy in men
Ischuria affects men more often than women and children, so they are given a cystostomy more often. Men also experience more discomfort from it, because... their organ is arched.
Indications for its application:
- Prostate diseases (adenoma or tumor). Adenoma is an indication for cystostomy in men. As it progresses, it enlarges the prostate gland and can compress the urethra. Ischuria develops. Often the adenoma degenerates into adenocarcinoma, which risks blocking the urethra.
- Operations on the bladder or penis. With such interventions, it is often necessary to apply a special catheter.
- Neoplasms of the bladder or pelvis have become increasingly common. Tumors are localized in different places, but the most dangerous are at the mouth of the ureter or urethra. If the tumor is in the place where the bladder passes into the urethra, then within a few months its growth will lead to anuria (urine will stop flowing into the bladder).
- The urethra is blocked by a stone or foreign body. This is a consequence of urolithiasis. The stone can pass through the urethra for more than one day. This interferes with the flow of urine and prevents a catheter from being inserted. Rescue in cystostomy.
- There is pus in the bladder, requiring it to be washed out.
- The penis is injured.
Carrying out diagnostics and a therapeutic course in some cases requires installing a catheter in the patient’s bladder. Most often, the tube is inserted through the urethra, but it is also possible to place it through the abdominal wall, located in front. The catheter performs the following important functions:
- removes urine;
- flushes the bladder;
- helps administer the medicine.
Causes
Symptoms
The main manifestations of bladder tamponade are pain when trying to urinate, the urge either does not have an effect, or a small amount of urine is released. Upon palpation, a bulge is detected above the pubis; this is a full bladder. The slightest pressure on it causes pain. A person with bladder tamponade is emotionally labile and has restless behavior.
Based on determining the volume of blood in the bladder, the degree of blood loss is determined. Urine contains fresh or altered blood impurities. It is worth considering that tamponade of the urinary reservoir involves bleeding. The capacity of the bladder in a male is about 300 milliliters, but in fact the volume of lost blood is much larger.
Symptoms of a bladder rupture
Therefore, a sick person has all the signs of blood loss:
- pale and moist skin;
- heartbeat;
- weakness and apathy;
- dizziness;
- increase in heart rate.
The main complaints of a patient with tamponade will be pain in the area of the urinary reservoir, inability to urinate, painful and ineffective urge, dizziness, blood in the urine.
Anemia is one of the complications of the pathological condition
Prostate adenoma: catheterization or surgery?
When the bladder is full, it is quite easy to carry out medical manipulations, because the organ is greatly stretched, which means its size is increased. In addition, the anterior wall of the bladder is not protected - it is not covered by the peritoneum, but is only adjacent to the abdominal muscles.
Technique for performing the procedure:
- The patient lies down on the operating table, the medical staff fixes his legs, arms, and slightly lifts him in the pelvic area.
- To prevent infection by pathogenic bacteria, the puncture area is thoroughly disinfected with a special solution. If there is hair at the puncture site, then this area is shaved in advance (before the puncture).
- Next, the doctor palpates the patient to determine the highest point of the organ and its approximate location, then anesthetizes with 0.5% novocaine, injecting the solution 4 cm above the pubic symphysis.
- After the onset of anesthesia, a puncture is performed using a 12 cm needle, the diameter of which is 1.5 mm. The needle is slowly inserted through the anterior abdominal wall, piercing all layers, eventually reaching the wall of the organ. Having pierced it, the needle is deepened by 5 cm and the urinary fluid is removed.
- After complete emptying, the needle is carefully removed so as not to cause bleeding, then the bladder cavity is washed with an antibacterial solution.
- The puncture area is disinfected and covered with a special medical bandage.
The development of specific complications after puncture is a rare occurrence. However, if medical workers neglected the rules of asepsis, then the penetration of pathogenic microorganisms leading to inflammation is likely.
Serious complications include:
- abdominal puncture;
- bladder perforation;
- injuries to organs located near the puncture organ;
- urine getting into the fiber that is located around the organ;
- purulent-inflammatory process in the fiber.
Despite possible complications and risks, puncture is sometimes the only method of helping the patient. The quality of its implementation and the patient’s postoperative period almost entirely depend on the experience of the surgeon.
Bladder catheterization is a temporary measure for adenoma if there are complications (infections) or the need to flush the bladder and divert urine after transurethral resection (TUR). This is the gold standard for treating adenoma when residual urine appears.
Adenoma cannot be treated with catheterization if conservative treatment(drugs such as doxazosin and finasteride, herbal medicine) do not provide any effect, it is necessary to decide on surgery. Depending on the volume of the prostate, minimally invasive laser (vaporization and enucleation) and standard (TURP) operations can be performed.
They cannot refuse you surgery because of your age; the heart problem is solved together with a cardiologist and anesthesiologist during the preparation for the operation. If one specialist refuses you surgery, find another, a third, go to a specialized clinic and regional center, today adenoma can be successfully treated at any age, a catheter with a urinal is not a death sentence!
Suprapubic capillary puncture: indications for use
Suprapubic capillary puncture is performed when the bladder is full, in case of acute urinary retention, when the patient is unable to void naturally. This manipulation is resorted to when it is impossible to release urine from the bladder using a catheter. More often, such a procedure is necessary in case of injury to the external genitalia and urethra, in particular with burns, in the postoperative period. In addition, suprapubic puncture is performed for diagnostic purposes to collect high-quality urine samples.
This manipulation allows us to obtain pure material for medical research. Urine samples do not come into contact with the external genitalia. This allows you to create the most accurate picture of the pathology than with analyzes using a catheter. Capillary puncture is considered a reliable method for examining urine in newborns and small children.
Bladder puncture technique
Before carrying out the manipulation, medical workers prepare the puncture area: the hair is shaved and the skin is disinfected. In some cases, the patient is examined using an ultrasound machine to accurately determine the location of the urinary canal. The surgeon can examine the patient without special equipment determine the boundaries of a crowded bubble.
For the operation, the patient must lie on his back. General anesthesia is not used for this procedure; the puncture area is anesthetized using local anesthetic drugs. Then a special long needle is inserted under the skin to a depth of 4-5 centimeters above the pubic joint. The needle penetrates the skin, abdominal muscles, and pierces the walls of the bladder.
The doctor must make sure that the needle goes deep enough so that it cannot slip out. After this, the patient is turned over on his side and tilted slightly forward. Urine flows through a tube attached to the other end of the needle into a special tray. After the bladder is completely emptied, the needle is carefully removed and the manipulation site is treated with alcohol or sterile wipes.
If necessary, bladder puncture is repeated 2-3 times a day. If the procedure needs to be performed regularly, the bladder is punctured and a permanent catheter or drainage is left in place to remove urine. If urine is needed for testing, it is collected in a special syringe with a sterile cap. Before sending the material for testing to the laboratory, the contents are poured into a sterile tube.
Main indications for puncture:
- Contraindications to catheterization/inability to remove urine through a catheter.
- Injuries to the external genitalia, trauma to the urethra.
- Urine collection for reliable laboratory testing.
- The bladder is full, and the patient is unable to empty it independently.
Suprapubic puncture is a safe way to examine urinary fluid in young children and infants. Often, patients themselves prefer organ puncture, since when using a catheter the likelihood of injury is much higher.
Indications for the procedure
Suprapubic (capillary) puncture of the bladder can be performed for two purposes - therapeutic, that is, therapeutic, and diagnostic. In the first case, the puncture is performed to empty the organ in order to avoid its rupture due to excessive accumulation of urine.
The diagnostic purpose is to take a urine test. But this method is used quite rarely, although the analysis taken in this way is much more informative than that obtained by self-urination or catheterization.
If the cystic formation is small and does not manifest itself in any way, patients need to be examined by ultrasound twice a year to monitor the situation.
A common unpleasant consequence of manipulation with a puncture of the urethra is urethral fever. It can occur due to bacteria entering the blood. This happens when the urethra is injured by medical instruments. This complication is accompanied by chills and intoxication of the body. In more severe forms, urethral fever can trigger the occurrence of prostatitis, urethritis or some other serious diseases.
In addition, incorrect or too hasty manipulation can lead to false channel moves. There is a risk of urine flowing into the abdominal cavity and tissue. In order to prevent unwanted leakage, healthcare workers are advised to insert the needle not at a right angle, but obliquely.
Contraindications
Indications for bladder puncture are all those cases when the patency of the urethra is impaired and there is acute urine retention. For example, for injuries and burns of the genital organs.
Surgery is contraindicated for:
- Tamponade.
- Paracystitis, acute cystitis.
- Small capacity bubble.
- Hernia of the inguinal canal.
- Neoplasms in the bladder of a benign or malignant type.
- Obesity of the third stage.
- The presence of scars on the skin in the area of the intended puncture site.
Like any other invasive procedure, bladder puncture has its contraindications. These include:
- insufficient fullness - if the organ is empty or even half full, puncture is strictly prohibited, since there is a high risk of complications;
- pathological blood clotting - coagulopathy;
- period of bearing a child;
- the patient has a hemorrhagic diathesis.
Hemorrhagic diathesis is a contraindication to manipulation
The list of contraindications continues:
- history of dissection of the anterior abdominal wall along the linea alba below the navel;
- confusion, enlargement or stretching of the peritoneal organs;
- the presence of inguinal or femoral hernias;
- inflammation of the bladder - cystitis;
- abnormalities of organs that are located in the pelvis (cysts, sprains);
- infectious lesion of the skin at the puncture site.
There are cases when puncture is impossible. This procedure is prohibited to perform in case of various injuries of the bladder and its low capacity. Manipulation is not advisable for men with acute prostatitis or prostate abscesses. The procedure is prohibited for women during pregnancy. Complications during this manipulation can also occur in patients with complex forms of obesity.
Other contraindications to puncture are:
- acute cystitis and paracystitis;
- bladder tamponade;
- neoplasms of the genitourinary organs (malignant and benign);
- purulent wounds in the area of the operation;
- inguinal hernias;
- scars in the puncture area;
- suspicion of bladder displacement.
A cystostomy is a hollow tube through which urine is removed directly from the bladder and collected in a special bag that temporarily replaces the bladder. A regular catheter is inserted directly into the urethral canal, and a cystostomy is inserted through the peritoneal wall.
Such a catheter is necessary when the bladder does not empty, although it is full. This happens when:
- A regular catheter cannot be inserted.
- It is believed that the patient will have difficulty urinating for a long time, and a cystostomy is placed for a long time.
- The patient has acute ischuria (urinary retention)
- The urethra (urethra) is damaged due to pelvic trauma, medical or diagnostic procedures, or during sexual intercourse.
- It is necessary to determine the daily volume of urine, but it is impossible to place a regular catheter through the urethra.
Cystostomy eliminates the manifestation of many diseases when urination is impossible. But she does not treat them, but restores the flow of urine.
If the bladder is empty or half empty, the procedure is prohibited, as the risk of consequences increases;
What could be the consequences?
With proper installation of a cystostomy and its proper use, as a rule, side effects does not arise. But the risk of complications cannot be excluded. Practicing urologists have described the following possible pathological reactions and conditions:
- Allergy to tube material.
- The incision site is bleeding.
- The wound is rotting.
- The intestines are damaged.
- The bladder becomes inflamed.
- The tube pulls out spontaneously.
- The place where the tube is attached is irritated.
- The patient may stop urinating on his own. The ability to urinate atrophies. The body does not strain; the tube does the work for it. Therefore, you should try to urinate yourself within a week after cystostomy.
- Urine flows into the peritoneum.
- The tube becomes clogged with blood and mucus.
- The stoma hole closes.
- Blood in the urine after cystostomy.
- The walls of the bladder are damaged.
- Suppuration around the cystostomy. Mucus or pus on the wound indicates infection. If there is no systemic inflammation, the suppuration is treated with antiseptics.
Puncture of a kidney cyst is an operation carried out in accordance with all the necessary rules for carrying out interventions in the human body. The procedure is performed only in a clinical setting, after which the patient remains in the hospital for 3 days under the supervision of medical personnel. Usually, after this therapy, the patient recovers quickly and safely.
During the rehabilitation period, an increase in body temperature and swelling in the puncture area may be observed, which quickly disappear. Since the entire process is controlled by an ultrasound machine, miscalculations are excluded - puncture of the pelvis, large blood vessels. However, complications can still occur:
- bleeding into the renal cavity;
- opening of bleeding into the cyst capsule;
- the onset of purulent inflammation due to infection of the cyst or kidney;
- organ puncture;
- violation of the integrity of nearby organs;
- allergy to sclerosing solution;
- pyelonephritis.
IMPORTANT! If the patient has polycystic disease or a formation larger than 7 cm, the puncture is considered ineffective.
