Cystostomy

Cystostomy is a surgical procedure that creates an opening from the abdominal wall into the urinary bladder to allow urine to drain. The resulting drain, often a catheter or tube, provides urinary diversion. Cystostomy can be temporary or long-term and may be performed by a percutaneous approach or during an open operation, producing a cystostomy tube.

Indications for cystostomy include acute urinary retention when catheterization is not possible or contraindicated, and chronic or obstructive conditions such as benign prostatic hyperplasia, urethral stricture, stones, or tumors. It is also used for bladder drainage in neurogenic or nonfunctional bladders, after certain pelvic injuries, or as part of palliative care to relieve symptoms.

Techniques fall into two main categories. Suprapubic cystostomy places a catheter through the lower abdomen into the bladder and can be done percutaneously under imaging guidance or as an open surgical procedure. The open approach exposes the bladder directly for access. It is important to distinguish cystostomy from cystotomy, which is an incision into the bladder itself; cystostomy creates a channel to drain urine rather than opening the bladder wall for repair.

Complications can include infection, bleeding, catheter blockage, urine leakage around the catheter, fistula formation, injury to the bowel or bladder, electrolyte disturbances, and rarely peritonitis. Long-term use requires regular catheter care, monitoring for infection, and timely catheter changes. Follow-up with a urologist is common to determine the appropriate duration and any need for alternative urinary management.