New Technique of Suprapubic Cystostomy with Newly Devised Metal Sound: Bladder Surgery

Kim, Young Soo

Abstract

A longer metal sound with larger curvature is devised for bladder surgery. This sound was applied in 19 cases of bladder surgery performed at Korea University Hospital for 17 months from November 1976 to March 1978 and the results were excellent in all these cases. This new 17 F. metal sound is easily inserted through the urethra just like an usual metal sound such as Van Buren or Benique type. When the tip of the sound is reached to the bladder wall this tip is readily felt under the skin of suprapubic area. The local anesthetic is injected by infiltration in the skin, subcutaneous tissues and muscle layers of the lower abdomen and bladder wall. While the tip of the sound is felt over thesestissues. A small midline incision is made over the area where the tip of the sound is felt, and this incision is carried through the skin, subcutaneous tissues and the fascia of the rectus muscle. The muscle itself easily devided by the tip of the sound. And the peritoneum is usually reflected by the sound. When the bladder wall reached, two hanging sutures are made on both sides of tented bladder wall by the tip of the sound. Then the incision into the bladder wall is carried out at the point of the tip. The bladder wall is rasped by two Allis forceps. As the hemostat enters the lumen, the entire thickness of the bladder wall is rasped with Allis forceps and the incision is enlarged to provide the desired exposure of the interior of the bladder. Closure is done with ordinary way depends upon whether cystostomy is desired. The advantages of this technique are as follows 1. The peritoneum is usually reflected spontaneously by the sound. 2. The rectus muscle is easily devided by the tip of the sound. 3. In bladder surgery, the mucosa of the bladder is easily separated and pushed away from the bladder muscularies for a considerable distance, making it difficult to find the same separated bladder mucosa again. This problem is solved by this technique. 4. Shortening of operation time. 5. Local anesthesia performed with very small amount of anesthetics. 6. Less bleeding is noted because the tissues over the tip of sound become ischemic.