Epicystostomy

An epicystostomy is a surgically created opening or artificial outlet (stoma) in the bladder wall that connects to the outside of the body through the abdominal wall. This procedure can be performed for surgical purposes and is usually used when the normal route for urine output through the urethra is blocked or dysfunctional.

A variety of patients may require an epicystostomy, including:

1. People with congenital abnormalities of the urinary tract: Some children may be born with abnormalities of the urinary tract that make it impossible to urinate normally through the urethra. In such cases, an epicystostomy may be created.
2. Patients with urethral obstruction: If a patient has a narrowing (stricture) of the urethra that cannot be treated with medication or surgery, an epicystostomy can be used to bypass this problem.
3. People with certain medical conditions: Some medical conditions, such as certain bladder cancers or post-surgical complications, may also require an epicystostomy to facilitate urination.

An epicystostomy may require care and specific nursing skills, including regular bladder emptying and ensuring that the periostomy area is hygienic. People with an epicystostomy are usually trained in their care by a specialist nursing service.

Indications for the procedure

An epicystostomy (an artificial opening in the bladder wall connected to the outside of the body through the abdominal wall) may be prescribed in the following cases:

1. Urethral obstruction: An epicystostomy may be created if a patient has a narrowing of the urethra (stricture) that makes it difficult or impossible to urinate normally through the urethra. This can be caused by a variety of reasons, including medical abnormalities, injury, infection, or bladder cancer.
2. Surgical interventions: After certain surgical procedures, such as bladder removal (cystectomy), patients may require an epicystostomy for temporary or permanent urine diversion.
3. Bladder Care: Some patients may be prescribed an epicystostomy for bladder care in the event of bladder dysfunction or other medical conditions that make it impossible to urinate normally.
4. Congenital urinary tract anomalies: Children with congenital urinary tract anomalies that make it difficult to urinate through the urethra may require an epicystostomy.
5. Patients with limited motility or inadequate ability to control urination: An epicystostomy may facilitate urination for patients with limited mobility or motility.

Technique of the epicystostomies

An overview of the technique of this operation:

1. PatientPreparation: The patient will usually undergo anesthesia (local or general) to numb the surgical area and prevent pain. The patient may also be prepared for surgery, including overnight fasting and administration of intravenous fluids.
2. Positioning: The patient will be placed in the correct position to access the bladder. This may include lying on the operating table with legs raised and hips apart.
3. Bladder Access and Identification: The surgeon will make an incision in the anterior abdominal wall and carefully identify the bladder.
4. Creation of an epicystostomy: A surgical instrument will be used to create an opening in the bladder. It is usually shaped so that urination can be controlled and comfortable for the patient.
5. Epicystostomy fixation: The epicystostomy is fixed to the anterior abdominal wall to prevent it from closing. This can be done with special sutures or other fixation devices.
6. Completion of the surgery: The surgeon will close the access to the bladder and restore the normal layers of the abdominal wall.
7. Early postoperative care: After surgery, the patient may be given antibiotics and other medications to prevent infections and allow for normal healing. The patient may also be given instructions on epicystostomy care and urine collection.
8. Long-term care: Patients with an epicystostomy may require ongoing care to maintain hygiene and prevent complications.

It is important to note that an epicystostomy is a complex surgical procedure and should be performed by experienced surgeons in a specialized clinic.

Complications after the procedure

Complications following the creation of an epicystostomy may include:

1. Infection: An epicystostomy can become a source of infection if proper hygiene is not maintained. Infection can lead to inflammation and discomfort.
2. Changes around the stoma: The skin around the epicystostomy may become irritated, inflamed or even destroyed due to constant exposure to urine and urinary products.
3. Stoma prolapse: In some cases, the stoma may protrude from the anterior abdominal wall (prolapse). This can lead to pain, discomfort and impaired stoma function.
4. Stomaobstruction: The stoma may be blocked, resulting in an inability to drain urine normally. This may require urgent medical intervention.
5. Psychological aspects: The surgical creation of a stoma can affect the patient's psychological state by causing stress, depression or anxiety.
6. Reactions to stoma materials: Some patients may experience allergic reactions to the materials used for the stoma or fixation.
7. Adjustment problems: Some patients may find it difficult to care for or adjust to the new reality of living with an epicystostomy.

Epicystostomy failure

Means that the epicystostomy, which is an artificial opening between the bladder and the anterior abdominal wall, does not fulfill its function properly, that is, it does not allow you to control urination or keep dry.

This condition can have a variety of causes and complications, including:

1. Infections: Infections around the epicystostomy or inside the bladder can cause inflammation and failure.
2. Constrictionor blockage of the epicystostomy: A narrowing or blockage of the bladder near the epicystostomy may prevent normal urination.
3. Lack of urinary control: Some patients may have difficulty controlling urination through an epicystostomy, which may result in unwanted urination.
4. Dislocation or collapse of the epicystoma: The epicystoma itself may be dislocated or collapsed, rendering it ineffective.
5. Fixation problems: If the epicystostomy is not securely fixed to the anterior abdominal wall, it may become unstable.

Treatment of epicystoma failure depends on the cause and characteristics of the epicystoma. This may include correction of a surgical epicystoma, treatment of infections, regular evaluation and care, and consultation with medical specialists such as urologists and surgeons. Patients with epicystoma failure may require regular medical evaluation and care of the epicystoma to ensure that it is working properly and is comfortable for the patient.

Care after the procedure

Epicystostomy care requires special attention and skill. Here are some basic care steps:

1. Hygiene: The main rule of care is to maintain absolute cleanliness. Wash your hands regularly before and after contact with the epicystostomy.
2. Maintaining the urine collection bag: If a urine collection bag is used, ensure that it is properly positioned and securely attached to the epicystostomy. The bag should be empty and clean.
3. Bag Change: Depending on bag size and individual needs, the urine collection bag is changed on average every 1-3 days or as needed.
4. Bladder emptying: It is important to empty your bladder as recommended by your doctor. This may require the use of a catheter or other special devices.
5. Monitoring the epicystostomy area: Regularly examine the epicystostomy area (the area where the epicystostomy connects to the skin) for signs of inflammation, irritation, redness, or ulcers. If you see any changes, tell your doctor.
6. Selection of specialized products: You may need special medical devices such as barrier creams or patches to prevent skin irritation around the epicystostomy.
7. Following yourdoctor's recommendations: Your doctor or nurse can provide you with specific instructions for epicystostomy care, and it is important to follow their recommendations.
8. See a specialist: If you have any problems, including inflammation, pain, bleeding, or difficulty with your epicystostomy, contact your doctor or health care provider.

Epicystostomy care can be complex, and education and support from nursing professionals is very important. It is important to be hygienic and follow the doctor's instructions to prevent complications and ensure comfort.

Epicystostomy removal

It may be necessary for a variety of reasons, such as if it was temporary and is no longer needed, or if complications arise that require its removal. The procedure to remove an epicystostomy is usually performed by a surgeon or urologist and may proceed as follows:

1. Preparation: The patient is prepped before the procedure, including an assessment of their general condition and medical conditions, as well as blood and urine tests.
2. Anesthesia: Removal of an epicystostomy may require local or general anesthesia, depending on the specific situation and the patient's wishes.
3. Surgical removal: The surgeon or urologist makes a small incision in the area where the epicystostomy is located. The stoma is then removed and the surgeon completes the procedure. Sometimes additional surgical interventions may be needed, for example, to restore urinary function.
4. Wound closure: After stoma removal, the surgeon closes the wound with sutures or tissue glue. This helps restore skin integrity and prevents infection.
5. Postoperative care: The patient may be given instructions on how to care for the operated area, including local wound care, antiseptic treatment, and other measures to prevent complications.
6. Follow-up visits: After surgery, the patient may have follow-up visits with the physician to assess healing and general condition.

Recovery from epicystostomy removal may take some time and depends on the individual patient and the nature of the surgery. Patients are usually advised to follow their doctor's instructions and be monitored regularly to assess healing and restore normal urinary function.