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Suprapubic Bladder Drainage After Extraperitoneal Cystotomy

From the Division of Urogynecology and Reconstructive Pelvic Surgery, Good Samaritan Hospital, University of Cincinnati School of Medicine, Cincinnati, Ohio.

Address reprint requests to: Mickey M. Karram, MD Good Samaritan Hospital Seton Center 375 Dixmyth Avenue Cincinnati, OH 45220 E-mail: mickey-karram{at}trihealth.com

Objective: To observe the effects of cessation of continuous bladder drainage after short-term catheterization in women who had extraperitoneal cystotomies.

Methods: The study population included 84 women, 78 of whom had retropubic urethropexies and six of whom had retropubic paravaginal repairs. Intentional cystotomy was done intraoperatively to assure ureteral patency, bladder integrity, and no inadvertent suture penetration into the bladder. All cystotomies were closed in two layers with 3-0 chromic suture. Suprapubic catheters were placed intraoperatively in all cases. In all women except four with gross hematuria, continuous bladder drainage was stopped and voiding trials were started within 24 hours after surgery. Suprapubic catheters were removed when women spontaneously voided 80% of total bladder volume.

Results: Suprapubic catheters were discontinued on average 4.1 days after surgery (range 2.7–14.1 days). Average bladder volume at initial clamping of the suprapubic catheter was 382 mL (range 224–510 mL). At this volume the integrity of the cystotomy should have been challenged appropriately. The women were observed for a minimum of 3 months with no immediate or long-term complications.

Conclusion: Extraperitoneal cystotomy in a nondependent portion of the bladder does not require continuous bladder drainage for more than 24 hours. This information should allow pelvic surgeons to be more liberal with intraoperative cystotomies if bladder integrity or ureteral patency needs to be confirmed.