Ultrasound-guided suprapubic cystostomy catheter placement in the emergency department

doi:10.1016/j.jemermed.2003.11.016

The Journal of Emergency Medicine

Volume 26, Issue 3, April 2004, Pages 319-321

Presented at the American College of Emergency Physician (ACEP) annual scientific assembly in Seattle Washington, October 2002.

https://doi.org/10.1016/j.jemermed.2003.11.016 Get rights and content

Abstract

T he purpose of this article is to describe a series of patients undergoing ultrasound-guided suprapubic cystostomy catheter placement in the Emergency Department. A series of 17 consecutive patients who underwent emergent real-time ultrasound-guided suprapubic cystostomy in the ED over a 2-year period is reported. The procedure was facilitated by direct ultrasound imaging of the bladder using a Digital Sonoace 5500 machine. Procedural notes and follow-up records were analyzed for efficacy, safety, and complications. The results demonstrated that trans-abdominal ultrasound confirmed urinary retention before drainage in each of the 17 cases enrolled. Each patient required emergent suprapubic cystostomy catheter placement for acute urinary outflow obstruction because urethral bladder catheterization was not possible or was contraindicated. Continuous real-time ultrasound-guided percutaneous suprapubic cystostomy placement and decompression of the bladder was successful in all 17 (100%, 90–100% CI: 95%) cases. There were no complications reported. In conclusion, real-time ultrasound imaging of the bladder was successful for the purpose of aiding the guidance of a suprapubic cystostomy catheter placement in the ED and might represent an improvement from the standard blind method presently used.

Introduction

Ultrasound scanning has been described as useful in facilitating many procedures in the Emergency Department (ED): cardiac pacemaker placement, central venous catheter placement, pericardiocentesis, thoracentesis, foreign body removal, and bladder aspiration 1, 2. It is the general consensus that ultrasound provides additional safety and efficacy by providing real-time imaging that is superior to blind approaches. Although ultrasound-guided bladder aspiration has been described in the literature, we describe a consecutive series of ultrasound technology used in conjunction with emergency bladder drainage in the context of a suprapubic catheter placement guided by ultrasound (3).

Section snippets

Methods

A prospective case series was conducted to assess the safety and efficacy of ultrasound-guided suprapubic cystostomy catheter placement in the ED. We subsequently describe a consecutive series of patients who underwent real-time ultrasound-guided procedures over a 2-year period. The trial was conducted in a large urban university-affiliated ED with an annual census of 65,000 patients. Patients were eligible for enrollment if they were at least 18 years of age, had at least three attempts of

Results

Of the 17 patients enrolled, all were men with ages ranging from 36 to 92 years (median age of 60.7). Ultrasound imaging accurately detected the presence of a dilatated bladder in each case. Ultrasound-guided suprapubic cystostomy placement was successfully performed in every patient studied without reports of complications. Acute urinary retention requiring acute decompression by way of an emergency suprapubic cystostomy occurred due to prostatic hypertrophy in 10 patients, strictures and

Discussion

Urethral catheterization is the most frequent urological procedure performed in the ED. Emergency Physicians are frequently faced with the need to evaluate and treat patients with acute urinary retention requiring bladder drainage. A certain number of these patients will require emergency bladder decompression by suprapubic cystostomy. Although ultrasonography has been reported to facilitate needle aspiration of the bladder in children, no studies have been conducted on its potential use for

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Citation Excerpt :
However, preliminary measurements from this study did not detect a spatial mismatch: The median (IQR) DSC between the CBCT and US gold standard STAPLE contours was 0.78 (0.09), which is similar to the interobserver contouring variability of the uterus measured in previous work (median [IQR] DSC of 0.78 [0.11]).31 Because the bladder is situated anteriorly to the uterus, its volume can influence US image quality: A full bladder can provide an acoustic window to the gynecologic anatomy because urine has a low acoustic attenuation.32,33 Although the correlation coefficient between bladder area and contour confidence was relatively low (0.37), it was statistically significant and in the expected direction, indicating that observer contour confidence increases with increasing bladder size.
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Selected topics: emergency radiologyUltrasound-guided suprapubic cystostomy catheter placement in the emergency department

Abstract

Introduction

Section snippets

Methods

Results

Discussion

Ann Emerg Med

Ann Emerg Med

Am J Obstet Gynecol

Urology

J Urol

J Vasc Interv Radiol

Selected topics: emergency radiology
Ultrasound-guided suprapubic cystostomy catheter placement in the emergency department