Key points of open suprapubic cystostomy.

(1) Position: Lie on your back, with your head slightly lower and your feet slightly higher, so that your abdomen moves to the head side.

(2) Incision: Make a median incision on the pubic bone, with a length of 6 ~ 10 cm, and separate the rectus abdominis and conus to both sides to reach the anterior bladder space.

(3) Exposing the anterior wall of the bladder: wrap the finger with gauze, separate the preperitoneal fat from the peritoneum, and expose the anterior wall of the bladder with longitudinal blood vessels. When separating retroperitoneal folds, it should be avoided to prevent urine leakage and pollution of abdominal cavity. When the bladder is empty, contracture or rupture, it is necessary to prevent the peritoneum from being mistakenly cut into the bladder and entering the abdominal cavity. Once the peritoneum is ruptured, it should be sutured immediately.

(4) Incision of the anterior wall of bladder: on both sides of the midline slightly higher than the anterior wall of bladder, clamp it with two tissue forceps, lift the bladder wall, puncture it with a syringe between the two forceps, and then cut the bladder after extracting the normal saline filling the bladder. When doing cystostomy, cut 1 ~ 2 cm, allowing finger exploration; Other operations can be expanded as appropriate. The overflowing washing liquid is sucked out by an aspirator. The artery on the bladder wall must be ligated immediately to stop bleeding, so as to avoid retraction and rebleeding.

(5) Bladder exploration: Put your finger into the bladder to explore and identify the lesion. If possible, remove the lesion at the same time.

(6) Suture the front wall of the bladder: put the balloon catheter, umbrella catheter or mushroom catheter into the bladder incision. Suture the bladder wall two layers. The inner layer is sutured intermittently with 2-0 chromium catgut (when there is no catgut, the muscle layer can also be sutured intermittently with silk thread, but it can't pass through the mucosal layer to avoid postoperative stone formation); The outer layer was sutured intermittently with 4-0 silk thread. The catheter is led out through the upper corner of the abdominal incision.

(7) Drainage suture: wash the wound with isotonic saline, place a cigarette in the anterior bladder space for drainage, and lead it out from the lower corner of abdominal incision. Suture rectus abdominis anterior sheath, subcutaneous tissue and skin layer by layer. When sewing rectus abdominis, a needle can be fixed at the neck of bladder to avoid bladder contracture. Skin suture should be used around the catheter to prevent it from coming out. Umbrella or mushroom catheter should be led out above the incision of bladder and abdominal wall to prevent bladder contracture after long-term drainage.