Cystotomy. A procedure in which the bladder is cut open.
Cystolithotomy. A procedure in which the bladder is opened to remove
(3) Cystostomy. A procedure in which an opening is made into the bladder
(4) Cystectomy (total). A procedure in which the bladder and adjacent
structures are excised.
c. Patient Preparation.
(1) To facilitate identification and dissection, the bladder is usually drained
of urine and filled with a sterile irrigating or antiseptic solution as a part of the
preoperative preparation. Equipment and instruments for catheterization and irrigation
should be prepared, in addition to the surgical setup. Irrigating solutions should be
sterile, isotonic, and at body temperature.
(2) The patient lies in the supine position for most open operations of the
bladder. The Trendelenburg position may be desired, since it tilts the pelvis high and
offers good visualization of the pelvic organs, including the bladder. The patient may be
draped with a nonabsorbent disposable skin drape and a fenestrated laparotomy sheet.
d. Sterile System for Bladder Irrigation.
(1) Each hospital has its own system for bladder irrigation. Suitable
solutions should be specified by the surgeon.
(2) The system may consist of prepackaged irrigating solutions and sterile
sets of connecting tubing, or it may be a flask, rubber tubing, and connector set such as
the Valentine irrigator, which is prepared and sterilized by the operating room personnel
as part of the instrument setup. With the Cotter system, the irrigating fluids are usually
mixed and poured by the operating room personnel. Sterile pitchers or other containers
for mixing and pouring will then be needed.
e. Operative Procedure (Suprapubic Cystotomy and Cystostomy).
(1) The bladder is distended preoperatively with the prescribed irrigating
solution instilled via catheter. A vertical or transverse suprapubic incision is made
through the skin and subcutaneous layers to the muscle using a scalpel, thumb forceps,
and scissors. Bleeding vessels are controlled with hemostats and ligated. Wound