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  • 02 Cystotomy

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    M Amriyan Nurrakhman
    62 views28 pages
    This document discusses cystotomy, which is a surgical procedure to access the urinary bladder through an incision. It provides indications for cystotomy including removal of bladder stones. It discusses alternatives to cystotomy like medical dissolution or lithotripsy. It outlines preoperative, intraoperative, and postoperative considerations for patient evaluation and monitoring as well as anesthesia and analgesia. Key steps of the cystotomy procedure are described including making a ventral incision, exploring the bladder, taking samples, and closing the incision in a single layer appositional manner. Commonly used suture materials are also mentioned.

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    02-Cystotomy

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    This document discusses cystotomy, which is a surgical procedure to access the urinary bladder through an incision. It provides indications for cystotomy including removal of bladder stones. It discusses alternatives to cystotomy like medical dissolution or lithotripsy. It outlines preoperative, intraoperative, and postoperative considerations for patient evaluation and monitoring as well as anesthesia and analgesia. Key steps of the cystotomy procedure are described including making a ventral incision, exploring the bladder, taking samples, and closing the incision in a single layer appositional manner. Commonly used suture materials are also mentioned.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    62 views28 pages

    02 Cystotomy

    Uploaded by

    M Amriyan Nurrakhman
    This document discusses cystotomy, which is a surgical procedure to access the urinary bladder through an incision. It provides indications for cystotomy including removal of bladder stones. It discusses alternatives to cystotomy like medical dissolution or lithotripsy. It outlines preoperative, intraoperative, and postoperative considerations for patient evaluation and monitoring as well as anesthesia and analgesia. Key steps of the cystotomy procedure are described including making a ventral incision, exploring the bladder, taking samples, and closing the incision in a single layer appositional manner. Commonly used suture materials are also mentioned.

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    of 28

    CYSTOTOMY

    Drh. Siti Zaenab


    [email protected]
    Indikasi
    Lithiases
    removal of cystic and urethral calculi
    identification and biopsy of masses
    repair of ectopic ureters
    evaluation of urinary tract infection
    resistent to treatment
    cystotomy: alternatives
    Medical dissolution

    Urohydropulsion

    Cystoscopy

    Lithotripsy
    Perioperatif Considerations

    Patient evaluation

    Preoperative / Postoperative x-rays


    Patient evaluation
    Assosiate condition:
    -Minimal
    -Optimalisasi
    Blood work:
    -HCT
    -TP
    -Electrolites
    -BUN
    -Creatinin
    Physical Examination:
    -maybe anxious
    -straining
    -minimal dehydration

    Premedication:
    -if patient is anxious, give the following:
    - Diazepam (0,2mg/kg bb IV)
    Gambar x-ray

    Sebelum Operasi

    Sesudah Operasi
    Intraoperative Considerations
    Induction:
    if premedicated give: propovol 2-4mg/kg iv
    if no premeds given : propovol 4-8mg/kg iv or
    ketamin (5,5mg/kg IV) with diazepam
    (0,28mg/kg IV)
    Maintenance: Isofluran
    Fluid needs: 5-10ml/kg 1st hour
    Monitoring:
    BP, HR, Respiratory rate, SpO2, temperature
    Postoperative Considerations
    Analgesia: Morphine (0.05-0.2mg/kg iv)
    or (0.1-0,5mg/kk im q1-4hr)
    NSAIDS are contraindicated in patients with
    hypotention, hypovolemia, or renal
    compromise
    Monitoring: SpO2, BP, HR, Respiratory
    rate, Temperatur, Urine output
    Blood work: repeat previously abnormal
    blood work
    Cystotomy Steps

    Median umbilicopubic coeliotomy


    Ventral incision
    Samples
    Exploration- retropulsion
    single layer appositional closure
    Median umbilicopubic coeliotomy
    Ventral incision
    Female
    Ventral incision
    Male
    Stay Suture
    Ventral incision - Stay Suture
    Pool Suction Tip

    Incision
    Kassa Steril
    Mayo or Metzenbaun
    Scouping
    scouping out stone with bladder spoon
    gently
    verify uretra by placing red rubber catheter
    retrograde or antegrade through uretra
    flushing scooping at least 3 times
    explore the interior bladder and trigone
    with glove finger
    Scouping
    Cystotomy : samples
    Bladder wall : Pathology
    Mucosa, urine, stone(s): Bacteriology
    Stone : Composition
    Cystotomy : closure
    Lapisan Bladder:
    1. serosa
    2. muscularis
    3. submucosa
    4. mucosa
    Simple Continous Pattern
    (Thikened Bladder)
    Thin Bladder
    Single-Layer Appositional
    Closure
    Cystotomy: sutures
    Absorbable
    Monofilament
    Round/tapercut needle
    Polydioxanone (PDS II), Polyglyconate
    (Maxon) Poligrecaprone 25 (Monocryl),
    Glycomer 631 (Biosyn), Polyglytone 6211
    (Caprosyn)
    Cystotomy : Key Points!
    VENTRAL
    1-layer appositional closure
    Aviod lumen if posible
    TERIMAKASIH

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