A cystotomy is a surgical procedure involving a direct incision into the wall of the urinary bladder. This operation is frequently performed in urology. The purpose of this surgical entry is to allow a surgeon direct access to the bladder’s interior to diagnose or treat various conditions. It is an effective method for addressing problems that cannot be managed through less invasive techniques.
The Purpose of a Cystotomy
A cystotomy addresses several conditions that interfere with the normal function of the urinary tract. One frequent reason is cystolithotomy, the surgical removal of bladder stones (calculi) that are too large or dense to be dissolved or removed endoscopically. These mineral deposits cause inflammation, pain, and can potentially block the flow of urine.
A cystotomy is also performed to repair a bladder damaged by trauma, such as blunt force or penetrating injury. The incision allows the surgeon to visualize and suture a bladder rupture, restoring its integrity. Furthermore, the procedure may be used to remove abnormal tissue, such as bladder tumors or large blood clots causing an obstruction.
The term cystotomy is sometimes used when referring to a cystostomy—creating a surgical opening for suprapubic catheter drainage. This is necessary when the urethra is blocked or when long-term bladder drainage is required, such as with spinal cord injuries or severe prostate enlargement. In these cases, the incision provides a path for a drainage tube to be placed directly into the bladder, bypassing the urethra.
How the Procedure is Performed
The cystotomy procedure requires the patient to be under general anesthesia. Before the skin incision, a thin catheter is often placed through the urethra into the bladder and filled with sterile fluid to distend it. This distention makes the bladder easier to locate and secure, minimizing the risk of injury to surrounding abdominal organs.
A surgeon makes an incision in the lower abdomen, usually just above the pubic bone in the suprapubic area, to access the pelvic cavity. The bladder is identified and isolated from the other abdominal contents. The surgeon then makes a precise incision into the wall of the bladder, typically on the front surface, which is less vascular and helps avoid the ureters.
Once the bladder is open, the surgeon performs the intended action, whether removing stones, excising a tumor, or repairing a laceration. After the goal is achieved, the bladder is thoroughly inspected and flushed to ensure all debris is removed. The incision in the bladder wall is then closed using layers of fine, dissolvable suture material to create a watertight seal. Finally, the abdominal layers and the skin incision are closed.
What to Expect During Recovery
Recovery from an open cystotomy usually requires a hospital stay of one to three days, depending on the patient’s overall health and the complexity of the surgery. Pain management is a priority, and patients receive prescribed medication to control discomfort, which is typically most noticeable in the first few days post-operation. Patients are encouraged to move and walk shortly after the procedure, often on the same day, to promote circulation and prevent complications like blood clots.
A temporary urinary catheter may be left in place for a few days to allow the bladder incision to heal without the stress of filling and emptying. After the catheter is removed, patients may notice a frequent urge to urinate or a temporary burning sensation, which generally subsides as the bladder wall heals. It is common to see blood-tinged urine for up to a week following the procedure, which is a normal sign of the healing process.
Patients are advised to avoid strenuous activities, heavy lifting, and intense exercise for several weeks; a full return to normal activities often takes between two and six weeks. It is important to monitor the surgical site for signs of infection, such as fever, excessive redness, swelling, or drainage. Any inability to urinate or significant, persistent pain should be reported to the healthcare team immediately, as these could indicate a complication.