Division of Interventional Radiology, Department of Radiology, UCLA, Los Angeles, CA; David Geffen School of Medicine at UCLA, Los Angeles, CA.
Rosalind Franklin University of Medicine and Science, Chicago, IL.
Urology. 2020 Aug;142:207-212. doi: 10.1016/j.urology.2020.05.015. Epub 2020 May 20.
To compare two techniques-trocar and Seldinger-for performing percutaneous suprapubic cystostomy.
125 patients, mean age 71.8 ± 16.5 years (range, 15-102 years), underwent primary suprapubic cystostomy from January 2013 to December 2018. Trocar access (N = 60) was performed as a single step using a puncture cannula without guidewire access. Seldinger access (N = 65) involved needle puncture, guidewire placement, and serial dilation. A retrospective review of patient records was conducted.
All procedures were technically successful. Mean catheter size was 13.1 ± 2.0 and 13.9 ± 2.0 French for trocar and Seldinger, respectively (P = .044). Mean procedure time was significantly reduced using trocar technique, 12.4 ± 7.7 versus 25.7 ± 12.1 minutes (P <.001), and was associated with lower anxiolytic dose, 1.2 ± 0.8 versus 1.9 ± 1.1 mg midazolam (P = .003), and less radiation exposure, 20.2 ± 59.5 versus 100.7 ± 98.5 mGy (P <.001). Catheter occlusion was the most common complication (28.8%), followed by UTI (13.6%) and bladder spasm (8.0%). All but 2 complications were classified as Clavien-Dindo grade I or II. Catheter occlusion was more frequent in the trocar group (41.7% vs 16.9%, P = .003), while bladder spasms were more frequent in the Seldinger group (13.8% vs 1.7%, P = .018).
Suprapubic cystostomy via trocar is associated with faster procedure time, lower anxiolytic dose, and less radiation. While major complications are rare, catheter occlusion is a common occurrence that may be overlooked. Although we detected more occlusions with trocar technique, this may be confounded by a catheter-tract size discrepancy.
比较经皮耻骨上膀胱造口术的两种技术——trocar 和 Seldinger 技术。
2013 年 1 月至 2018 年 12 月，125 例年龄 71.8±16.5 岁（15-102 岁）的患者接受了原发性耻骨上膀胱造口术。trocar 入路（N=60）采用穿刺套管进行单一操作，无需导丝进入。Seldinger 入路（N=65）包括针穿刺、导丝放置和连续扩张。对患者病历进行回顾性分析。
所有手术均技术成功。trocar 和 Seldinger 组的导管大小分别为 13.1±2.0 和 13.9±2.0 French（P=0.044）。trocar 技术的平均手术时间明显缩短，为 12.4±7.7 分钟与 25.7±12.1 分钟（P<0.001），并与较低的安定剂量相关，分别为 1.2±0.8 毫克与 1.9±1.1 毫克咪达唑仑（P=0.003），辐射暴露量较低，分别为 20.2±59.5 毫戈瑞与 100.7±98.5 毫戈瑞（P<0.001）。导管阻塞是最常见的并发症（28.8%），其次是尿路感染（13.6%）和膀胱痉挛（8.0%）。除 2 例外，所有并发症均被分类为 Clavien-Dindo Ⅰ级或Ⅱ级。trocar 组的导管阻塞更为常见（41.7%比 16.9%，P=0.003），而 Seldinger 组的膀胱痉挛更为常见（13.8%比 1.7%，P=0.018）。
经皮耻骨上膀胱造口术 trocar 入路与手术时间更短、安定剂量更低、辐射更少相关。虽然主要并发症罕见，但导管阻塞是一种常见的并发症，可能被忽视。虽然我们在 trocar 技术中检测到更多的阻塞，但这可能与导管通道大小的差异有关。
