Interventional Radiology Image-Guided Suprapubic Cystostomy Using Trocar versus Seldinger Technique: A Comparative Analysis of Outcomes and Complications - 21/07/20
, Ricky B. Patel 3, Scott J. Genshaft 1, 2, Siddharth A. Padia 1, 2, Justin P. McWilliams 1, 2, John M. Moriarty 1, 2, Ravi N. Srinivasa 1, 2Abstract |
Objective |
To compare two techniques—trocar and Seldinger—for performing percutaneous suprapubic cystostomy.
Materials And Methods |
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.
Results |
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).
Conclusion |
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.
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| Financial Disclosure: 1. Dustin G. Roberts, MD – None. 2. Ricky B. Patel, BS – None. 3. Scott J. Genshaft, MD – None. 4. Siddharth A. Padia, MD, FSIR – Consulting: Boston Scientific, Bristol Myers Squibb. 5. Justin McWilliams, MD, FSIR – Consulting: Boston Scientific, Penumbra, Neuwave Medical. 6. John M. Moriarty, MD, FSIR – Grant funding: Angiodynamics Inc; Advisory Board: Argon Medical Inc.; Consulting: Boston Scientific Inc, Angiodynamics Inc, Argon Medical Inc, Inari Medical Inc, Thrombolex Inc. 7. Ravi N. Srinivasa, MD, FSIR – None. All authors have read and contributed to this manuscript. |
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| All individuals have given their permission for inclusion in this manuscript and for publication. |
Vol 142
P. 207-212 - août 2020 Retour au numéro
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