Suprapubic cystostomy for neurogenic bladder using Lowsley retractor method: a procedure revisited

To report our experience with the Lowsley retractor method for suprapubic cystostomy (SPC) in patients with neurogenic bladder (NGB).

A retrospective study was performed of 44 patients with NGB who underwent SPC with the Lowsley retractor method. The subjects were selected from 90 patients undergoing SPC by 1 surgeon from 1995 to 2010. The age, sex, indication, anesthesia type, catheter type, blood loss, fluids administered, and duration and complications were recorded.

A total of 49 primary catheter placements were performed in 44 patients. A total of 23 men and 21 women were included. The etiology of NGB was spinal cord injury and multiple sclerosis in 38 subjects (86%). The mean age was 44 years (range 18-86). The cases were performed under general anesthesia, except for 8 (16%) that were successfully performed with local and monitored anesthesia. The operation time documented in 19 cases (39%) was 20.2 ± 5.5 minutes (range 11-31). The Foley catheter size ranged from 16F to 22F. The blood loss was minimal, and there were no intraoperative complications or incorrect catheter placements. One patient returned with significant hematuria 1 day after the procedure. No other minor or major complications were noted.

Patients with NGB have been shown to have a greater risk of complication during percutaneous suprapubic catheter placement. SPC using the Lowsley retractor was described by Zeidman et al in 1988. Their report did not detail the patient characteristics or operative experience. To our knowledge, no other institutional experience with the technique has been reported. The present report describes the Lowsley retractor method as a quick and safe ambulatory procedure for patients with NGB.