PMC5702393_01
Suprapubic cystostomy site growth with urinary catheter in situ.
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Physical examination revealed a fungating growth surrounding the suprapubic cystostomy site (Figure 1).
A contrast enhanced computed tomography scan image of suprapubic cystostomy site growth, transverse section.
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Contrast enhanced computed tomography scan of the abdomen and pelvis revealed a tumor around the cystostomy tract without involving the bladder and lymph nodes were negative (Figure 2).
Cystogram performed through suprapubic cystostomy demonstrates obstruction beyond the prostatic urethra.
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Cystogram was done to assess the possibility of perineal urethrostomy to place the urinary diversion after resection (Figure 3).
Wide local excision of the growth.
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The growth was excised with a macroscopic margin of 1 cm from skin down to the rectus sheath and cuff of the bladder with the cystostomy tract also removed en bloc (Figure 4).
After the tumor resection, the skin incision lines to raise the flap are illustrated.
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As shown in Figure 5, skin incision was made vertically and the width of the skin paddle was decided by the defect in the excision site in a way to close the defect.
Photograph of completion of reconstruction, showing that the urinary catheter is exteriorized through the flap.
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A silicon catheter was passed through the center of the flap while taking care not to damage the vascular supply to the flap (Figure 6).
Healed wound at 6 months of follow-up.
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Otherwise, the patient had uncomplicated recovery after surgery.  Figure 7 illustrates the healed surgical wound.
Well differentiated squamous cell carcinoma at low power (x40) (a) and high power (x100) (b).
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