Retensi Urin Akut Retensi Urin Akut.pptx

Retensi Urin Akut

1. ‘Understanding the Practice of Day-to-Day Urological Clinical Topics’ dr. M. Puteh Mauny, SpU July - 2024 ‘Urgent Matters: Key Considerations in Acute Urinary Retention for General Practitioners’ urologi.fk.usk.ac.id

2. Anatomic Consideration MALE •About 18 to 20 cm long. •The anterior urethra is approximately 16 cm and lies within the penis distally and the perineum proximally. •Pendulous / penile urethra; •Bulbar urethra •Fossa navicularis. •The posterior urethra is 4 cm long and lies within the pelvis proximal to the corpus spongiosum. •Preprostatic or bladder neck, •Prostatic urethra •Membranous urethra •The average normal male meatus should accommodate a 24-Fr instrument or catheter. •The prostatic urethra should accommodate a 32-Fr instrument and the bladder neck a 28-Fr catheter or instrument. ‘Understanding the Practice of Day-to-Day Urological Clinical Topics’

3. Anatomic Consideration FEMALE •Approximately 4 cm in length and is present within the anterior vagina •The normal caliber of a female urethra is 22 Fr ‘Understanding the Practice of Day-to-Day Urological Clinical Topics’

4. Indications For Lower Urinary Tract Drainage DIAGNOSTIC • Children or females: for sterile acquisition of urine for culture • Suspicious of urinary tract trauma -> for diagnosis of a urethral or bladder injury • Urodynamics studies • Cytology THERAPEUTIC • Urinary retention: • Benign prostatic hyperplasia (BPH) • Clot retention • Urethral strictures • Urinary retention and urinary incontinence when other definitive treatment options are not possible • Hematuria if continuous bladder irrigation is required • Intravesical treatments such as Bacillus Calmette-Guérin vaccine or Mitomycin • Major surgery to drain the bladder and monitor urine output • Extraperitoneal bladder injury and selected cases of intraperitoneal bladder injury • Conservative management of Small vesicovaginal fistulas. ‘Understanding the Practice of Day-to-Day Urological Clinical Topics’

5. Contraindications Absolute contraindication: • Suspected or confirmed urethral injury or a history of bladder neck closure or repair. • Relative contraindications. • Recent urethral surgery or urethral stricture. ‘Understanding the Practice of Day-to-Day Urological Clinical Topics’

6. TECHNIQUE OF URETHRAL CATHETERIZATION Men - Women - Children ‘Understanding the Practice of Day-to-Day Urological Clinical Topics’

7. Urethral Catheterization in Men • Supine position • It is essential that the catheter be inserted completely before filling the balloon, even though the return of urine may be seen before this. • If the foreskin wasretracted, the clinician must ensure that the foreskin is replaced over the glans to prevent paraphimosis. • Sterile 2% lidocaine jelly may be used instead of lubricant jelly in patients who are apprehensive orif initial attempts at catheterization have failed. ‘Understanding the Practice of Day-to-Day Urological Clinical Topics’

8. Urethral Catheterization in Women •Supine frog-legged position. •The thumb, pointer, and middle finger of the non dominant hand are used to spread the labia before sterilization of the meatus. •Lifting anteriorly while spreading the labia may help improve visualization. •The catheter is lubricated with sterile lubricant, then the catheter is inserted gently into the meatus. •If visualization of the meatus is difficult, the patient may be placed in Trendelenburg position, and more assistance may be needed for retraction. ‘Understanding the Practice of Day-to-Day Urological Clinical Topics’

9. ‘Understanding the Practice of Day-to-Day Urological Clinical Topics’ Urethral Catheterization of Children • Male children may have physiologic phimosis, which should not be forced to retract. • The foreskin can be gently moved ventrally or dorsally to identify the meatus. • Ensure that the catheter size is appropriate for the age of the child.

10. TYPES OF URETHRAL CATHETERS ‘Understanding the Practice of Day-to-Day Urological Clinical Topics’

11. ‘Understanding the Practice of Day-to-Day Urological Clinical Topics’ Types of Urethral Catheters SHAPE • Catheters either have a straight tip or a coudé tip. • A council tip catheter can be passed over a wire because it has an opening at the distal tip, unlike a typical catheter, which is blind-ending. Council catheters are available with either a straight or coudé tip. NUMBER OF PORTS • A one-port catheter can be effective in drainage of the bladder because its lumen is greatest in diameter. • A two-port catheter is the most common type and is effective for anchoring because a balloon can be filled with sterile water to prevent the catheter from migrating distally. • A three-port catheter is used for bladder irrigation, most commonly in patients with hematuria. The extra port is usually connected to a saline bag and fluid is continuously infused. MATERIAL • Catheters can be manufactured from latex, rubber, silicone, or polyvinylchloride (PVC). They can be manufactured with hydrophilic, antibiotic, or antiseptic coatings.

12. ‘Understanding the Practice of Day-to-Day Urological Clinical Topics’ Catheter Sizing Invented by: Joseph-Frédéric-Benoît Charrière 1 French (Fr) = 1 Charrière (Ch) = 0.33 cm

13. ‘Understanding the Practice of Day-to-Day Urological Clinical Topics’ Single-Lumen Catheters Who require intermittent catheterization

14. ‘Understanding the Practice of Day-to-Day Urological Clinical Topics’ Double-Lumen Catheters •Most prevalent and are used commonly for simple catheterization of patients in the hospital setting. •May be made with latex, silicone, or PVC. •They also may have a straight tip or acoudé tip.

15. ‘Understanding the Practice of Day-to-Day Urological Clinical Topics’ Hematuria Catheter • Can be extremely helpful in patients with significant hematuria with clots. • These catheters usually have three lumens to initiate continuous bladder irrigation. They are also made with PVC, which does not compress.

16. ‘Understanding the Practice of Day-to-Day Urological Clinical Topics’ Suprapubic Catheterization • Patients with a urethral disruption from trauma may require temporary placement of an SP catheter for bladder drainage. • There are various techniques to place an SP catheter , which include. Open Cystotomy. Trocar Technique. Seldinger Technique.

17. ‘Understanding the Practice of Day-to-Day Urological Clinical Topics’ Difficult Catheterization Prostatic Obstruction : If BPH is expected, the practitioner should use an 18-Fr coudé catheter Urethral Stricture Urethral Trauma - In posterior urethral injuries, one gentle passage of a catheter may be attempted Abnormal Anatomy Posterior Urethral Valves Obesity Reconstruction of the Lower Urinary Tract Bladder Replacement or Neobladder Continent Urinary Reservoir or Indiana Pouch Urinary Conduit Bladder Neck Reconstruction or Closure

18. ‘Understanding the Practice of Day-to-Day Urological Clinical Topics’ Complications OfLower Urinary Tract Drainage Infection Iatrogenic Trauma Stricture Erosion Malignancy Catheter Knotting Balloon Malfunction

19. ‘Understanding the Practice of Day-to-Day Urological Clinical Topics’ References : 1. Campbell-Walsh-Wein Urology, Twelfth Edition. 2021. Chapter 11. Lower Urinary Tract Catheterization.

20. Thank You