Urological instruments(uses,indication&contraindication).pptx

This ppt contain informations about Urological instruments, their uses ,indications and contraindications

1. INSTRUM ENTATIONS Presented by: Ruaa Amer Dania Haidar Ruaa Abbas Taher Hamza

2. The Contents: 1 - U reteric S tent 2 - Nephrostomy 3 - S uprapubic C atheterization 4 - C ystoscopy

3. U reteric S tent  A ureteral stent is a soft thin, flexible plastic tube about 10 - 12 inches long ,to prevent or treat obstruction of the urine flow from the kidney.  It is placed in the ureter .  Available in various sizes ,designs &material.

4. Indica tions ● U reteral obstruction ● Adjunct to stone therapy ● Post - operatively following ureteroscopic surgery - Manipulation of a kidney stone - Biopsy - Dilation of a ureteral stricture

5. Stent placement  The procedure is usually performed under general anaesthesia .  During this procedure, a tube with a tiny optic camera is inserted through the urethra into your bladder. The bladder is inspected, and ureteric opening is located. This method is sometimes used as a temporary measure, to prevent damage to a blocked kidney, until a stone remove perform ed.

6. H ow to remove it ? ▪ By cystoscopy. ▪ By attached string towards a stent at the ureteral area. String is a long piece , like structure starts from a particular end of stent and drape out towards the urethra, remains visible at the meatus of the urethral area.Hold the visible string firmly and apply continuous and steady pulling until and the stent comes out completely. The curls at the end of ureteral stent are flexible

7. C om plications  1 - Dislocation  2 - Infection  3 - Blockage ,  4 - Ureteral fistula  5 - Increased urgency and frequency of urination  Blood in the urine, leakage of urine  pain in the kidney, bladder, or groin, and pain in the kidneys during, and short time after urination

8. Nephrosto my  A nephrostomy is an artificial opening created between the kidney and the skin which allows for the urinary diversion directly from the upper part of the urinary system.

9. Indicat ions 1 - Acute or chronic upper urinary tract obstruction , specially when a double - J stent cannot be placed through the ureter . 2 - Renal pelvis disorders ( eg , UPJ obstruction, horseshoe kidneys, ureter duplex, ureter fissures, double renal collecting systems) 3 - Hydronephrosis in renal transplant allografts 4 - Treatment of staghorn calculi and large or lower - pole kidney ston es 5 - Stones or tumors associated with distal obstruction or a foreign body that cannot be removed through the ureter 6 - permanently for urine drainage in patients in whom a retrograde access to the kidney is impossible ( eg , advanced metastatic tumors, loss of the total ureter

10. How to do it ?  The collecting system of the kidney is punctured percutaneously with a needle under fluoroscopic, ultrasonographic , or CT guidance. The needle is passed through the skin, subcutaneous tissue, external and internal muscle layers, and the renal parenchyma to reach the collecting system. When the needle has entered the renal collecting system, a guidewire is passed through the needle into the kidney and possibly down the ureter .

11. Compl ications  The complications of nephrostomy are  severe bleeding (hemorrhage): 3 %  tube dislodgement: 1 %  tube blockage: 1 %;  serious infection: 1 %;  damage to adjacent structures: rare  vascular injury requiring removal of the affected kidney or embolization 1 % – 3.6 %.

12. Suprapubic catheterization  When placement of a urethral catheter is contraindicated or unsuccessful, percutaneous suprapubic urinary bladder catheterization is a commonly performed procedure to relieve urinary retention. General indications :  Urethral injuries  Urethral obstruction  Bladder neck masses  Benign prostatic hypertrophy (BPH)  Prostate cancer

13. How to do it ?  Obtain informed consent  Provide adequate parenteral analgesia.  Clean the lower abdominal wall.  Shave the suprapubic area.  Palpate the distended bladder and mark the insertion site at the midline and 2 fingers ( 4 - 5 cm) above the pubic symphysis .  Apply an antiseptic solutin from the pubis to the umbilicus.  Advance the needle through the skin, subcutaneous tissue, rectus sheath, and retropubic space, while alternating injection and aspiration, until urine enters the syringe.  make a 4 - mm stab incision at the insertion site with the blade.  insert the needle obturator into the Malecot catheter and lock it  Connect the syringe to the port of the needle obturator  withdraw the obturator needle  Connect the extension tubing to the catheter and connect the tubing to a urinometer or a leg bag

14. Compl ications  1 - Gross hematuria is typically a transient cond ition  2 - post obstruction diuresis is possible  3 - Cellulitis and abscess formation.  4 - Displacement  5 - Bowel perforation and intra - abdominal visceral injuries are possible

15. Contrain dications  It is absolutely contraindicated in the absence of an easily palpable or ultrasonographically localized distended urinary bladde r.  And relatively contraindicated in the following situations: 1 - Coagulopathy (until the abnormality is corrected) 2 - Prior lower abdominal or pelvic surgery (potential bowel adherence to the bladder or anterior abdominal wall; may recommend that a urologist perform an open cystostomy ) 3 - Pelvic cancer with or without pelvic radiation (increased risk of adhesions ).

16. Cyct oscope  A cystoscopy is a procedure to look inside the bladder using a thin camera called a cystoscope .  There are two types of cystoscopes : a standard rigid cystoscope and a flexible cystoscope . The choice of which scope to use depends on the purpose of the exam.  The test is both for diagnosis and treatment.

17. Flexible Cystoscopy A thin (about the width of a pencil), bendy cystoscope is used, and you stay awake while it's carried out

18. Rigid Cystoscopy A slightly wider cystoscope that doesn't bend is used, and you're either put to sleep or the lower half of your body is numbed while it's carried out

19. Indicat ions  Diagnostic :  hematuria  persistent irritative symptoms  Urinary retention  Recurrent UTI  Suspected new growth  Retrograde pyelogram  Thera peutic  Placement of stent  Resection of bladder tumors  Extraction or laser lithotripsy of stones .

20. We may find :  * Interstitial cystitis  * Bladder stones  * Ulcerations inside the urethra or bladder  * Growths or cancer  * Prostate enlargement  * Urethral strictures  Complications :  Urinary tract infection  Hematuria  Dysuria  Bladder or urethral injury

21. THANKS FOR ATTENTION