DR.Numa'an Sunday, August 21, 2016
Session 4 urology
1
How to differentiate B/t anuria & urine retention ?
عن طريق ال
foley's catheter
فلمن نخلي الفولي و يطلع إدرار هذا معناتها
retention
بس إذا ما طلع هذا معناتها
anuriaDrugs should be
Foly catheters-
In urology booklet (back to page 23 )
https://www.muhadharaty.com/lecture/
Notes
-how to Mx obstructed FC ??-N/S
inj.
obstructed Foley's catheter can be
–
opened
by injection of either distal water or saline
and distal water is preferable
-normal urethra diameter =1cm=30F
-latex
اصفر
silicone
زجاجية
-How to choose type ??
here is no absolute way to decide the size it depends on
the age and the condition of the patient.
avoided in pt w/ urine
retention ?
1-anticholinergic
2-antihistaminic
3–Diuretics
DR.Numa'an Sunday, August 21, 2016
Session 4 urology
2
-how to know the site of bleeding (bladder & urthra)???-by urthrography
-CVA pt w/t chronic foley catheter use can presented w/t SCC
-the number 30ml in foly was meaning ballon size .
-type of fluid used for balloon inflation---Distill Water
because tap water and glucose water may contain debris and crystals that may close the
small opening of the balloon
-in male = under U/S guided deflation by
spine needle
-in Female =lethiotomy position
------Benefit of xylocaine?
1 _ local anesthesia
2 _ lubrication
2 _ dilation of urethra
Catheterization
شرح للطريقة بهذا الف
ي
ديو
https://www.youtube.com/watch?v=wGoHiesVm5o
صيغة السؤال طريقتين
يسالك عندي مريض وحطله فولي كاثتر او
Just put a foly catheter.
Answer/1-introduce URself & explain what U R going to do
2-talk to examiner the indication & why U r doing it.
3-U should take pt to isolated place.
4-total sterile place should be kept & disinfect the area
5-in male ----supine position
In female -----lithotomy position
6-xylocain should be applied
7-in male = the shaft of penis should be handled in a perpendicular plane
8-avoid bad handling w/t catheter after insertion to avoid urine drinking(put urine bag &
keep the tubes under ur control)
9-avoid syringe-mediated balloon inflation before reaching the bladder (u can know by urine
flow into bag)
10-after inflation ,draw back the tube out.
Structure of 2-way Foly Catheter
A-bore of inflation of balloon?
B-bore of urine passage
DR.Numa'an Sunday, August 21, 2016
Session 4 urology
3
11-in female don't do the catheterization to unmarried virgin female if u don't know the
proper technic
12-how to know he position of urethra in female ? –by either asking the pt to pass ur during
the procedure or injecting xylocaine to area where the urethra will dilate
Suprapubic catheterization
https://www.youtube.com/watch?v=xxB0aOh4SeA
DRE
Positions of DRE :
-knee chest position
-left lateral position
-lithotomy position
-what's the C/I ?—any painful problem in anal
region.
??
procedure
-
DRE( knee chest and left lateral the most
-
positions used)
_procedure of DRE same as foley
introduction...etc we use xylocaine or any
lubricant because its not painful procedure
only cause discomfort then start checking.
-procedure is done first by using the pulp of your index
when you enter then to vertical normal position
OSCE station
https://www.youtube.com/watch?v=bK1GTLpL_F8
Ddx. Hard nodule
1_Ca. Prostate
2 _ prostatic stone ( calcium phosphorus )
3 _ post prostatic biopsy
4 _ chronic granulomatous disease as TB
Prostatic ca
PBH
PR exam:
Irregular surface.
Hard in consistency.
Enlarged.
Could loss of median sulcus.
Tethered rectal mucosa to
the prostate.
PR exam:
Smooth surface.
Firm in consistency.
Enlarged.
Preserved median
sulcus.
Free mobile rectal
mucosa on the surface of
the prostate.
DR.Numa'an Sunday, August 21, 2016
Session 4 urology
4
Renal Trauma
بالملزمة متوفرة كل المعلومات
On Renal trauma management
Complete bed rest,
اهم شي
Until the urine is clear ( no Hematuria )
_AVOID putting foly 's catheter to prevent ascending infection
_The degree of hematuria does not reflects the severity of renal injury. In severe hematuria
clot retention may occur(treatment of choice is to use 3 way foley cath. only prevent clot
retention dosn't stop bleeding). Absence of hematuria does not exclude renal injury.
_what is the most important test for this patient?
contrast CT(help in staging renal injury)
_25 years female fall from height and have stage 3 renal injury?? complete bed rest(
اهم شي
---
) till urine is grossly clean from hematuria