UROLOGICAL TOOLS — the special tools applied to diagnosis, medical manipulations and operations on bodies of urinogenital system.
Still in the ancient time carried out such operations as a perineal and side lithotomy with use of special tools, and also expansion of an urethra of a buzhama (the last were found, e.g., at excavation Pompeii). A. Paré was an inventor of original urological tools, to-ry offered metal probes and tools for a lithotomy. Free (P. Franco, 1561) in the treatise about tumors offered the razrezyvayu-shchy nippers for a perineal lithotomy consisting of the central motionless core from to-rogo two side edges proceeded. This model was taken as a basis afterwards by G. Dupuy tren ohm, designed double cast and volume for a side lithotomy. The perineal and side lithotomy a long time was considered main the Urals. operation; used the tools separate to its performance from to-rykh occasionally apply and now: the catheter with a side channel, the curette, a screw kamnedro-bitel of Buyalsky, the hidden knife-litotom of Pirogov, etc. made the Vnutriuret-ralny section of cicatricial urethrostenoses still And. Paré, but this operation was widely adopted in the second half of 19 century after the invention of an ureterotome J. G. F. Maison-neuve.
Nek-ry tools widely known earlier have hl. obr. historical value: e.g.,
Lyuis's separator intended for receiving urine separately from each kidney and representing metal buzh, dividing a bladder into two half the hidden rubber crossing point tense by means of the outside screw. A number of tools sometimes use and now: e.g., kamneshchup (kamneiskatel) — the metal probe with a short beak (fig. I), with the help to-rogo determined a stone in a cavity of a bladder by knock or in an urethra; a dilator of Koll-manna — the tool with the moved apart branches used in a crust, time in a combination with an ureterotome at treatment of strictures of an urethra (fig. 24). At hron. prostatitises for holding thermal procedures intestinal thermophores — pear-shaped hollow metal devices with two branches (fig. 31), and also the special tool for self-massage of a prostate (fig. 10) serve.
Improvement At. and. went in parallel with development of surgery. After allocation of urology (see) to the independent area a wedge, medicine, the research in many respects connected with implementation of new methods, development of difficult surgeries on bodies of urinogenital system, a large number of new tools appeared. The domestic industry issues more than 200 names of urological tools, some tools go on sale in the form of sets. K U. and. do not carry the optical equipment, napr, cystoscopes (see Tsistoskopiya), urethroscopes (see Uretroskopiya). Depending on range of application At. and. divide into several groups. Nek-ry types of urological tools are presented in the table.
UROLOGICHESKIYA TOOLS 109
Tools for diagnosis, medical manipulations and urethra, bladder and prostate operations. Apply meato-meter (fig. 17) to determination of caliber of an outside opening of an urethra — the metal cone graduated on Sharryer's (fig. 36) scale. Expansion of an urethra at its strictures is made by means of varied in form and to caliber elastic and metal buzhy (see). For a section of the narrowed outside opening of an urethra use the meato-toma having an appearance of scissors with outer cutting edges (fig. 19) or a knife with a safety button on the end (fig. 18). Tunnelization of impassable strictures and cicatricial obliterations of the tail of an urethra and neck of a bladder across Frakman is made the buzhom-perforator (fig. 1) — a curved metal buzh with the hidden edge, a cut moves forward pressing the handle after the end of a buzh reaches an obstacle and the buzh-perforator is fixed in this situation. A knife cut dense hems then there is possible an expansion of the narrowed site and carrying out a constant catheter. At the strictures passable for thin elastic buzhey-conductors, it is possible to make an internal urethrotomy by means of an ureterotome (fig. 32, 33). It consists of a trunk, to-ry has a trench on the convex party (a back ureterotome) or bent (a front ureterotome); in this trench the triangular knife with stupid top intended for a section of a stricture slides. The stupid top of a knife protects a normal mucous membrane of an urethra from damage. On the end of an ureterotome there is a coupling with cuttings for its navinchivaniye on the thin buzh-conductor, after the Crimea the ureterotome is carried out to an urethra. Use of this tool offered still Mezonne-vy was considerable achievement in treatment of strictures of an urethra. Later the ureterotomes representing a combination with Otis (fig. 35) or Kollmann's dilator and also the optical ureterotome allowing to make a section of a cicatricial urethrostenosis under control of an eye (fig. 34) were implemented in practice.
Carrying out a rubber catheter in a bladder, especially at the deformed urethra and after an urethrotomy, and also introduction samofik-siruyushchikhsya catheters (see Catheters) it is possible to carry out by means of wire mandrins with the mobile fixer (fig. 15) or with the handle fixer (fig. 16). Mandrin can give desirable curvature, to-ruyu accepts also the catheter fixed on it in the tense state. Retrogradno a constant catheter is entered by means of the conductor (fig. 20), to-ry has an appearance of a flexible metal handle with olives on the ends. If to remove a safety cap of an olive, the union with deep spiral cutting is bared, on a cut it is possible to fix the rubber and plastic tubes applied as a constant catheter. For tunnelization of an urethra use Bougie with a flute and a through hole at a head (fig. 2).
Instillation (see) medicines in an urethra is made by means of Lants's syringe with a cylinder (fig. 26) or the ordinary syringe, the special tip (fig. 12) from elastic rubber adapted for introduction to an outside opening of an urethra is put on a cannula to-rogo. Washing of the forefront of an urethra is made, using the same rubber tips or a cannula of Zhane, to-rye directly or through a three-way cock connect tubes to the tank containing wash liquid.
For deduction of the pharmaceuticals entered into an urethra on a penis impose a unit soft clamp — a penisklemma (fig. 5). At men with an incontience of urine after operative measures in a neck of a bladder and the tail of an urethra, and also as a result of diseases or damages of c. N of page use the clip, close in a form, made of flexible soft plastic (a clip Baum-ryukkera); pressure caused by it is much less, than from use of other clips.
Every 3 hour the clip is removed and empty a bladder.
For injections of medicines en take l no under a mucous membrane (e.g., hormonal drugs, solution of novocaine in the presence of a stone in intramural department of an ureter, etc.) use a special needle (fig. 8) or a needle catheter (fig. 9).
Electrothermic coagulation patol. educations in a cavity of a bladder and an urethra (see Diathermocoagulation) carry out by means of the urethroscope and the cystoscope, in to-rye enter elastic electrodes (fig. 45, 46). Foreign bodys (see) delete from an urethra with urethral nippers (fig. 44). Pieces of fabric of a tumor or mucous membrane of a bladder and urethra for gistol. researches can be taken the tweezers on a flexible core (fig. 37) entered through an operating cystoscope; in the same way enter into a cavity of a bladder the special scissors used for a section of the mouth of an ureter or removal of a ligature from nerassasyvayu-shchikhsya materials. Both of these tools enter a set of an operating cystoscope.
At bladder operations, transvesical interventions on the tail of an urethra and a prostate gland special ranorasshiritel with a set of removable mirrors (fig. 21, 22), the lighter apply to a cavity of a bladder and a suction for blood and liquid (fig. 23). At allocation of a bladder it is taken away a flexible mirror (fig. 7). During operation deeply in a cavity of a bladder additional lighting quite often is required; in these cases use a special lamp on a flexible core, to-ruyu enter into a bladder through an urethra (fig. 13). The lighter with a flexible core and a set of mirrors with fiber light guides of «Korall-MT» (see Endoscopy), etc. is implemented in practice.
During removal of papilloma of a bladder the closed spoon nippers of Ovnatanyan (fig. 43) find application, at to-rykh working sponges are densely closed. The papillary tumor captured by them is isolated from surrounding healthy fabrics and by that inoculation of tumor cells in a wall of a bladder is prevented. There are also spoon nippers for capture and simultaneous electrothermic coagulation of the basis of a papillary tumor (fig. 42).
Stones delete with Levkovich's nippers with direct (fig. 40) and spoon-shaped working sponges bent (fig. 41) from the opened bladder, the inner surface to-rykh has a rashpilny notch. Multiple small stones delete from a bladder with a stupid spoon (fig. 14).
The suprapubic puncture and drainage of a bladder are carried out various in a form special troakar (fig. 28), through to-rye
accessory instruments and general purpose for diagnosis and treatment of diseases of urinogenital system
a bladder the drainage tube (so-called trocar cystostomy) can be entered and left in Tools for diagnosis, medical manipulations and operative measures on a kidney and an ureter. There are troakara with branches (fig. 29), an inflatable cuff (fig. 30), etc.
After enucleation of adenomatous nodes to capture and deduction of a mucous membrane of a bladder and edges of a bed of a prostate apply web-footed nippers (fig. 39). For a stop of bleeding from the capsule of a prostate use a clip with the long branches (fig. 4) bent on an edge. At a prostatectomy (see) concerning cancer the prostate is taken and tightened in a wound Young's (fig. 25) retractor. It is convenient to take the Vylushchenny adenomatous node, without injuring a mucous membrane of a bladder, fenestrated nippers (fig. 38); on the interior of sponges of nippers there is a direct cross notch providing reliable fixing of fabric. At bladder operations the clip is convenient for an attachment of a wall of a bladder to skin of a stomach (fig. 6). For a transvesical adenomectomy (see. And a denoma of a prostate) use a vesicoprostatotome (fig. 3) — a disk knife on the long curved handle; in the center of a knife there is an opening for an urethral catheter.
The puncture biopsy of a prostate is carried out by a puncture through a crotch or a wall of a rectum a special trocar-vykusyvatelem (fig. 27), to-ry represents a stylet with dredging at an edge. The tube is put on a stylet, the internal end to-rogo is pointed on edge and performs function of a knife.
Tools for diagnosis, medical manipulations and operative measures on a kidney and an ureter. At an exposure of a kidney apply a ranorasshiritel with removable mirrors (fig. 58, 58a) and a mirror shovel with a bend iod a right angle to assignment of a kidney (fig. 55). For crossclamping of vessels of a renal leg the clips bent on radius with the atraumatic notch (fig. 49) protecting from sliding use Fedorov's (fig. 51, 52) clips with the powerful branches bent under various corner with a slanting or cross notch, and also. C.II. Fedorov offered clips with removable handles (fig. 50); they are imposed at impossibility to tie up vessels; in this case the clip is left in a wound for 2 — 3 days. With improvement of quick accesses and implementation of preliminary embolization of a renal artery (see Wren to a tgenoendovask lyar N aya x up at r - Giya) need for clips of this kind decreased.
At a piyelotomiya apply special mirrors with long handles and tiny working parts to cultivation of edges of a wound of a renal pelvis. Mirrors release five types depending on size and a form (fig. 54). Especially for extraction of stones from cups of a kidney use fenestrated nippers with various curvature of a bend of a working part (fig. 59, 60), and also with the moving apart brashn (fig. 61), many from to-rykh were developed according to
S. P. Fedorov's proposal. At a nephrostomy (see) the curved clip conductor (fig. 53) is convenient for perforation of renal fabric and carrying out a drainage tube in a pelvis of a kidney.
The puncture biopsy of kidneys (transdermal and open) is carried out special needles of several types. At a plucked needle a working part is presented by the split mandrin (fig. 57); Ambyurzhe's needle has the pointed mandrin with dredging and the cutting tube (fig. 56).
Fixing of the allocated ureter and the stone which is in it is made the special tool — the holder with the semi-ring-shaped captures on sponges forming two rings (fig. 47) or a continuous ring (fig. 48) at a smykaniye. Stones delete with nippers with fenestrated sponges (fig. 62, 63) from ureters.
From ureters apply various nonmetallic and metal extractors to an endovesical removing calculus:
Durmashkin's catheter with an inflatable cylinder (fig. 65), Tseyss's (fig. 64) catheter loop, wire loops — «baskets» of Dormia (fig. 66), Johnson (fig. 67), Pashkovsky (fig. 68), etc. The last enter into an ureter in the compressed state, will see off above a stone, straighten «basket» and take in it a stone. Also the extractor like Dormia with a cylinder lower than «basket» (fig. 69) is applied.
Accessory instruments and general purpose for diagnosis and treatment of diseases of urinogenital system. By the principle of kamneiskate-la the phonoindicator («FON-IM») with a set of probes applied in a crust, time to detection of foreign bodys in urinary tract in the contact way is arranged. Contact of the probe with firm objects causes mechanical oscillations, to-rye will be transformed to electric, amplify and reproduced a loudspeaker.
Crushing of urinary stones in a cavity of a bladder by means of lithitriptors with success is replaced with method of destruction of stones in the elekt-rogidravlichesky way under direct vision by means of the «Urate» device; splinters of stones wash through a catheter tow truck by means of an aspirator (see Lithotripsy).
Big distribution was gained by devices for measurement of a tone of muscles of a bladder and its switching device (tsisto-meters, sfinkterometra), to-rye represent the manometrical systems connected by a catheter to a bladder or an urethra (see the Manometer). On a scale of the manometer pressure noted at emergence of a desire on an urination (tsistometriya) or at the time of overcoming resistance of a sphincter is registered (sfinkterometriya). There are also devices of an urofloumetra, for determination of force of reduction of a detruzor by measurement of rate of volume flow of freely falling stream of urine.
Suture and an alloying of the bleeding vessels in the depth of a wound facilitates use of the boomerang needle holder with a set of needles (fig. 73) and a special nitepodava-tel (fig. 74). At stitching the needle holder remains motionless; pressing its handle reports to a needle the arc-shaped movements thanks to what fabric is punctured. There is also boomerang needle holder with the automatic delivery of thread (fig. 75). For more convenient stitching in the depth of a wound, advances and tightenings of loops of a ligature on vessels use also Vinogradov's «stick», a wire fork of Geselevich and other models of forks (fig. 71, 72), direct and curved.
For uslovnoreflektorny treatment of enuresis, and also at care of seriously ill patients as a signaling device about an involuntary urination use the device Real (fig. 70).
Bibliography: Medical tools,
devices, devices and the equipment, the Catalogue, under the editorship of. I. A. Antonova, prince 5, section — Urology, M., 1960; Mitchell-Heggs F. Radcliffe Drew H. G. The instruments of surgerv, p. 294, L., 1963.
V. G. Boychenko, Ya. V. Gudynsky
T and l and c and
SOME TYPES of UROLOGICAL TOOLS
Total length (L). Weight (M). Sizes of a working part: length (Oh, width (£), diameter (d), volume (v)
the Name of tools and their appointment (in brackets number of the drawing is specified)
Outward of tools
Tools for diagnosis, medical manipulations and urethra, bladder operations
and a prostate