CATHETERIZATION OF URIC WAYS (grech, katheter the probe) — introduction of a catheter to uric ways. To. m of the item make from diagnostic and to lay down. purpose. Distinguish catheterization of an urethra, bladder, ureters and a renal pelvis.
Indications and Contraindications
Indications: acute and hron, ischuria, need of endourethral and endovesical introduction medicinal and radiopaque substances, determination of capacity and tone of a bladder, evacuation of a residual urine and determination of its quantity. To. m of the item apply to a tsistouretrografiya and receiving urine from a bladder for laboratory researches. Catheterization of an ureter and a renal pelvis is shown for definition of passability of upper uric ways, localization of an obstacle, for separate removal of urine from each kidney, performance of a retrograde ureteropiyelografiya, elimination of a staz of urine, bringing down of concrements, bougieurage, introduction of drugs to upper uric ways.
Contraindications — acute inflammatory processes of an urethra and bladder.
Equipment of catheterization
At men apply various to catheterization of a bladder catheters (see), women have a special female (short) catheter. To. the m of the item should be produced with the most strict observance of all rules of an asepsis and antiseptics. The catheter shall be outside oiled liquid or glycerin.
Catheterization of an ureter and a renal pelvis is made by means of the special kateterizatsionny cystoscope.
To. m of the item usually make without anesthesia. Only in exceptional cases at an acrimony of the patient and to children apply local or general anesthesia (it is preferential at introduction of metal or semisolid tools). For the purpose of anesthesia most often enter solution of novocaine into an urethra; it promotes relaxation of an outside sphincter and does catheterization painless. Administration of novocaine is contraindicated if there is a fresh injury of an urethra at an urethremorrhagia. The general anesthesia is carried out by the general rules. With success apply not barbituric analgetics of short action (Sombrevinum, fentanyl).
At introduction to a bladder of a rubber catheter of Nelaton of the patient stack on a back with slightly divorced legs, between hips put a tank for collecting urine. The doctor, standing on the right side from the patient, takes the left hand his penis, wraps it a gauze napkin and opens a head. The right hand wipes a balanus around an outside opening of an urethra with the wadded ball moistened in disinfecting solution (for example, in 1% solution of Rivanolum). Having drained a sterile dry gauze ball a balanus, big and index fingers of the left hand opens sponges of an urethra, and the right hand by means of tweezers enters a catheter into an urethra. The catheter is fixed a mouse-tooth forceps above the proximal end (beak) on 2 — 3 cm, and the distal end (pavilion) is held between IV and V fingers. Advancing tweezers a catheter in an urethra, at the same time displace towards a penis a little. It promotes smoothing of folds of a mucous membrane of an urethra. Emergence from a catheter of a stream of urine indicates finding of a beak of a catheter in a cavity of a bladder.
Sometimes in the course of introduction the catheter meets an obstacle in the field of an outside sphincter owing to a reflex spasm of muscles. In such cases it is necessary to suspend temporarily advance of a catheter, to slightly take it back, to suggest the patient to make several deep breaths, at the same time the sphincter relaxes, and the catheter freely passes by a prostatic part of an urethra in a bladder.
At adenoma of a prostate To. the m of the item a rubber catheter can present great difficulties, and then resort to introduction of elastic, semisolid and metal catheters.
Catheterization a semisolid catheter of Timann or an elastic catheter of Mercier has the features. The distal end of these catheters (beak) is bent up at an angle 45 °, and on their pavilion there is an eminence («cockerel») corresponding to an arrangement of a beak. Methods of introduction of these catheters the same, as soft. At the elderly men having adenoma of a prostate during the carrying out a catheter of this type by a prostatic part of an urethra the beak shall move ahead closer to a front wall of an urethra, usually free from adenomatous nodes. As indicator of position of a beak serves position of «cockerel».
The metal catheter (fig.) is entered the same receptions, as metal buzh (see. Bougieurage ). During the carrying out a metal catheter on an urethra it is not necessary to do sharp and violent movements. Catheterization is considered successful when on a catheter urine follows, there is no bleeding and pain in an urethra (the last usually are at formation of the false course).
The Kateterizatsionny cystoscope, unlike ordinary — so-called viewing, has one or two channels for carrying out on them catheters and is supplied with special adaptation, a cut allows the ureteric catheter entered into a bladder to give a certain corner in relation to a long axis of the tool. It facilitates introduction of the end of a catheter in the mouth of an ureter. Having entered the kateterizatsionny cystoscope into a bladder, find the respective mouth of an ureter and enter an ureteric catheter into it. Separate subsequent smooth pushes the catheter is advanced in an ureter on required height, usually to a renal pelvis. At hit of the internal end of a catheter in a pelvis the rhythm of drops of the urine following from it becomes frequent. The cystoscope is taken, and the peripheral end of an ureteric catheter is fixed an adhesive plaster to skin of an upper part of a hip. It is easy to determine length of the catheter entered into upper uric ways as on an outer surface of a catheter there are divisions expressed in centimeters. The entered catheter in case of need can be left in an ureter at several o'clock or days as constant.
If an ischuria chronic, the bladder is strongly stretched, and catheterization is made for the first time, it is not necessary to empty quickly a bubble since after that at the weakened elderly people with diseases of cardiovascular system and the lowered function of kidneys there can come the so-called reaction to emptying which is expressed in disturbance of secretory ability of kidneys up to an anury and development of uraemic intoxication. At such patients bladder emptying at each catheterization is made gradual removal of urine in the small portions. If it is possible to carry out a rubber catheter to a bubble, then it is left for a long span (a constant catheter).
With the same purpose sometimes enter an ureteric catheter into a bladder and leave without overlapping of its gleam. Continuous release of urine on drops provides gradual and slow bladder emptying within several hours.
During the use of a metal catheter perforation of a wall of an urethra and formation of the false course, an inflammation of an epididymis and so-called kateterizatsionny (urethral) fever is possible. The false course at catheterization can arise in places of natural barriers in an urethra, in the presence in it patol, changes (a stricture of an urethra, adenoma of a prostate), at rough, violent carrying out a catheter.
At formation of the false course it is necessary to resort to a capillary puncture of a bladder or high section of a bubble (see. Vesicotomy ).
The inflammation of an epididymis (epididymite) after catheterization of a bladder is a consequence of insufficiently careful observance of an asepsis or existence of an endogenous infection. Contrary to gonorrheal such epididymite quite often leads to development of heavy suppuration and can be a source of a septicaemia. For the purpose of prevention of an epididymite beforehand apply antiseptic agents, appoint carrying a suspenzoriya.
A serious complication of catheterization is also the so-called urethral fever arising later a nek-swarm time after implementation of the procedure; the patient has a fever, gektichesky temperature increase, plentiful sweat, a serious general condition, sometimes with sharp weakening of cordial activity. As the reason of «urethral fever» serves the infection (microorganisms or their toxins) getting into a blood channel from the existing inflammatory centers through the injured mucous membrane of an urethra. For the warning of urethral fever to the patients who are subject to catheterization and quite often being carriers of an infection of uric ways, preventively appoint antibiotics and the corresponding himiopreparata. Treatment of urethral fever includes antibacterial and antipyretics, in hard cases — with elements of an intensive care.
Failure of catheterization of an ureter and pelvis can be caused patol, the process in a bladder hiding the ureteric mouth or impassability of an ureter (an obliteration of its gleam, a prelum from the outside, excesses, obstruction by a concrement, a blood clot, caseous or purulent traffic jams).
Bibliography Corin D. L., Smolin V. V. and Gutkin X. G. Damage of ureters and kidneys at a retrograde piyelografiya, Urology, No. 3, page. And, 1961; M. O Furniture of catheterization of ureters in the diagnostic and therapeutic purposes, Urol, and nefrol., No. 5, page 21, 1969, bibliogr.; The multivolume guide to surgery, under the editorship of B. V. Petrovsky, t. 9, page 62, M., 1959; Nechiporenko A. 3. About perforation of a kidney and an ureter a catheter, Urology, No. 3, page 14, 1961; The Guide to clinical urology, under the editorship of A. Ya. Py-tel, page 158, M., 1969; The Reference book on urology, under the editorship of N. A. Lopatkin, page 264, M., 1978; Complication of urologic surgery, ed. by R. B. Smith a. D. G. Skinner, Philadelphia, 1976.