Page 1359 - TNFlipTest

Toronto Notes 2019
Selected Urological Procedures
Urology U41
• U/Sofadrenals,gonads,uterus,andfallopiantubes • endoscopyandgenitographyofurogenitalsinus
Treatment
• steroidsupplementationasindicated(e.g.CAH) • sexassignmentafterextensivefamilyconsultation
■ must consider capacity for sexually functioning genitalia in adulthood, fertility potential, and psychological impact
• reconstructionofexternalgenitaliabetween6and12mo
• long-termpsychologicalguidanceandsupportforbothpatientandfamily
Enuresis
• seePediatrics,P9
Selected Urological Procedures
Bladder Catheterization
• cathetersizemeasuredbytheFrench(Fr)scale–circumferenceinmm
• each1mmincreaseindiameter=approximately3Frincrease(standardsize14-18Fr) • shouldberemovedassoonaspossibletoreducetheriskofUTI
Continuous Catheterization
• indications
■ accurate monitoring of U/O
■ relief of urinary retention due to medication, neurogenic bladder, or intravesical obstruction ■ temporary therapy for urinary incontinence
■ perineal wounds
■ clot prevention (22-24 Fr) for CBI
■ intra- and post-operative
■ comfort for end of life care
Alternatives to Continuous Catheterization
• intermittentcatheterization
■ PVRmeasurement
■ to obtain sterile diagnostic specimens for U/A, urine C&S
■ management of neurogenic bladder or chronic urinary retention
• condomcatheter
• suprapubiccatheter
Causes of Difficult Catheterizations and Treatment
• patientdiscomfort→usesufficientlubrication(±xylocaine)
• collapsingcatheter→lubricationasabove±firmerorlargercatheter(silasticcatheter)
• meatal/urethralstricture→dilatewithprogressivelylargercatheters/ballooncatheter
• traumaticinjury:repeatedpriorattemptsatcatheterizationhavecreatedtraumaticfalsepassage • BPH→useCoudécatheterasangledtipcanhelpnavigatearoundenlargedprostate
• urethraldisruption/obstruction→filiformandfollowersorsuprapubiccatheterization
• anxiouspatient→anxiolyticmedication
Complications of Catheterization
• infection:UTI,bladderfistula,bladderperforation(rare) • meatal/urethraltrauma
Contraindications
• trauma:bloodattheurinarymeatus,scrotalhematoma,pelvicfracture,and/orhighridingprostate
Robinson tip
Coudé tip
Inflation port Urine
Two-way Foley
Inflation port Urine
Irrigation port
Three-way Foley
Figure 24. Transurethral (Foley) catheters
© Tobi Lam