INSTRUMENTATIONS

Presented by:
Ruaa Amer
Dania Haidar
Ruaa Abbas
Taher Hamza
The Contents:

1- Ureteric Stent

2- Nephrostomy

3- Suprapubic Catheterization

4- Cystoscopy
 Ureteric Stent
 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.
Indications

● Ureteral obstruction
● Adjunct to stone therapy
● Post-operatively following ureteroscopic surgery
- Manipulation of a kidney stone
- Biopsy
- Dilation of a ureteral stricture
 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
performed.
 How 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
 Complications

 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
Nephrostomy
 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.
Indications
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
stones
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
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.
Complications

 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%.
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
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
Complications
 1- Gross hematuria is typically a transient
condition
 2- post obstruction diuresis is possible
 3- Cellulitis and abscess formation.
 4- Displacement
 5- Bowel perforation and intra-abdominal visceral
injuries are possible
Contraindications
 It is absolutely contraindicated in the absence of an easily
palpable or ultrasonographically localized distended urinary
bladder.

 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).
Cyctoscope
 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.

Flexible Cystoscopy
A thin (about the width of a pencil), bendy
cystoscope is used, and you stay awake while it's
carried out
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
Indications
 Diagnostic :
 hematuria
 persistent irritative symptoms
 Urinary retention
 Recurrent UTI
 Suspected new growth
 Retrograde pyelogram
 Therapeutic
 Placement of stent
 Resection of bladder tumors
 Extraction or laser lithotripsy of stones .
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
THANKS FOR ATTENTION