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Urology Presentation PAR Nurses Conference: Nov 3 2012

Urology Presentation PAR Nurses Conference: Nov 3 2012. Herman Kwan Urologist Peace Arch Hospital. Outline:. Green light laser Ileal conduits Urinary catheters Difficult catheterization Ureteroscopy, laser lithotripsy Stent intolerance CBI tips. Green light laser.

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Urology Presentation PAR Nurses Conference: Nov 3 2012

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  1. Urology Presentation PAR Nurses Conference: Nov 3 2012 Herman Kwan Urologist Peace Arch Hospital

  2. Outline: • Green light laser • Ileal conduits • Urinary catheters • Difficult catheterization • Ureteroscopy, laser lithotripsy • Stent intolerance • CBI tips

  3. Green light laser

  4. Laser wavelength is absorbed by hemoglobin It will not vaporize anything without hemoglobin.

  5. Traditional TURP

  6. Green light Laser video

  7. Green light laser summary • Same results as standard TURP • Less bleeding • DAY CARE PROCEDURE!!

  8. ILEAL CONDUIT

  9. Early complications of abdominal stomas • bowel necrosis • Bleeding • Dermatitis • parastomal hernia • Prolapse • Obstruction • stomal retraction • stomal stenosis

  10. URINARY CATHETERS

  11. Urethral dilators

  12. Difficult catheterization • Use the right catheter • Bigger is usually better • Coude men • Use a urojet • Want lubricant all the way to the bladder • Hold the penis on stretch • Straightens urethra

  13. Difficult catheterization: female • Exposure: lights, frog-leg…do not disadvantage yourself! • finger in vagina (non dominant hand) and slide catheter above finger • Atrophic vaginits, retracted urethra

  14. SUMMARY CATHETERIZATION • Use a urojet. He will thank you for it. • Try a coude. You don’t need an order to do this. • Keep the penis on stretch. • Push the catheter to the hilt, then blow ballon up.

  15. Urolithiasis

  16. Ureteroscopy and laser lithotripsy

  17. Flexible/rigid ureteroscopes

  18. Postop Ureteroscopy • Flank pain! • Can’t pee! • Hematuria! • Stent pain

  19. Stent with dangle string

  20. Why do stents cause so much pain?

  21. Stent discomfort • Strategies to minimize: • Medications that calm the bladder • Anticholinergics (ditropan, B&O supp) • Opiods (morphine, demerol) • Ensure bladder is empty • Alpha blockers

  22. CBI tips • Continuous bladder irrigation • Purpose: keeps urine clear and dilute so clots cannot form • It is not to irrigate out clots!!!

  23. Bladder full of clot = big trouble! • Catheter may clog and bladder may over distend with CBI. This is can be a disaster in immediate post op period • Bladder tumor resection • Radical prostatectomy • TURP • Partial nephrectomy

  24. CBI take home messages: • Keep it running so urine is pinkish clear • Check for bladder distension • Keep drip chamber clear • CBI post TURBT: CLOSE MONITORING! • CBI does not flush out clots • Needs tomey syringe and hand irrigation for this. • Deflate balloon when irrigating

  25. Drains: • Purpose: to let the surgeon know what is happening at the site of surgery • Is there a urine leak? • Is there bleeding?

  26. Partial nephrectomy

  27. Drain management • Typically kept on bulb suction • Note appearance: bloody? Urine? • Note volume • Send it for creatinine • If serous will be same as serum creatinine • If urine will be over 1000

  28. end, thank you!

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