CATHETERS & GUIDE WIRES

1. CATHETERS & GUIDE WIRES Dr Keshavamurthy R Professor of Urology Institute of Nephro-Urology

2. GUIDEWIRES Use of guidewire – sine qua non of entire field of Endo-urology. Early 1980 – Use in Urology Guidewire – 1) Provides access to particular part of the Urinary tract. 2) Serve as a guide over which catheters and stents can be passed.

3. GUIDEWIRES Classified based on following properties Size Tip design Surface coating Shaft rigidity SIZE : Guidewires are available in various length and diameter In Urology – 145 -150cm Diameter – 0.018 to 0.038in

4. GUIDEWIRES Tip Design Tip of the guidewire must provide a reliable atraumatic path up the ureter. Ureteral anatomy & pathologic process dictate which tip is most capable of achieving and maintaining ureteral access Straight tip Angled tip J tip Length of the floppy – 3cm to 15cm

5. GUIDEWIRES SURFACE COATING Purpose of surface coating is to reduce friction Low co-efficient of friction to negotiate up the ureter Polytetrafluoroethylene ( PTFE) Hydrophilic coating – polymers which can absorb water to produce non frictionless surface. Various colors are used in coating

6. GUIDEWIRES SHAFT RIGIDITY Spring guide Inner core wire Mandrel Spring guide is a round wire tightly wrapped around the core. For smooth passage of instrumentation Core provides the strength and stability to the wire

7. GUIDEWIRES FIXED CORE MOVEABLE CORE Superstiff guide wire – the inner core diameter is increased and the spring guide is flattened thus maintaining the diameter. Newer guidewires – combining the features of different types Eg : TRIWIRE 12cm hydrophilic coated tip, superstiff nitinol non slippery body, flexible end to protect damage

8. GUIDEWIRES DIFFERENT TYPES STANDARD FIXED CORE PTFE STRAIGHT TIP J TIP BIWIRE

9. GUIDEWIRES DIFFERENT TYPES AMPLATZ SUPERSTIFF WIRE DOUBLE FLEXIBLE ROADRUNNER

10. GUIDEWIRES DIFFERENT TYPES NITINOL WIRE ( HIWIRE) GLIDEWIRE

11. CATHETERS

12. FOLEY CATHETER History : First written record of use of urethral catheter - 6th Century B C Sushruta Chinese – 1st Century B C used Aliumfistulosum a variety of onion leaves coated with lacquer KATHIENAI - Greek word meaning “ Send down” Erasistratus of lulis – named it in 4th Century B C

13. HISTORY ( Contd ) Until middle of Nineteenth century - Metallic catheter Charles Goodyear – Discovered vulcanized rubber Auguste Nelaton – Rubber catheter which was firm yet flexible 1935 – Frederick Eugene Basil Foley - invented a one piece catheter with a self retaining balloon. He lost a patent battle with BARD , however the name FOLEY was retained.

14. URINARY CATHETERS 1. Drainage 2. Access 3. Diagnostic studies

15. URINARY CATHETERS Several ways to classify Size Channel Balloon size Tip design : Coude, Tieman, Whistle tip Material Position

16. URINARY CATHETERS Material : Latex Silicone coated latex All silicone PVC PTFE Coated Hydrogel coated Antibiotic impregnated

17. FOLEY CATHETER Color coding 10fr - White 14Fr – Green16fr – Orange 18fr - Red 20fr – Yellow 22fr - Purple24fr - Blue

18. FOLEY CATHETER Three way foley Two way silicone coated All silicone foley Hematuria foley catheter Tieman catheter

19. MALECOT’S CATHETER 1892 – MALECOT Senior Intern of Felix Guyon Wing tipped self retaining catheter

20. DE PEZZER CATHETER 1890 – De Pezzer Mushroom ended catheter

21. PIGTAIL CATHETER ROBINSON CATHETER

22. URETERIC CATHETERS SPIRAL TIP CATHETER Used for drainage and retrograde pyelogram. The spiral tip aids in negotiation of a tortuous or partially obstructed ureter. The large sideport below the spiral allows passage of a wire guide. CONE TIP CATHETER Used for Bulb ureterogram

23. URETERIC CATHETERS RUTNER URETERIC CATHETER Used for retrograde pyelogram. The tip stabilizes the catheter by temporarily wedging in and occluding the ureteral orifice FLEXI TIP CLOSED END CATHETER Used for drainage and retrograde pyelogram. The flexible tip is designed for atraumatic entry of the ureteral orifice and navigation of a tortuous ureter.

24. URETERIC CATHETERS Used for directing a flexible-tipped wire guide in the ureter. Angled tip ureteric catheter

25. URETERIC CATHETERS Echo tip open end ureteral catheter Used for drainage and irrigation. The EchoTip band enhances ultrasonic and fluoroscopic visualization of the catheter tip location Whistle tip ureteric catheter

26. URETERIC CATHETERS Pollack Universal ureteric catheter Used for atraumatic passage of a wire guide, biopsy brush or other devices in the ureter. The device can also be used for drainage or retrograde pyelogram Kumpe catheter Used in combination with a HiWire , Bentson or other flexible-tipped wire guide to gain difficult ureteral access beyond a redundant or tortuous ureteral segment. The catheter can be used to manipulate around and beyond a ureteral stone, or possibly to dislodge or free a lightly impacted stone from the mucosal wall.

27. URETERIC CATHETERS BUSH Ureteral illuminating catheter Used for transillumination of the ureters during laparoscopic or open surgical procedures. Transillumination helps to identify the ureter and minimize potential trauma to the ureter.

28. THANK YOU