Urology Presentation PAR Nurses Conference: Nov 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

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

Traditional TURP

Green light Laser video

Green light laser summary Same results as standard TURP –Less bleeding –DAY CARE PROCEDURE!!

ILEAL CONDUIT

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

URINARY CATHETERS

Urethral dilators

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

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

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.

Urolithiasis

Ureteroscopy and laser lithotripsy

Flexible/rigid ureteroscopes

Postop Ureteroscopy Flank pain! Can’t pee! Hematuria! Stent pain

Stent with dangle string

Why do stents cause so much pain?

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

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

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

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

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

Partial nephrectomy

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

end, thank you!