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

5. Green light laser

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

7. Traditional TURP

9. Green light Laser video

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

11. ILEAL CONDUIT

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

16. URINARY CATHETERS

17. Urethral dilators

18. 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

19. 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

23. 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.

24. Urolithiasis

25. Ureteroscopy and laser lithotripsy

26. Flexible/rigid ureteroscopes

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

32. Stent with dangle string

33. Why do stents cause so much pain?

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

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

36. 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

37. 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

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

40. Partial nephrectomy

41. 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

42. end, thank you!