1. Specialized methods of Urological Treatment ( Lecture # 2 )

2. CATHETERISATION Catheters are used mainly therapeutically to relieve urinary retention. Catheters are used mainly therapeutically to relieve urinary retention. Types and sizes of catheters Material : Material : - soft silicon coated latex (silicon is highly resistant to incrustation), it can be introduced up to 4 weeks - 100% silicon - it can be introduced up to 8 weeks (it is better, but more expensive)

3. CATHETERISATION cont. … Types of catheters : 1. One way catheter : for dilatation of urethral stricture, to discover residual urine (better it is performed by ultrasound), to introduce contrast medium into the bladder 2. Two way catheter : self-retaining balloon catheter = Foley catheter 3. Three way catheter : for irrigation (lavage) of bladder (by bleeding to bladder after prostatectomy, due to bladder tumour)

4. CATHETERISATION cont. … Division by a tip of catheter : Nelaton - straight round tip Tiemann - curved pointed tip Size of catheters : French scale = Charrie scale = circumference in mm diameter is size in F (Ch) divided by ( = 3.14) e.g. catheter 18 F has diameter 6 mm

5. ENDOSCOPY Two types of endoscopes: 1. rigid. 2. flexible. Examination is more difficult, an endoscope is more expensive, through this endoscope can be passed only flexible instruments, but for patient is this flexible endoscopy more pleasant

6. ENDOSCOPY cont. … Panendoscopy : Uretroscopy and cystoscopy = endoscopy of urethra and urinary bladder Panendoscopy : Uretroscopy and cystoscopy = endoscopy of urethra and urinary bladder Ureteroscopy :Endoscopy of ureter Ureteroscopy :Endoscopy of ureter Ureterorenoscopy : Endoscopy of ureter and renal pelvis too Ureterorenoscopy : Endoscopy of ureter and renal pelvis too Endoscopic operations Lithotripsy : disintegration of stone in bladder and ureter Lithotripsy : disintegration of stone in bladder and ureter Transurethral resection of prostate (TURP = TUPE) and bladder tumour ( TURT ) Transurethral resection of prostate (TURP = TUPE) and bladder tumour ( TURT )

7. ENDOSCOPY cont. … Nephroscopy It is used mainly for treatment of stones = nephrolitholapaxy It is used mainly for treatment of stones = nephrolitholapaxy

8. Nephrostomy To the dilated renal pelvis is introduced under ultrasound and/or radiological control catheter (= percutaneous nephrostomy). Percutaneous nephrostomy step by step: Needle puncture of dilated renal pelvis under X- ray or/and ultrasonography control Needle puncture of dilated renal pelvis under X- ray or/and ultrasonography control Guide wire passed down needle Dilatation of channel over guide wire Guide wire passed down needle Dilatation of channel over guide wire "pig-tail" catheter inserted over guide wire "pig-tail" catheter inserted over guide wire

9. Fig. Scheme of introduction of percutaneous nephrostomy.

10. BIOPSY Prostate biopsy Indication: suspicion on prostate cancer It is performed transrectal (or transperineal) under mainly ultrasound control Indication: suspicion on prostate cancer It is performed transrectal (or transperineal) under mainly ultrasound control Biopsy of kidney It is done under ultrasonography or CT control. Mainly used in nephrology, biopsy for kidney tumour is indicated rarely. It is done under ultrasonography or CT control. Mainly used in nephrology, biopsy for kidney tumour is indicated rarely.