输尿管镜下筋膜扩张器扩张治疗成年男性尿道狭窄——附6例报告

目的：探讨输尿管镜下筋膜扩张器扩张治疗成年男性尿道狭窄的疗效和安全性。方法：门诊常规行尿道扩张失败的6例成年男性尿道狭窄患者，采用输尿管镜下筋膜扩张器进行尿道扩张（自尿道外口进输尿管镜，到尿道狭窄段时均无法通过，留置斑马导丝经狭窄段进入膀胱，并在其引导下循序用F8～F18筋膜扩张器扩张狭窄尿道），术后留置尿管至少2周。观察手术效果。结果：6例患者尿道扩张全部成功，无发生尿道热、假道形成、直肠损伤等并发症。拔除尿管后，患者最大尿流率由治疗前4～9mL／s上升至13～21mL／s。随访3个月-1年，4位患者排尿通畅，未出现再次狭窄。2位患者需再次门诊常规尿道扩张，术后患者未再出现排尿不畅。结论：输尿管镜下筋膜扩张器扩张治疗成年男性尿道狭窄疗效较好，安全性好。     

改良金属导尿管治疗球部尿道损伤22例

目的:探讨用改良金属导尿管治疗球部尿道损伤的价值.方法:将普通金属导尿管改良,经尿道插入膀胱,导入导丝,引导插入Foley导尿管.结果:22例球部尿道损伤患者经常规导尿失败后改用本法,16例成功插入导尿管,随访无一例尿道狭窄.结论:改良金属导尿管治疗球部尿道损伤方法简单、有效.     

内镜辅助下筋膜扩张器治疗男性尿道狭窄

目的:探讨内镜辅助下筋膜扩张器治疗男性尿道狭窄的方法及疗效。方法:对2015年9月~2017年9月共9例尿道狭窄临床治疗经验进行分析总结。本组患者均行椎管麻醉或者全麻,先于输尿管镜下或膀胱尿道镜下寻及尿道狭窄处,将斑马导丝直视下通过狭窄段置入膀胱,后用筋膜扩张器顺次递增方法扩张狭窄段尿道,保留导尿4~6周,并随访疗效。结果:本组9例患者均成功扩张尿道,并术后成功置入F20/22导尿管;手术时间平均25min,手术无明显失血;术后4~6周(平均40d)停保留导尿后正常排尿,随访1~24月未见尿道狭窄复发。结论:内镜辅助下筋膜扩张器可以有效治疗复杂男性尿道狭窄,方法简单易于掌握,适宜临床推广使用。     

医源性多假道尿道狭窄的治疗体会

目的探讨多假道尿道狭窄的治疗方法。方法对4例后尿道狭窄合并医源性多假道的患者内镜下放置斑马导丝,在导丝引导下行筋膜扩张器尿道扩张术。结果通过正确的路径,顺利找到狭窄尿道,4例患者获满意疗效。结论内镜下放置导丝,在导丝的引导下筋膜扩张器尿道扩张术是治疗医源性多假道尿道狭窄的有效方法。     

电子膀胱软镜联合 S形尿道扩张器在尿道狭窄微创治疗中的应用

目的：探讨电子膀胱软镜联合S形尿道扩张器微创治疗尿道狭窄的疗效。方法采用平卧位局麻下电子膀胱软镜直视置入斑马导丝，沿导丝用套入法通过S形尿道扩张器进行尿道扩张治疗男性尿道狭窄31例，患者狭窄长度0.5~2.0cm。结果所有患者均成功手术，未发生医源性损伤。本组患者在治疗及随访中无假道，无明显出血，无尿道穿孔、直肠损伤，无永久性尿失禁等并发症发生。结论电子膀胱软镜联合S形尿道扩张器治疗尿道狭窄成功率高、安全、痛苦小，患者耐受性好。     

硬脊膜麻醉导管在导尿中的应用

1999～ 2 0 0 2年我们对应用导尿管 9例 (其中 6例用氟雷氏尿管 ,2例加用金属导尿管 )导尿失败后 ,借助硬脊膜麻醉导尿管引导 ,导尿取得成功 ,方法介绍如下。1　对象和方法1.1　对象　本组尿潴留患者皆为男性 ,年龄最大 81岁 ,最小5 9岁 ,平均 74岁。其中前列腺增生 4例 ,脑血管意外 2例 ,外伤性尿道狭窄 1例 ,阑尾炎与斜疝术后各 1例。1.2　方法　经使用氟雷氏尿管或金属导尿管导尿失败后 ,按常规导尿法将硬脊膜麻醉导管插入尿道见尿液流出后用 1次性吸痰管或头皮针以前者为导丝插入尿道至膀胱 ,见尿液流出后再插入 2 cm固定 ,并拔出硬脊膜…     

硬性膀胱镜加软性膀胱镜在尿道会师术中的应用

目的:探讨硬性膀胱镜加软性膀胱镜在尿道会师术中的应用价值.方法:1998年以来,在硬性膀胱镜加软性膀胱镜并软性导丝引导下尿道会师术治疗男性尿道损伤25例,疗效与同期常规方法治疗男性尿道损伤31例进行比较.结果:25例病人中23例一次成功,2例由于骨盆骨折尿道完全断裂改用常规手术,获随访21例,1例尿道狭窄,需定期尿道扩张;对照组获随访29例,11例尿道狭窄.双会师术尿道狭窄的发生率明显低于常规手术组(P《0.01).结论:在尿道会师手术中,软性膀胱镜由于管径小、弯曲灵活,造成尿道再损伤小,配合硬性膀胱镜并软性导丝的引导下放置双腔导尿管牵引,创伤小,并发症少,具有一定的优越性.     

硬膜外麻导管用于婴儿导尿的临床观察

随机选择1990年1月~1997年9月男性婴儿尿潴留导尿术患者50例,其中25例选用普通导尿管导尿为对照组,25例选用硬膜外麻导管导尿为观察组,进行效果比较,经统计学处理,结果显示:观察组导尿成功率明显优于对照组,2组比较有显著差异性,P<0.05.作者认为男性婴儿尿潴留选用硬膜外麻导管导尿克服了因尿道狭窄小儿普通导尿管插管困难和损伤尿道的缺点,具有一定的临床应用价值.     

硬膜外导管在婴幼儿导尿术中的应用

在给男性婴幼儿导尿时,常因尿道口及尿道狭窄置使导尿术失败。为此,我们在实际工作中,常用一次性硬膜外导管应急代替导尿管为其导尿,效果较好。现介绍如下。1用物麻醉用一次性无菌硬膜外导管1根,5ml注射器1支,其他与常规导尿术所用物品相同。2方法导尿术按常规操作。将一次性无菌硬膜外导管前端用石蜡油润滑,沿尿道走向缓慢置入6~7cm后,轻轻挤压下腹部或在导管末端用注射器回抽,见尿液后连针头接尿袋。3体会硬膜外导管每小时可流滴尿液为45~50ml,可满足婴幼儿留置导尿。硬膜外导管成本低,对尿道损伤小,成功率高。尿袋挂在低于患者身体处,使…     

1例巧用导丝缓解PICC置管患者拔管困难的护理

总结1例经外周静脉置入中心静脉导管拔管困难患者在导丝引导下顺利拔管的护理经验。拔管前对拔管困难患者做好心理护理,排除穿刺侧肢体存在影响拔管的各种因素,如导管反折处静脉狭窄、血管内膜受损、血栓形成及血管痉挛和血管收缩等。做好充分的皮肤准备,边热敷边拔管,并配合调整穿刺侧肢体做内旋、外旋、内收、外展等各种姿势,几次尝试拔管失败后,为避免导管过度牵拉而断裂,尝试将备用无菌导丝重新放入PICC内,在导丝引导下,借助导丝缓冲力,减缓导管牵拉张力,最终将导管顺利拔出。     

Transabdominal Ultrasound-Guided Urethral Catheterization with Transrectal Pressure

Background

Occasionally, difficulty with standard urethral catheterization is encountered.

Objective

We conducted a pilot study to evaluate whether transabdominal ultrasound (TAUS) showed the tip of a urethral catheter and whether TAUS-guided catheterization with transrectal pressure is successful in male patients in whom performing standard catheterization is difficult.

Methods

The eligible study participants included adult male patients in whom standard catheterization failed in our emergency department or who were transferred from other facilities after failure of catheterization and subsequent urethral bleeding. The enrolled patients included those in whom the tip of a catheter could not be advanced through the posterior and bulbar urethra judging from the inserted length. First, an emergency nurse advanced a catheter until the progress was obstructed. Next, an emergency physician performed TAUS to detect the tip of the catheter. If the tip was detected, the physician inserted the index finger into the rectum and kept pushing the site of the obstruction. After following these procedures, the nurse again advanced the catheter.

Results

Six patients were enrolled. The tip of a catheter was detected in the urethra or the false passage using TAUS in 4 of the 6 patients. In these 4 patients, the curve of the urethra became gentle or the false passage was compressed by transrectal pressure and the tip was advanced smoothly to the bladder.

Conclusions

In some male patients in whom performing standard urethral catheterization is difficult, TAUS reveals the tip of the catheter and TAUS-guided catheterization with transrectal pressure can be safe and useful.     

Modified sonourethrography assists urethral catheterization

Sonourethrography (SUG) is an infrequently used modality to observe the male urethra. We modified SUG to examine the reasons for difficulty in urethral catheterization and to determine a safe approach to resolve these problems. Following retrograde urethral jelly injection, modified SUG (mSUG) was performed in male patients with difficulty in urethral catheterization. mSUG was performed using transcutaneous ultrasonography in patients for whom the catheter became lodged in the penile urethra. In other patients, mSUG was performed using transrectal ultrasonography. We divided the causes of difficult indwelling urethral catheterization into physiological and pathological conditions. With regard to physiological conditions, the urethral catheter became stuck in the bulbous portion, membranous urethra, and prostatic urethra. mSUG distinguished the problematic part of the urethra in real time, and it assisted in overcoming the problem. With regard to pathological conditions, urethral stricture after trauma or surgery was clearly demonstrated in the penile and prostatic portions of the urethra. As with physiological conditions, mSUG images assisted in navigating the catheter through the problematic pathological areas or demonstrated the need to abandon the catheterization. mSUG can visualize the male urethra clearly during urethral catheterization and provide real-time assistance with the procedure.     

护理干预对全身麻醉后留置尿管病人复苏期躁动的影响

[目的]探讨护理干预对全身麻醉后留置尿管病人复苏期躁动的影响。[方法]将100例胸外科全身麻醉男性手术病人随机分成实验组和对照组。对照组气管插管全身麻醉后,按照常规插入14 Fr~16 Fr双腔导尿管留置导尿;实验组除按对照组条件外尚进行心理疏导、插尿管前从尿道注入液状石蜡、复苏期按摩、热敷下腹部等综合护理干预措施。比较两组病人复苏期尿管刺激反应及躁动程度。[结果]实验组病人复苏期尿管刺激症状及躁动情况显著低于对照组病人。[结论]综合护理干预可减少全身麻醉后留置尿管病人复苏期尿管刺激症状及躁动发生率,帮助病人安全、平稳度过麻醉复苏期,减少并发症的发生。     

利多卡因胶浆在男性患者术前留置导尿中的应用效果

目的探讨利多卡因胶浆在男性患者术前留置导尿中的应用效果。方法便利抽样法选择2011年5—12月,在嘉兴市第二医院手术室需术前留置导尿的男性患者80例为研究对象,按随机数字表法将其分为观察组和对照组,每组40例。观察组患者使用利多卡因胶浆润滑导尿管和尿道,对照组患者采用石蜡油棉球润滑导尿管。记录两组患者导尿管置入的一次成功率、置入导尿管时的疼痛程度,并比较患者插管后10min尿道刺激反应程度。结果观察组患者导尿管置入的一次成功率明显高于对照组,差异有统计学意义（P〈0．01）;观察组患者置入尿管时的疼痛程度明显减轻,与对照组比较,差异有统计学意义（P〈0．01）;观察组患者插管后10min尿道刺激反应轻,与对照组比较,差异有统计学意义（P〈0．01）。结论男性患者需术前留置导尿时,应用利多卡因胶浆润滑导尿管和尿道能取得很好的效果,减轻患者疼痛及不适,提高了置人导尿管的一次成功率。     

普外科中年男性病人不同方法留置尿管的效果评价

[目的]观察普外科中年男性病人不同方法留置尿管的效果。[方法]将90例留置尿管的中年男性病人随机分为实验组和对照组,实验组在留置尿管前5min从尿道外口注入1%盐酸丁卡因胶浆5 g后按常规方法将尿管置入;对照组在留置尿管前5min从尿道外口注入无菌液状石蜡5 mL后也按常规方法将尿管置入。[结果]实验组一次置管成功率明显高于对照组,置管过程及置管后疼痛程度、肉眼血尿程度明显低于对照组(P<0.05)。[结论]1%盐酸丁卡因胶浆可明显减轻围术期中年男性病人的疼痛程度及肉眼血尿程度,提高一次置管成功率。     

护理干预对全身麻醉后留置尿管病人复苏期躁动的影响

[目的]探讨护理干预对全身麻醉后留置尿管病人复苏期躁动的影响.[方法]将100例胸外科全身麻醉男性手术病人随机分成实验组和对照组.对照组气管插管全身麻醉后,按照常规插入14 Fr～16 Fr双腔导尿管留置导尿;实验组除按对照组条件外尚进行心理疏导、插尿管前从尿道注入液状石蜡、复苏期按摩、热敷下腹部等综合护理干预措施.比较两组病人复苏期尿管刺激反应及躁动程度.[结果]实验组病人复苏期尿管刺激症状及躁动情况显著低于对照组病人.[结论]综合护理干预可减少全身麻醉后留置尿管病人复苏期尿管刺激症状及躁动发生率,帮助病人安全、平稳度过麻醉复苏期,减少并发症的发生.     

Late venous laceration after inappropriate placement of a left internal jugular hemodialysis catheter: a case report

Central venous catheterization is a necessary and common method of building the circulation pathways of patients with end-stage kidney disease. Venous rupture is a severe and fatal complication of central venous catheterization. We herein present a case of slowly occurring venous rupture after reinsertion of a left internal jugular vein (IJV) catheter. A man in his early 70s was hospitalized with end-stage kidney disease. We inserted a hemodialysis catheter through the left IJV. A short section of the patient’s catheter slipped out 1 month later. The original catheter was reinserted at its primary position without a guidewire. The patient reported chest pain and developed hypotension during dialysis the next day. He underwent femoral venous catheter insertion and heparin-free dialysis. The patient finally recovered and underwent regular hemodialysis using an arteriovenous fistula in the left forearm. This is the first reported case of venous laceration after repeated left IJV catheterization. Left IJV catheterization is associated with high rates of complications and should be closely monitored with the help of radiography during and after the operation. Central venous catheters should be carefully placed with clear knowledge of their direction and location to prevent serious complications.     

Factors Affecting Pain Scores during Female Urethral Catheterization

OBJECTIVES: To compare pain and discomfort ratings of female patients undergoing urethral catheterization randomized to topical application of plain lubricant versus lidocaine gel prior to the procedure. METHODS: This was a prospective, randomized, double-blind study involving female patients requiring urethral catheterization at an urban university-based academic emergency department. A staff nurse blinded to the lubricant type injected 5 mL of sterile surgical lubricant or 2% lidocaine gel into the urinary meatus. After 1 minute, an 8-F (for specimen collection) or a 16-F (for continuous collection) catheter was inserted into the urethra. Each patient rated the pain of the procedure on a validated 0- to 100-mm visual analog scale. The Mann-Whitney U test was used to analyze associations between pain ratings, lubricant type, and catheter size. Logistic regression was used to identify the contribution of lubricant type, catheter size, age category, difficulty of insertion, preprocedural pain, and diagnosis of urinary tract infection to procedural pain rating. RESULTS: One hundred women were randomized to plain lubricant (n = 50) or lidocaine (n = 50). The overall mean ( +/- SD) pain score was 23.5 +/- 27.2 mm. No significant differences in pain ratings were found based on catheter size or lubricant type. Younger women, aged 18-59 years, experienced higher pain ratings than women aged 60-101 (mean pain difference 14.4 mm; 95% CI = 4.3 to 24.5; p < 0.006). Multiple logistic regression identified preprocedural pain as the only predictor of higher pain rating after catheterization (OR 1.02; 95% CI = 1.002 to 1.039, p = 0.03). CONCLUSIONS: Catheter size and lubricant type did not affect the severity of pain after urethral catheterization in women.     

Evaluation of a device to facilitate female urethral catheterization.

Urethral catheterization is a skilled procedure that nurses in hospital settings perform routinely. The opening of the female urethra is located within the vulvar vestibule, making insertion of urinary catheters into females a greater technical challenge than in males. Researchers evaluated whether a new device might decrease the time required for catheter insertion, increase the likelihood of inserting the catheter on the first attempt (improved accuracy), and reduce patient discomfort. Comments about the device from both patients and nurses also are reported.