|Minor Surgical Procedures in Remote Areas (MSF, 1989, 172 p.)|
|Chapter 5: uro-genital procedures|
Drainage of urine
Acute retention of urine
Urgent procedure is necessary for:
· Narrowing of the
· Adenoma or cancer of the prostate
· Pelvic tumor
· Pelvis trauma
· Sterilised gloves and drapes
· Sterile catheters, generally Foleys n° 12,14,18 for example
· Lubrification with chlorhexidine (+ cetrimide) (see table page 7)
· Sterile compresses
· 10 ml syringe
(Figures 88, 89)
· Careful disinfection of the meatus, the glan and the prepuce, through the hole in the drapes.
· Coat the catheter with chlorhexidine (+ cetrimide) (see table page 7)
· The left hand holds the penis vertically
· The right hand carefully introduces the catheter through the meatus.
· Change the size of the catheter if introduction is difficult.
· When the catheter reaches the bulbar angle (13 to 15 cm), direct it towards the base.
· NEVER FORCE THE CATHETER, it is better to use a suprapubic catheter than to traumatise the urethra.
· Advance the catheter to the hilt before inflating the balloon (5 to 10 ml of liquid).
· Next, gently pull the catheter until the balloon abuts on the bladder neck.
· Always replace the prepuce around the glans, to prevent a paraphymosis.
· If the catheter is to remain in place, connect it to a sterile urine container, otherwise to a perfusion tube attached to a short necked bottle.
· Clean the meatus each day, and eventually, depending on the clinical context, institute antibiotic treatment (cotrimoxazole: 1,600 mg de SMX/day in 2 divided doses x 5 days for an adult.
When urethral catheterisation presents difficulties, and when there is a risk of damage to the urethra with the catheter (trauma to the bladder, trauma to the urethra, and urethral stenosis, etc.).
The bladder must be dilated: A DISTENDED BLADER IS OBLIGATORY.
· A prepared pack exists with a unique "cystocath". If not available, a large trochar and long catheter perforated at one end (at least 14G), can be used.
· Drapes with a hole, and sterile gloves
· Suture material
· Local anesthetic
· Shave and then disinfect the suprapubic region with polyvidone iodine (see table page 7).
· Make a bubble in the skin with lidocaine a finger breadth above the symphysis pubis in the median line. Anesthetise the deep tissue planes (Figure 91).
· With the same syringe ensure that aspiration produces urine.
· Puncture through the anesthetised bubble, asking the patient to cough.
· Introduce the perforated drain: advance 10 to 15 cm of the catheter, remove the trocar and attach the catheter to a sterile urine container.
· Fix the drain to the skin with a non resorbable suture and a dressing.
· Clean the drain at least once a day and institute urinary antibiotic treatment (cotrimoxazo/e: 1,600 mg of SMX/day in 2 doses for adults x 5 days) (Figures 92, 93, 94).