Special Surgical Procedures II
LESSON 3: Procedures in Genitourinary Surgery
Section Ii: general considerations in genitourinary surgery
3-12
3-12. DRAINAGE TUBES AND CATHETERS
a. Ureteral catheterization may also precede radical operations. Preoperative preparations of the patient and cystoscopy instruments with catheterizing telescopes are needed.
b. Whenever the urinary tract is opened, there is the danger of leakage of urine. All such wounds require careful drainage. Drainage tubes in the urinary tract must be kept open at all times and the surgeon should be notified immediately if there is no drainage. The tube or catheter used to drain the bladder suprapubically must be stiff enough to prevent collapse. An angulated tube or catheter may be useful in preventing kinking if bulky dressings are used. The catheters or tubes should be tested for patency, flushed and suctioned prior to use. Modern vacuum drainage collectors (of the Hemovac type) have been successful in maintaining drainage and keeping wounds dry.
c. Ureterostomy and nephrostomy tubes must be carefully identified, fixed in position, and guarded to prevent dislodgment or obstruction. There are various types of catheters available for specific situations. Catheters are used for diagnostic purposes and to explore the urethra for stenosis, discover residual urine in the bladder, and introduce contrast medium into the bladder.
d. Filiform tips and followers are used to dilate narrow strictures. Graduated woven ureteral catheters are used to introduce radiopaque material or obtain a sterile urine specimen from the renal pelvis and to help determine renal function.
e. The olive-tipped bougies are used to calibrate the urethra. The silk woven catheter may be used to manipulate past enlarged prostatic lobes. In some cases, a catheter stylet is used to insert a catheter. The catheter should be lubricated before the stylet is inserted. The catheter is drawn taut over the stylet so that its tip cannot become dislodged. Catheters with inflatable balloons are used for drainage and for pressure to help control bleeding.
