Aɖuɖɔtoe Kpata Kple Aɖuɖɔtoe si Woxena Ðe Ame Me ƒe Beléle Kpata¶

Acute urinary retention (AUR) nye ŋutetemanɔamesi kpata, si me vevesese le be woakɔ tsinyegoea me togbɔ be tsinyegoe si yɔ fũ, si keke kabakaba, si me **aɖuɖɔ si xaxa 500 va ɖo esi wu 1,500 mililita (17 va ɖo 50 fluid ounces) le hã. Nusi hiã kpata nenema ke enye cutely blocked indwelling urethral (Foley) alo suprapubic catheter, afisi mineral encrustation, mucus ɣi, mɔ̃ ƒe kink, alo ʋu ƒe sisi ƒoa catheter drainage tube la nu ƒu le. Ne aɖuɖɔ mete ŋu si le tsinyegoea me o la, tsinyegoe me tsi ƒe nyaƒoɖeamenu dzina ɖe edzi kabakaba, si wɔnɛ be ƒodo ƒe akpa si le anyime (suprapubic) ƒe ʋuʋu sesẽ, autonomic nervous system surges (ʋu ƒe sisi ƒe dzidziɖedzi sesẽ alo eƒe agbe afɔku vɛ autonomic dysreflexia ƒe dɔléle si nye autonomic dysreflexia le dɔnɔ siwo xɔ abi le aklã me), megbenyaƒoɖeamenu si yi dzi si xea ayiku eveawo siaa (ayiku megbe ayiku ƒe abixɔxɔ sesẽ kple akpa eve ƒe hydronephrosis), kple urosepsis ƒe dɔléle.

Wò agbanɔamedzi enumake ne ame aɖe mate ŋu aɖu aɖuɖɔ o alo eƒe aɖuɖɔtoe si me tsi le si xe mɔ na wòe nye be wòadzudzɔ tsinono katã enumake (tsi geɖe nono ne tsinyegoe ƒe dodoƒe xe mɔ na tsinyegoe ƒe keke fũ kple vevesese nu sẽna ɖe edzi), screen for neurological cauda equina ƒe dɔléle si nye cauda equina ƒe dɔléle (akɔtave kple sɔdola ƒe ʋuʋu alo afɔ ƒe gbɔdzɔgbɔdzɔ) kple ** .autonomic dysreflexia ƒe dɔléle si nye autonomic dysreflexia** (taɖuame si le ƒoƒom kple ʋusɔgbɔdɔ le dɔnɔ si xɔ abi le aklã me), wɔ sekɛnd 60 ƒe gotagome ka ƒe mɔ̃memi ƒe dodokpɔ (ɖe ʋuƒo siwo wotro la ɖa, nàɖe afɔ ƒe ka sesẽwo ɖa, eye nàɖiɖi tsidzɔƒe ƒe akploa ɖe anyi le tsinyegoe ƒe seƒe te) ne ʋuka aɖe le teƒea xoxo, mègatutu ka siwo le ʋuka me sesĩe gbeɖe o, eye nàyi dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ enumake hena tsinyegoe ƒe teteɖeanyi si me dɔlékui mele o.

Wɔ esia fifia¶

1. Dzudzɔ tsi kple tsiwo katã nono enumake: Ne tsinyegoe ƒe do alo catheter xe la, tsi ɖesiaɖe si nàno la toa ayiku me yia tsinyegoe si xaxa me, si kekea detrusor lãmeka ƒe kaawo ɖe enu eye wònaa suprapubic spasms vevesesetɔe nu sẽna ɖe edzi.
2. Call emergency medical services immediately if high-risk neurological, septic, or trauma red flags are present: Call your local emergency number (911 in the United States and Canada, 112 across the European Union, 999 in the United Kingdom, 000 in Australia) or check our directory of xexlẽdzesi siwo wozãna kpata ne aɖuɖɔtoe ƒe ŋutetemanɔamesi kpe ɖe:
3. Akɔta ƒe abi si wu T6 kple taɖuame si le ƒoƒom, mo si le dzo dam/fifia, alo ʋu ƒe sisi le dzi yim (Autonomic Dysreflexia ƒe Dɔléle, nɔnɔme kpata si hea ʋusɔgbɔdɔ vɛ).
4. Akɔtave, akɔta/akɔta ƒe ʋuʋu ("saddle anesthesia"), alo gbɔdzɔgbɔdzɔ/afɔwo ƒe ʋuʋu (Cauda Equina ƒe Dɔléle).
5. Asrã (>=38.0 degree Celsius / 100.4 degree Fahrenheit), ʋuʋudedi si ʋuʋuna, tɔtɔ, alo taɖuame (Urosepsis).
6. Akɔta ƒe gbagbã nyitsɔ laa, abi si woxɔ le afɔti dzi, alo ʋu si le dodom tso tsinyegoea ƒe nugbɔ (akɔta ƒe gbagbã; mègate catheter dede eme gbeɖe o vaseɖe esime woawɔ retrograde urethrogram).
7. Ne Foley alo suprapubic catheter si nɔa amea me si dzudzɔ tsi sisi la, ƒu du 60-Second External Tubing Check fifia:
8. Unkink: Trace tube bliboa tso ŋutilãa me va ɖo kotokua me; ɖɔ afisi dɔnɔa bɔbɔ nɔ alo mlɔ ʋuƒoa dzi le ɖaɖɛ, ʋuʋudedi, alo ʋuƒo ɖaɖɛ ɖesiaɖe dzɔdzɔe.
9. Unclamp: Kpɔ egbɔ be womegblẽ plastic slide clamp alo catheter flip-flo valve ɖesiaɖe ɖi wòtu le vo me o.
10. Klɔ afɔtiwo: Ðe Velcro afɔ-kotoku ƒe ka sesẽ siwo ate ŋu anɔ silicone lumen falɛfalɛa ƒom la ɖa.
11. Ðe akploa ɖe akɔta te: Tsɔ tsidzɔƒe ƒe akploa yi anyime le tsinyegoe ƒe kɔkɔme te (aɖuɖɔ mate ŋu atso togbɛ dzi atsi tre ɖe nuheŋusẽ ŋu o; akplo si nɔa abadzivɔa dzi la wɔa yaƒoƒo si xea mɔ na tsi ƒe sisi).
12. MÈGAhe Foley ka si le eme la do goe GBEÐE ne mèɖe ya le ememe tsilénu ƒe ʋuƒoa me o, eye MÈGADE naneke ɖe ʋukaa me GBEÐE o: Wotsɔa mililita 10 ƒe tsi si me tsi yɔ fũu si lolo abe cherry tomato ene la blaa Foley ka si le tsinyegoea me. Ne wohe ka aɖe do goe eye wodo balloon la ɖe eme la, egbãa ʋuka si me ʋu sina tona kple tsinyegoe me, si wɔnɛ be ʋu gã aɖe dona le ʋukawo me.
13. Mègazi ƒodo si keke la dzi sesĩe o (Credé maneuver nye afɔku le xexe me): Ne èzi tsinyegoe si keke sesĩe, si xe mɔ na dzi sesĩe la, enaa tsinyegoe me nyaƒoɖeamenu dzina ɖe edzi, ezia aɖuɖɔ si me dɔlékui le dzi wòtrɔna yia ayikuawo me (vesicoureteral reflux), eye ate ŋu agbã tsinyegoe ƒe gli si le tsɛ alo tsinyegoe ƒe diverticulum.
14. Yi kɔdzi ƒe dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ kaba ne aɖuɖɔ aɖeke meto le gaƒoƒo 4 va ɖo 6 me le vevesese si wolé ɖe te megbe o (alo gaƒoƒo 1 va ɖo 2 le tsinyegoe si xe mɔ na ame ƒe ʋuka me): Tsinyegoe ƒe ka si me dɔlékui mele o dodo kpata ɖea vevesesea dzi kpɔtɔna le sɛkɛnd 30 me eye wòkpɔa tsinyegoe ƒe lãmeka kple ayiku ta tso abixɔxɔ tegbee le kekeme me.

flowchart TD
    Start["Vevesese Be Womate Ŋu Aɖe Aɖuɖɔ (Suprapubic Fullness/Spasms) ALOO Aɖuɖɔtoe Zero Tso Indwelling Catheter Me"] --> StopDrink["1. Dzudzɔ Tsi Siwo Katã Si Wonona Enumake eye MÈGAZI Ƒodo ƒe Anyi Sesẽe O"]
    StopDrink --> CheckNeuro{"2. Kpɔ Aflaga Dzĩ Veviwo ɖa: Abi si le aklã me + Taɖuame/ ʋusɔgbɔdɔ si kɔ (Autonomic Dysreflexia), Saddle Numbness/Afɔ ƒe Gbɔdzɔgbɔdzɔ (Cauda Equina), Asrã/Vɔvɔ̃, alo Pelvic Trauma?"}
    CheckNeuro -->|Yes| CallEMS["Ƒo ka na Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ (911 / 112 / 999) Enumake"]
    CheckNeuro -->|No| HasCath{"3. Ðe Foley alo Suprapubic Catheter si Le Dɔnɔa Me Fifiaa?"}
    HasCath -->|Yes: Blocked Catheter| CheckTube["Du 60-Second Tubing Check: Dzɔdzɔ Kinks, Ʋu Clamps, Ðe asi le Straps, Hang Bag Below Hips"]
    HasCath -->|No Catheter| UrgentED["Tsɔe Yi Dɔwɔƒe si Kpɔa Tsinyegoe Kpata Gbɔ Enumake hena Tsinyegoe me Dzodzro Kple Sterile Catheter Decompression"]
    CheckTube --> Draining{"4. Ðe Aɖuɖɔ Dze Sisi Yi Akploa Me Le Aɖabaƒoƒo 5 Mea?"}
    Draining -->|No / Still Blocked or Bypassing| UrgentCath["Di Dɔnɔdzikpɔla Kpata / Kɔdzi Kpata hena Sterile Catheter Flush alo Trɔtrɔ (Mègahe Balloon Doe Gbeɖe O) ."]
    Draining -->|Yes| Monitor["Lé ŋku ɖe Aɖuɖɔ ƒe Amadede, Aɖuɖɔɖɔɖɔ, Kple Eƒe Agbɔsɔsɔme Ŋu nyuie"]

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Nusitae aɖuɖɔtoe ƒe ʋuʋu kpata dzɔna: Nusiwo gbɔ wòtsona zi geɖe le ŋutsuwo, nyɔnuwo, kple ɖeviwo ŋu¶

Zi geɖe la, aɖuɖɔtoe (micturition) bia be woawɔ nu eve siwo sɔ kple wo nɔewo siwo dzi sacral spinal cord (S2, S3, kple S4 parasympathetic nerves) kple brainstem pontine micturition center kpɔ ŋusẽ ɖo: ele be tsinyegoe ƒe lãmeka ƒe gli (detrusor muscle) na **aƒo **, gake tsinyegoe ƒe kɔ ƒe lãkusi ememetɔ kple prostate (alpha-1 adrenergic receptors) ele be ɖe dzi ɖi eye wòaʋu le ɣeyiɣi ɖeka me. Aɖuɖɔtoe ƒe ʋuʋu kpata dzea ame dzi ɣesiaɣi si wotu doa le ŋutilã me ALOO lãmeka/lãmeka ƒe tete do kpo nu:

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Acute versus Chronic Urinary Retention: De dzesi "Overflow Incontinence" (Nusitae aɖuɖɔtoe si le dodom MEfia be tsinyegoea le ƒuƒlu o)¶

Nukpɔsusu totro siwo me afɔku le wu le ƒomewo kple dɔnɔdzikpɔlawo dome dometɔ ɖekae nye be woasusui be esi ame aɖe le aɖuɖɔ sue aɖe ɖem le aɖabaƒoƒo 20 ɖesiaɖe me alo le tsi ƒom ɖe eƒe aɖuɖɔtoemetsitsi ƒe atikewo ŋu ta la, aɖuɖɔtoe mate ŋu axe mɔ nɛ o.

Le nyateƒe me la, aɖuɖɔ suesuesue siwo le dodom enuenu (mililita 30 va ɖo 50 le ɣeyiɣi ɖeka me) alo tsi si le dodom ɣesiaɣi le lɔlɔ̃nu faa me evɔ womaɖe ƒodo si le ete ƒe yɔyɔ gbɔdzɔe aɖeke o la nye Overflow Incontinence from severe urinary retention ƒe dzesi si wonya nyuie:

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Kuxiwo gbɔ kpɔkpɔ kpata na Blocked Indwelling Catheter (Foley alo Suprapubic) .¶

Ame miliɔn geɖe nɔa aƒeme kple indwelling urethral (Foley) catheter alo suprapubic catheter (si nye tsinyegoe me ʋu si gena ɖe tsinyegoea me tẽ to keyhole stoma sue aɖe si le ƒodo ƒe akpa si le ete le akɔtaƒua tame tututu). Esi wònye be dɔlékuiwo abe Proteus mirabilis ene xɔa aɖuɖɔtoe siwo nɔa anyi didi eye wowɔa enzyme urease ta la, wotrɔa aɖuɖɔ wòzua alkaline eye wònaa struvite kple calcium phosphate kristalo ("catheter encrustation") si ate ŋu axe ŋkumeɖonu siwo le ʋukaa ƒe nugbɔ le gaƒoƒo ʋɛ aɖewo ko me.

1. Alesi woawɔ ade dzesi catheter si xea mɔ na ame¶

Bu eŋu be catheter aɖe xe enumake ne:

• Aɖuɖɔ zero si dona ɖe nuƒoƒoƒu ƒe akploa me le gaƒoƒo 2 va ɖo 4 siwo va yi me (togbɔ be wonoa tsi le mɔ nyuitɔ nu hã).
• Amea xɔa ƒodo ƒe akpa si le ete (suprapubic) ƒe yɔyɔ yeye, tsinyegoe ƒe ʋuʋu si le veve sem, alo vevesese.
• Paradoxical "Catheter Bypassing" (Urine leaking AROUND the outside of the catheter): Dɔnɔdzikpɔla geɖewo kpɔa aɖuɖɔ wònyrɔna ɖe abadzivɔawo ƒo xlã catheter tube la ƒe gota eye wosusuna vodadatɔe be "Catheter la le sue akpa." Le nyateƒe me la, aɖuɖɔ si le dodom le catheter ƒe gota gome ("bypassing") gbɔe wòtsona ɣesiaɣi kloe catheter lumen being BLOCKED on the inside, si zi tsinyegoe si yɔ fũu vevesesetɔe dzi be wòayi ɖe ʋuʋudedi sesẽ siwo ƒua aɖuɖɔ doa goe le mɔ̃a ƒe gota gome.
• Le dɔnɔ si ƒe Akɔta ƒe Abi le akɔta ƒe seƒe T6 alo esi wu nenema gome la: Taɖuame kpata taɖuame si le ƒoƒom, ʋu ƒe sisi si dzina ɖe edzi 20 va ɖo 40+ mmHg wu gɔmedzedzea, dzi ƒe tsotso blewu alo le du dzi, fifia gbogbo aɖe si le dodom eye wòkɔna wu abi ƒe seƒe, kple goosebumps si le abi si wòxɔ ƒe seƒe te. Esia nye ** .Autonomic Dysreflexia ƒe Dɔléle**, eye aɖuɖɔtoe si xe lae nye #1 nusi gbɔ wòtso (si gbɔ autonomic dysreflexia ƒe amedzidzedze siwo wu 75 va ɖo 85 le alafa me tsona).

2. Afɔɖeɖe ɖesiaɖe si le dedie gotagome dodokpɔ be catheter si xe hã (Nusi ame sia ame ate ŋu awɔ le sɛkɛnd 60 me) .¶

Hafi nàyi kɔdzi alo ayɔ nutoa me dɔnɔdzikpɔla si kpɔa nudzɔdzɔ kpatawo gbɔ la, wɔ gotagome ɖaseɖiɖi si le dedie si me teƒe 5 le (si kpɔa mɔ̃ ƒe yaƒoƒo kple yaƒoƒo ƒe ʋuʋu gbɔ enumake):

1. Na dɔnɔa nanɔ tsitrenu nenye be Aklã ƒe Abi kple Autonomic Dysreflexia le eŋu: Amea bɔbɔ nɔ tsitrenu le dzidzenu 90 me eye nànɔ eƒe afɔwo ƒom la zãa nuheŋusẽ tsɔ ɖea ahɔhɔ̃a ƒe ʋu ƒe sisi si me afɔku le dzi kpɔtɔna enumake esime nèle ʋuka si me ʋu sina tona la me dzrom.
2. Ʋu kaƒomɔ̃a ƒe mɔ bliboa tso ŋutilã me yi akplo me eye nàlé ŋku ɖe eŋu: Kpɔe ɖa le avɔwo te, ata dome, kple bunɔkeke ƒe akɔtaɖonuwo te be nàka ɖe edzi be dɔnɔa menɔ anyi ɖe mɔ̃a dzi o eye be ʋuʋudedi siwo tro la mele eme o.
3. Kpɔ afɔ-kotoku ƒe ka kple catheter ƒe dedienɔnɔ ƒe mɔ̃wo (StatLock): Ðe afɔ ƒe ka sesẽ ɖesiaɖe si me elastic alo awu te ƒe akɔtaɖonu sesẽ siwo le mɔ̃a tem la ɖa.
4. Ðe tsidzɔƒe ƒe akploa ɖe anyi nyuie wu tsinyegoea ƒe kɔkɔme (akɔta): Kpɔ egbɔ be akploa le xɔxlɔ̃m le akɔta te faa (megagbɔ ɖe eme le mattress la dzi alo blae ɖe abadzivɔ dzi gbeɖe o). Ne tubing ƒe ka didi aɖe le anyigba ɖo ta anyigba eye emegbe wògalia yi dzi va ɖo akploa gbɔ la, kɔ ka si dzi woanɔ te ɖo la ɖe dzi blewu hena sɛkɛnd 5 ale be aɖuɖɔ si xaxa la nado ɖe akploa me eye wòagbã yaƒoƒo ɖesiaɖe.
5. Kpɔe ɖa be plug siwo woate ŋu akpɔ le plastic fesre si me kɔ la me hã: Kpɔ kadodo si me kɔ si me catheter la do go kple drainage bag tubing le:
6. Ʋu siwo le dzo dam viviti ("Clot Retention"): Ne ʋuka siwo le abe jelly dzĩ viviti ene yɔ mɔ̃a me fũ (si bɔ le prostate dɔwɔwɔ [TURP], tsinyegoe me dɔdzẽ ƒe amekoko, keklẽŋusẽ ƒe cystitis, alo traumatic catheter tugging megbe), Foley catheter si ƒe ŋutilã le ƒuƒlu si wozãna ɖaa mate ŋu aɖe tsi le ʋuka me o; ele be dɔnɔa nayi dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ enumake be woatsɔ **Fransetɔwo ƒe Mɔ Etɔ̃ ƒe Tsidede Tsinyegoe Me Tsi Tsi Tsi Tsi Tsi Etɔ̃ (CBI) Hematriuria Catheter tɔxɛ aɖe si me sesẽ 22 va ɖo 24 ade eme eye woatsɔ Toomey ƒe atikekui si me do gã le aɖe ʋu ƒe sisi le ʋu me kple asi.
7. Chalky white sand/grit alo thick yellow mucus: Fia mineral encrustation alo dɔlékui biofilm si xe mɔ na catheter ƒe nugbɔ.

3. Dedienɔnɔ ŋuti se veviwo: Nusi MELE be nàwɔ kple ka si woxe alo esi woɖe le eme GBEÐE o¶

• Mègate kpɔ GBEÐE be yeaklɔ tsinyegoe si xe alo ade tsie o negbe ɖe atikewɔla na hehe wò eye saline/catheter maintenance solution si me dɔlékui mele o kple catheter-tip syringe si me dɔlékui mele o le asiwò: Ne èklɔ pɔmpi me tsi si me dɔlékui mele o alo nàtsɔ atikekui tutu sesĩe ɖe ka si xe keŋkeŋ ŋu la, ate ŋu agbã tsinyegoe ƒe gli alo ado dɔlékuiwo ɖe ayiku me tẽ (dɔlékuiwo ƒe dɔléle). Ne wona hehee be wòawɔ tsilele fafɛ si me dɔlékui mele o eye tsi la do go tsitretsitsi sesẽ la, tɔ enumake; zi plunger la dzi gbeɖe o.
• Mègahe Foley-ka la gbeɖe alo ate kpɔ be yeatso kaƒomɔ̃a ƒe mɔ̃a be yeaɖe ya le ʋuƒo si tsi me o: Foley-ka ƒe ʋuƒo ƒe asike lãɖeɖe enuenu nana be yaƒoƒomɔ̃ sue si le rababa-gli la me la tsia enu tegbee ale be ʋuƒoa mate ŋu ado ya o. Ðɔkta alo dɔnɔdzikpɔla si wona hehee si zãa axadziʋuƒo (si me Luer-slip syringe le tsɔ ɖea tsi si me dɔlékui mele o 10 mL la ɖa) koe wòle be wòaɖe catheter.
• Gaƒoƒo 1 va ɖo 2 ƒe Se kpata ne Suprapubic Catheter ge do le vo me: To vovo na dzɔdzɔme tsinyegoe (si nɔa ʋuʋu ɖi) la, suprapubic catheter tract (amekoko ƒe mɔ si to ƒodo ƒe gli si le ete me yi ɖe tsinyegoea me) dzea egɔme nɔa tetem eye wòtua nu le miniti 30 va ɖo 120 me ne mɔ̃a he do goe le vo me. Ne suprapubic catheter aɖe ge do go la, tsɔ gauze pad dzadzɛ si me dɔlékui mele o tsyɔ ƒodo ƒe stoma sue la dzi eye yi dɔwɔƒe si te ɖe eŋu si kpɔa nudzɔdzɔ kpatawo gbɔ alo urology dɔnɔdzikpɔla si wona hehee gbɔ enumake (le gaƒoƒo 1 me) ale be woate ŋu atsɔ tube yeye si woatsɔ aɖɔlii la aƒu gbe dedie to trakt si li fifia me hafi wòatre nu.

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Nudzɔdzɔ kpata tɔxɛ aɖe: Acute Clot Retention (Ʋu ƒe Ʋuʋudedi Gã si me Ʋu ƒe Ʋuʋu le) .¶

Ne ʋu le dodom le ame aɖe ŋu le aɖuɖɔtoe me (tso ʋuka alo tsinyegoe ƒe dɔwɔwɔ nɛ nyitsɔ laa, ayiku ƒe abixɔxɔ, tsinyegoe me kansa, keklẽŋusẽ ƒe ʋuka me dɔdzẽ, alo ʋumenugbagbeviɣidɔlékuiwo me) la, enzyme aɖe si woyɔna be urokinase si dzea agbagba be yeaɖe ʋu sue aɖe ɖa la le amegbetɔ ƒe aɖuɖɔ me. Gake ne ʋu le dodom kabakaba la, ʋu ƒoa ƒu ɖe tsinyegoe si me dzo le la me wòzua tsinyegoe si le ʋeʋẽm, si le abe goma ene, dzĩ "abe aklã ene" alo esi le abe nudzodzoe ene.

Tsinyegoe siawo nyrɔna yia tsinyegoea ƒe gɔme (trigone) eye wowɔa dɔ abe rababa ƒe tsileƒe ƒe nutrenu ene ɖe tsinyegoe ƒe kɔ dzi (Acute Clot Retention).

• Alesi woawɔ ade dzesi Aɖuɖɔtoe ƒe Tsitretsitsi: Dɔnɔa toa aɖuɖɔ si le dzo dam alo burgundy viviti si me ʋuʋudedi dzĩ siwo woate ŋu akpɔ le la me, eye kasia ƒodo ƒe akpa si le ete ƒe ʋuʋu sesẽ kple aɖuɖɔtoe si mete ŋu toa aɖuɖɔ me kura o (alo tsi pink ƒe tsitete ɖeka ko toa aɖuɖɔ gã aɖe ŋu).
• Nusitae Clot Retention nye kɔdzi ƒe amekoko ƒe nɔnɔme kpata vavãtɔ: Tsinono alo French Foley catheter falɛfalɛ dzro aɖe si nye 14 alo 16 dede mawɔ dɔ o, elabena catheter falɛfalɛwo mu enumake eye ʋukawo xea mɔ na wo. Le dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ la, atikewɔlawo dea 22 alo 24 French Three-Way Council alo Coude Irrigation Catheter sesẽ aɖe eme, tsɔa asi tsɔa saline si me dɔlékui mele o kple 60 mL catheter-tip syringe tsɔa ʋu si le abe goma ene la doa goe le tsinyegoea me vaseɖe esime tɔtrɔgbɔa me kɔ, eye wotsɔa 3-lita kotoku siwo me Continuous Bladder Irrigation (CBI) si klɔa tsinyegoea ɖa ɣesiaɣi ale be ʋumenugbagbevi yeyewo mate ŋu adzɔ o.

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Nusiwo dzɔna le dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ: Tsinyegoe me toto, tsinyegoe ƒe ʋuʋu, kple Post-Obstructive Diuresis¶

Ne míese ŋutilã ƒe dɔwɔwɔ eve siwo dzɔna le tsinyegoe si keke vɔ megbe teti le kɔdzi gɔme la, eɖe nusita ɖɔktawo léa ŋku ɖe dɔnɔwo ŋu le ka si wotsɔ dea tsinyegoe me vɔ megbe la me:

1. Enumake Abatidzi Ultrasound Tsinyegoe Scan kple Catheterization:
2. Ne dɔnɔdzikpɔla alo ɖɔktaa va ɖo la, ewɔa sɛkɛnd 10 ƒe ultrasound bladder scan si me vevesese mele o ɖe ƒodoa ƒe akpa si le ete be yeadzidze aɖuɖɔ si xaxa ƒe lolome tututu (zi geɖe la, 500 va ɖo 2,000+ mililita) eye wòdea ami si me dɔlékui mele o ƒe tsinyegoe me ka (ezãa intraurethral 2% lidocaine anesthetic gel wodoe aɖabaƒoƒo 5 do ŋgɔ be wòana tsinyegoea natsi eye wòana tsinyegoea naɖe dzi ɖi, alo Coudé-tip catheter si woƒo blewu be wòaƒu du nyuie le tsinyegoe si lolo dzi).
3. De dzesii le "Clamping the Catheter Every 500 mL" ŋu: Le ŋutinya me la, wofia dɔnɔdzikpɔlawo be woabla catheter le tsi 500 mL ɖeɖe vɔ megbe le vɔvɔ̃ be ne woɖe tsi le tsinyegoe bliboa me zi ɖeka la, ana ʋu nado ("hematuria ex vacuo") alo ana woatsi dzodzodzoe ta. Egbegbe tsinyegoe ŋuti mɔfiamewo kple dɔdamɔnu dodokpɔ siwo wowɔ le vome ɖo kpe edzi be tsinyegoe bliboa ƒe tsi si woɖena le tsinyegoe bliboa me bliboe, si yia edzi zi ɖeka la le dedie eye wònyo wu tsinyegoe ƒe akpa aɖe ƒoƒo: esime ʋu ƒe sisi dzi ɖena kpɔtɔna vie le dzɔdzɔme nu (si ɖea veveseseɖeamenu ƒe ʋuʋudedi si le eme ɖa) eye aɖuɖɔtoea ƒe amadede pink sue aɖe ate ŋu adzɔ tso lãkusi ƒe decompression me metsɔ le klatsa ƒe duƒuƒu me o, si ana tsinyegoea ƒe afã yɔ fũ enaa vevesese kple dɔlékuiwo xɔxɔ ƒe afɔku nɔa anyi didi.
4. Ŋkuléle ɖe "Post-Obstructive Diuresis" (Aɖuɖɔtoe ƒe dodo fũ le tsiɖeɖe vɔ megbe si nɔa anyi didi alo esi nu sẽ vevie):
5. Ne ame aɖe ƒe aɖuɖɔ si wu mililita 1,000 va ɖo 1,500 xa ɖe eƒe tsinyegoe me (vevietɔ le ŋkeke geɖe me le nyaƒoɖeamenu sesẽ ƒe ɣeyiɣi didi si me ʋu me creatinine sɔ gbɔ ɖo me) la, ayikuawo megate ŋu ƒoa aɖuɖɔ nu ƒu hena ɣeyiɣi aɖe ne woɖe aɖuɖɔ si xe mɔa dzi o.
6. Le gaƒoƒo 24 gbãtɔ siwo le catheter dede megbe la, ayikuawo ate ŋu akɔ aɖuɖɔ si me tsi le si wu mililita 200 le gaƒoƒo ɖesiaɖe me hena gaƒoƒo 2 tsiã ɖe enu (alo >mililita 3,000 le gaƒoƒo 24 me).
7. Togbɔ be ɖeko tsinyenye fafɛ ɖea dze, tsi, kple urea si wodzra ɖo fũu ɖa hã la, pathologic post-obstructive diuresis ate ŋu ana tsi naɖe le dɔnɔa me kabakaba eye wòaɖe sodium, potassium, magnesium, kple phosphate le woƒe ŋutilã me, si ana ʋusɔgbɔdɔ naɖiɖi eye dzi ƒe tsotso nawɔ dɔ nyuie o. Woléa ŋku ɖe dɔnɔ ɖesiaɖe si ƒe tsinyegoe me tsi si dona le gɔmedzedzea me wu mililita 1,000, si ƒe aɖuɖɔ si dona wu 200 mL/gaƒoƒo ɖeka hena gaƒoƒo 2, alo amesi ƒe ayiku xɔ abi vevie le ʋudodokpɔ me la le kɔdzi kple aɖuɖɔtoe yometiti gaƒoƒo ɖesiaɖe kple elektrikŋusẽ ƒe dodokpɔ hafi yia aƒeme.
8. Alpha-1 Blocker (Tamsulosin alo Alfuzosin) ƒe gɔmedzedze hena "Dodokpɔ si me Catheter Manɔmee" (TWOC) si akpɔ dzidzedze:
9. Le ŋutsu siwo ŋu benign prostatic hyperplasia (BPH) le siwo yia aƒeme kple ɣeyiɣi kpui aɖe ƒe Foley catheter kple afɔkotoku la, atikewɔla siwo kpɔa nudzɔdzɔ kpatawo gbɔ ŋlɔa atike si woano gbesiagbe selective alpha-1A blocker (abe tamsulosin 0.4 mg alo alfuzosin 10 mg). Alpha-blocker nono ŋkeke 3 va ɖo 7 ya teti hafi tsinyegoeŋutinunyala naɖe aɖuɖɔtoea ɖa ana prostate smooth muscle la naɖe dzi ɖi eye edzia mɔnukpɔkpɔ si li be ŋutsua nate ŋu aɖu aɖuɖɔ le eɖokui si le mɔ si sɔ nu ne catheter la do la dzina ɖe edzi zi gbɔ zi eve.

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Vidzidɔ ƒe gotagome nɔnɔme kpata eve siwo nana aɖuɖɔtoe me tsina kpata: Paraphimosis kple Retroverted Gravid Uterus¶

Tsɔ kpe ɖe tsinyegoe ƒe lolome, atikewo, kple aklã ƒe tete ŋu la, mɔ̃ɖaŋununya ƒe nɔnɔme kpata eve aɖewo koŋ ƒoa tsinyegoe si wotu la ŋutɔŋutɔ eye wòhiã be woade dzesii enumake:

1. Paraphimosis ("The Foreskin Tourniquet" le Ŋutsu, Ŋutsuvi, Kple Dɔnɔ Siwo Wotsɔ Catheter Me Aʋamatsomae Me) .¶

Paraphimosis nye tsinyegoe me nudzɔdzɔ kpata vavã si xɔa ɣeyiɣi sesẽ si dzɔna enuenu le kɔdziwo, ame tsitsiwo dzikpɔƒewo, alo le aƒeme ne wohe dɔnɔ si wometso aʋa na o ƒe akɔtaƒu (prepuce) ɖe megbe le ŋutsu ƒe vidzinu ƒe ta megbe (glans kple coronal sulcus) le dzadzɛnyenye, catheter dede, alo gbɔdɔdɔ ƒe nuwɔna me, eye left he megbe evɔ wometrɔe yi eƒe ŋgɔgbe ƒe nɔnɔme si sɔ.

• Nusi dzɔna: Aɖuɖɔtoe si wogbugbɔ ɖe megbe ƒe asigɛ sesẽ la wɔa dɔ abe rababa-bad tourniquet ene ƒo xlã asike si le ŋutsu ƒe vidzinu ƒe ta megbe tututu. Venous kple lymphatic drainage tso glans kple distal foreskin me tsia, si wɔnɛ be foreskin la zua balloon zua doughnut-like collar of tense, translucent fluid swelling esime ŋutsu ƒe vidzinu ƒe ta vuvu, trɔna viviti dosky purple alo bluish-black, eye wòƒoa tsinyegoea nu tsitsi (causing acute urinary retention and, le gaƒoƒo ʋɛ aɖewo megbe la, ischemic glans necrosis/gangrene).
• Kpekpeɖeŋu Gbãtɔ Enumake Kple Kɔdzi Dzi Ðeɖe Akpɔtɔ Na Paraphimosis:
• ELE BE ŋutsu alo ŋutsuvi ɖesiaɖe si metso aʋa na o si wotsɔ Foley-ka de eme la, ELE BE eƒe ŋgɔgbewu nagbugbɔ blewuu agbugbɔ ayi ŋgɔ le ŋutsu ƒe vidzinu ƒe ta dzi ne wotsɔ ka la ɖo teƒea teti.
• Ne paraphimosis do mo ɖa la, yi dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ enumake. Ðɔktawo tsɔa atike si naa alɔ̃dɔdɔ ame ƒe ŋutilã (alo wɔa akɔta ƒe lãmeka si xea mɔ na ŋutsu ƒe vidzinu), wotsɔa gaze alo osmotic compress xatsa kɔla si vuvu la, tsɔa asi ƒoa xlãe si nɔa anyi ɖaa ("asi si wotsɔ asigɛ ƒoa nui") aɖabaƒoƒo 5 va ɖo 10 be woatsɔ aƒo edema tsi si xaxa la ado goe le ŋgonu ƒe asigɛa me, eye emegbe woatutu ŋkumeɖoboloawo ɖe megbe blewuu kple asibidɛ eveawo esime wòle ŋgɔgbe ƒe ŋutigbalẽ hem yi ŋgɔ le ŋutsu ƒe vidzinu ƒe ta dzi.

2. Vidzidɔ si Wofɔ le Megbe si Wode Gaxɔ Me (Fɔfɔfɔ Kwasiɖa 10 Vaseɖe 16) .¶

Le dzɔdzɔme nu la, nyɔnu siwo ade 15 le alafa me ƒe vidzidɔ nye retroverted ("tilted backward"). Zi geɖe la, ne fufɔfɔ tsi wu kwasiɖa 10 va ɖo 12 la, vidzidɔa dona bɔbɔe tso akɔta yi ƒodo me.

Le nɔnɔme siwo mebɔ o me le fufɔfɔ ƒe kwasiɖa 10 kple 16 dome la, vidzidɔ si le tsitsim si trɔ ɖe megbe la xɔa ʋeʋẽ (wodea gaxɔ me) le ƒu si le ƒuta si le sacral promontory si le akɔta ƒe megbe la te. Ne vidzidɔ si xaxa la le kekem ɖe enu la, etutua vidzidɔa sesĩe yia ŋgɔ kple dzi le akɔtaƒua megbe, ekekea nyɔnu ƒe tsinyegoea ɖe enu heƒonɛ gbadzaa ɖe akɔta ƒe ƒunukpeƒea.

• Nuxlɔ̃amedzesiwo: Funɔ si le fufɔfɔ ƒe kwasiɖa 10 va ɖo 16 fɔna le ŋdi alo ŋdɔ me kple aɖuɖɔtoe ƒe ŋutetemanɔamesi kpata, vevesesetɔe, akɔta yɔ fũ, akɔta ƒe vevesese, alo tsi si to vovo na wo nɔewo.
• Kpekpeɖeŋunadɔ Gbãtɔ ƒe Ðoƒe Enumake ne èle mɔ zɔm yina Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ:
• Esi nèle lalam be woatsɔe ayi OB/GYN kple triage kpata la, gbɔɖemeƒe le klo-akɔta ƒe nɔnɔme (klo ɖe aba dzi kple akɔta kple abɔta ɖiɖi ɖe anyi ɖe akɔtaɖonu dzi aɖabaƒoƒo 10 va ɖo 15) alo miame axadzi Sims nɔnɔme zãa nuheŋusẽ tsɔ kpena ɖe vidzidɔa ƒe lãkusi kpekpea ŋu wòtrɔna yia ŋgɔ ɖa tso sacrum gbɔ, esime atikewɔlawo tsɔa Foley fafɛ aɖe dana catheter be wòakɔ tsinyegoea me eye wòaɖe vidzidɔa dzi akpɔtɔ blewuu ayi ƒodoa me.

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Ne wotsi tre ɖe tsinyegoe me ʋuka dodo ŋu KPƆKPƆ: Aɖuɖɔtoe ƒe Tɔtɔ si me Nuveviwɔame Le¶

Togbɔ be Foley catheter dede to aɖuɖɔtoe me nye atikewɔwɔ si wozãna ɖaa na aɖuɖɔtoe me tsi ƒe 99 le alafa me hã la, nuveviwɔame vevi ɖeka li si me wode se ɖe tsinyegoe me ka dede nu vevie elabena ne wotsɔ mɔ̃ aɖe ƒu gbe ɖe tsinyegoe si vuvu dzi la, etrɔa aɖatsi ƒe akpa aɖe wòzua aɖuɖɔtoe me ʋuʋu bliboe, si anɔ anyi le eƒe agbemeŋkekewo katã me alo ƒoa ka la doa goe yia akɔta ʋumenugbagbeviɣidɔ:

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Nya siwo wobiaa amewo enuenu¶

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Wolé ŋku ɖe dzɔtsoƒewo ŋu¶

• Amerika Aɖuɖɔtoeŋutinunya Habɔbɔ (AUA, United States): Aɖuɖɔtoe ƒe Dzesi Siwo Tso Benign Prostatic Hyperplasia (BPH) kple Acute Urinary Retention Guideline kple Catheter-Associated Urinary Tract Care dzi kpɔkpɔ.
• Europa Habɔbɔ si Kpɔa Aɖuɖɔtoeŋutinunya Gbɔ (EAU): EAU ƒe Mɔfiamewo le Ŋutsu ƒe Aɖuɖɔtoe ƒe Dzesi Siwo Menye Ahɔhɔ̃mekawo O, Aɖuɖɔtoe ƒe Tsitretsitsi Kpekpeɖeŋu, kple Aɖuɖɔtoedɔlélewo Dzi Kpɔkpɔ Ŋu.
• Dukɔa ƒe Lãmesẽnyawo Kple Belélename Ŋuti Nusrɔ̃ƒe (NICE, United Kingdom): Aɖuɖɔtoe ƒe Dzesi Siwo Le Ŋutsuwo Me: Wo Dzikpɔkpɔ (CG97) kple Dɔlékui Siwo Do Ƒome Kple Lãmesẽnyawo: Ɣeyiɣi Didi ƒe Aɖuɖɔtoe me Beléle (CG139).
• Consortium for Spinal Cord Medicine (Paralyzed Veterans of America, United States): Autonomic Dysreflexia kple Autonomic Dysfunctions Bubuwo ƒe Dzodzro Kple Edzikpɔkpɔ: Aɖuɖɔtoe Siwo Woxe ƒe Beléle Kpata.
• Nyman MA, Schwenk NM, Silverstein MD (Mayo Clinic Proceedings): Aɖuɖɔtoe ƒe ʋuʋu dzi kpɔkpɔ: tsinyegoe ƒe ʋuʋu kabakaba tsɔ wu vivivi kple kuxiwo ƒe afɔku (ɖo kpe edzi be tsinyegoe me tsi si le dodom kabakaba bliboe la le dedie eye wònyo wu tsinyegoe ƒe ƒoƒo ɖe ɖoɖo nu).

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Mɔfiame siwo do ƒome kplii¶

• Autonomic dysreflexia le aklã ƒe abixɔxɔ ƒe beléle kpata me
• Cauda equina syndrome kple aklã ƒe nutete sesẽ ƒe aflaga dzĩwo
• Ayiku me kpe ƒe vevesese sesẽ vs. ayiku si me dɔléle le si xe mɔ na (urosepsis) .
• Agbagbadzedze ƒe rhabdomyolysis, ayiku ƒe abixɔxɔ kpata, kple aɖuɖɔ si do viviti
• Akɔta ƒe gbagbã ƒe liƒolili kple ʋu si dona le ememe dzi ɖuɖu
• Xexlẽdzesi siwo woxɔna kpata le dukɔwo nu