Acute Urinary Retention ne Blocked Indwelling Catheter Obujjanjabi obw’amangu¶

Acute urinary retention (AUR) kwe butasobola okufulumya omusulo mu ngeri ey’amangu, eruma wadde ng’ekibumba kijjudde, ekiwanvuwa amangu nga kirimu **omusulo 500 okutuuka ku mililita ezisukka mu 1,500 (17 to 50 fluid ounces) ezisibiddwa. Eky’amangu kyenkanyi ye acutely blocked indwelling urethral (Foley) oba suprapubic catheter, nga mineral encrustation, omusulo omunene, mechanical kink, oba omusaayi clot corks catheter drainage tube okuggalawo. Omusulo bwe gutasobola kufuluma mu kibumba, puleesa y’omu misuwa erinnya mangu, ekivaako okusannyalala okw’amaanyi mu lubuto olwa wansi (suprapubic), okusannyalala kw’obusimu obw’okwefuga (puleesa okulinnya ennyo oba okutta omuntu obuzibu bw’okulowooza mu ngeri ey’okwefuga (autonomic dysreflexia). mu balwadde abalumwa omugongo), puleesa y’omugongo waggulu eggalawo ensigo zombi (oluvannyuma lw’ekibumba obuvune obw’amaanyi mu kibumba n’obulwadde bwa hydronephrosis obw’enjuyi zombi), ne obulwadde bwa urosepsis.

Obuvunaanyizibwa bwo obw’amangu ng’omuntu tasobola kufulumya musulo oba ng’alina ekituli ekizibikira mu musulo kwe okuyimiriza okunywa amazzi gonna amangu ddala (okunywa amazzi amangi ng’ekifo ekifuluma mu kibumba kizibiddwa kyongera okugaziwa ekibumba n’okulumwa ennyo), screen for neurological obulwadde bw’embalaasi (cauda equina syndrome). (okulumwa omugongo nga saddle okuzimba oba amagulu okunafuwa) ne ** .obuzibu bw’okulowooza mu ngeri ey’okwefuga (autonomic dysreflexia).** (okulumwa omutwe ne puleesa mu mulwadde alina obuvune ku mugongo), kola okukebera ttanka z’omugongo ogw’ebweru okumala sekondi 60 (okusumulula ttanka ezikyusiddwa, okusumulula emiguwa gy’amagulu egy’amaanyi, n’okukka ensawo y’okufulumya amazzi wansi w’omutindo gw’ekibumba) singa omusulo guba gwateekebwa dda, tosika, tosika, oba okukuba waya mu kateeta n’amaanyi, era ogende mu kitongole ky’abalwadde ab’amangu amangu ddala okukendeeza ku buzito bw’ekibumba (sterile bladder decompression).

Kino kikole kati¶

1. Lekera awo okunywa amazzi gonna n’amazzi amangu ddala: Omukutu ogufuluma oba ekituli ky’ekibumba bwe kizibikira, buli ky’onywa amazzi g’onywa gasengejja okuyita mu nsigo ne gayingira mu kibumba ekikwatiddwa, ne kyongera okugolola ebinywa by’ebinywa ebiyitibwa detrusor muscle fibers n’okwongera amaanyi mu kusannyalala okulumwa ennyo (agonising suprapubic spasms).
2. Kuba essimu y’abasawo ab’amangu amangu ddala singa wabaawo bendera emmyufu ez’akabi ennyo ez’obusimu, ez’amazzi amakyafu, oba ez’okulumwa: Kuba ku nnamba yo ey’amangu mu kitundu kyo (911 mu Amerika ne Canada, 112 okwetoloola omukago gwa Bulaaya, 999 mu Bungereza, 000 mu Australia) oba kebera ku dayirekita yaffe eya ennamba z’amangu singa obutasobola kufulumya musulo buwerekerwako:
3. Obuvune ku mugongo waggulu wa T6 nga omutwe gukuluma, ffeesi efuumuuka/entuuyo, oba puleesa okulinnya (Obulwadde bwa Autonomic Dysreflexia, embeera ey’amangu ereeta okusannyalala).
4. Obulumi mu mugongo ogwa wansi, okuziyira mu kisambi/amatabo ("saddle anesthesia"), oba okunafuwa/okuwunya mu magulu (Obulwadde bwa Cauda Equina).
5. Omusujja (>=38.0 degrees Celsius / 100.4 degrees Fahrenheit), okukankana okunyiiga, okutabulwa, oba okuziyira (Urosepsis).
6. Okumenya ekisambi gye buvuddeko, obuvune ku straddle, oba omusaayi okutonnya okuva ku ntikko y’omusulo (okukutuka kw’omusulo; togezaako kuyingiza catheter okutuusa nga okoleddwa retrograde urethrogram).
7. Omuntu bw’aba alina indwelling Foley oba suprapubic catheter eyalekera awo okufulumya amazzi, dduka 60-Second External Tubing Check kati kati:
8. Unkink: Londoola tube yonna okuva ku mubiri okutuuka mu nsawo; gololera ebikoona byonna ebisongovu, ebikyusiddwa oba ebiwujjo omulwadde w’atudde oba ng’agalamidde ku ttanka.
9. Unclamp: Kakasa nti pulasitiika slide clamp yonna oba catheter flip-flo valve teyalekebwa mu butanwa nga eggaddwa.
10. Sumulula emiguwa gy’amagulu: Sumulula emiguwa gya Velcro egy’ensawo y’amagulu egy’amaanyi egiyinza okuba nga ginyiga lumen ya silicone ennyogovu ng’eggaddwa.
11. Wansi ensawo wansi w’ebisambi: Tambuza ensawo y’amazzi wansi wansi w’omutindo gw’ekibumba (omusulo tegusobola kukulukuta waggulu nga gukontana n’amaanyi ag’ekisikirize; ensawo ewummudde ku mufaliso gw’ekitanda ekola airlock eyimiriza okufulumya amazzi).
12. TOGGYAMU kituli kya Foley ekibeera munda nga tofulumizza mufuuwa mu bbaatule ekwata munda, era TOFUNA kintu kyonna munda mu kituli: Ekituli kya Foley ekibeera mu kibumba kisibibwa munda mu kibumba nga kikozesa bbaatule ya mililita 10 ezijjudde amazzi ennene ng’ennyaanya ya cherry. Okuggyamu ekituli nga bbaatule efuukuddwa kikutula enseke n’omusulo, ekivaako omusaayi omungi mu misuwa.
13. Tonyiga nnyo ku lubuto olwa wansi olugaziye (Credé maneuver ya bulabe mu kuzibikira): Okunyiga n’amaanyi ku kibumba ekigaziyiziddwa ennyo, ekizibiddwa kissa puleesa mu nnyindo, kiwaliriza omusulo ogulina akawuka okudda emabega mu kibumba (vesicoureteral reflux), era kiyinza okukutuka ekisenge ky’ekibumba ekigonvu oba diverticulum y’ekibumba.
14. Genda mu kitongole ky’abalwadde ab’amangu mu ddwaaliro singa tewali musulo guyita mu ssaawa 4 ku 6 ng’ogudde mu bulumi (oba essaawa 1 ku 2 ng’omusulo guzibiddwa): Okussaamu omusulo ogw’amangu ogw’ekibumba ogutaliiko buwuka gumalawo obulumi mu sikonda 30 era gukuuma ebinywa by’ekibumba n’ensigo okuva ku buvune obw’olubeerera olw’okugolola.

flowchart TD
    Start["Obulumi Obutasobola Kufulumya Musulo (Suprapubic Fullness/Spasms) OBA Zero Omusulo Okufuluma Okuva Mu Indwelling Catheter"] --> StopDrink["1. Yimirira Amazzi gonna ag’omu kamwa mu bwangu era TOnyiga nnyo ku Lubuto olwa Wansi"]
    StopDrink --> CheckNeuro{"2. Kebera Critical Red Flags: Obuvune ku mugongo + Obulumi bw’omutwe/High BP (Autonomic Dysreflexia), Okuzirika kw’amatandiiko/Obunafu bw’amagulu (Cauda Equina), Omusujja/Okuziyira, oba Okulumwa mu kifuba?"}
    CheckNeuro -->|Yes| CallEMS["Kuba ku ssimu ey’amangu (911 / 112 / 999) Amangu ddala"]
    CheckNeuro -->|No| HasCath{"3. Mu kiseera kino Omulwadde Alina Indwelling Foley oba Suprapubic Catheter?"}
    HasCath -->|Yes: Blocked Catheter| CheckTube["Run 60-Second Tubing Check: Golola Kinks, Ggulawo Clamps, Sumulula Straps, Hang Bag Wansi w’ebisambi"]
    HasCath -->|No Catheter| UrgentED["Okutambuza mu bwangu mu kitongole ky’amangu okukola Scan y’ekibumba n’okukendeeza ku buzito bwa Sterile Catheter"]
    CheckTube --> Draining{"4. Omusulo gwatandika okukulukuta mu nsawo mu ddakiika 5?"}
    Draining -->|No / Still Blocked or Bypassing| UrgentCath["Noonya Nurse ow’amangu / Hospital Carre ow’amangu okusobola okufuuwa oba okukyusa catheter etaliimu buwuka (Never Pull Balloon Out)"]
    Draining -->|Yes| Monitor["Londoola nnyo Langi y’omusulo, Clots, ne Volume"]

Lwaki okuziyiza omusulo okw’amangu kubaawo: Ebitera okuvaako abasajja, abakazi n’abaana¶

Mu budde obwabulijjo, okufulumya omusulo (okufulumya omusulo) kyetaagisa ebikolwa bibiri ebikwatagana ebifugibwa omugongo ogw’omugongo (S2, S3, ne S4 parasympathetic nerves) n’ekifo ekifulumya amazzi mu bwongo (brainstem pontine micturition center): ekisenge ky’ebinywa eky’ekibumba (ekinywa ekifulumya amazzi) kirina okukonziba, ate nga n’omusuwa gw’ensingo ogw’omunda n’ennywanto (alpha-1 adrenergic receptors) zirina okuwummulamu n’okugguka mu kiseera kye kimu. Acute urinary retention okukuba buli outlet lwe banyigirizibwa mu mubiri ne ziggalwa OBA okukonziba kw’obusimu/ebinywa kulemererwa:

Acute versus Chronic Urinary Retention: Okutegeera "Overflow Incontinence" (Lwaki okutonnya omusulo TEKItegeeza nti ekibumba kyerere)¶

Emu ku ndowooza enkyamu ezisinga okuba ez’akabi mu maka n’abalabirira kwe kulowooza nti olw’okuba omuntu ayisa omusulo omutono buli luvannyuma lwa ddakiika 20 oba okufukirira paadi ze ez’obutaziyiza musulo, tayinza kuba na buzibu bwa musulo.

Mu butuufu, okuyita enfunda eziwera obutonnyeze obutonotono obw’omusulo (mililita 30 ku 50 omulundi gumu) oba okutonnya buli kiseera mu ngeri etaali ya kyeyagalire nga tofunye buweerero bwonna mu kujjula kw’olubuto olwa wansi kye kabonero akamanyiddwa ennyo aka Overflow Incontinence okuva mu kusigala kw’omusulo okw’amaanyi:

Okugonjoola ebizibu eby’amangu ku Blocked Indwelling Catheter (Foley oba Suprapubic) .¶

Obukadde n’obukadde bw’abantu babeera awaka nga balina indwelling urethral (Foley) catheter oba suprapubic catheter (catheter eyingira butereevu mu kibumba ng’eyita mu ka keyhole stoma akatono ku lubuto olwa wansi waggulu ddala w’eggumba ly’omu kibumba). Olw'okuba obuwuka nga Proteus mirabilis bufuga emisuwa egy'ekiseera ekiwanvu ne bukola enziyiza urease, bufuula omusulo alkaline ne butonnyesa struvite ne calcium phosphate crystals ("catheter encrustation") ezisobola okuziba ebikuta by'amaaso ku ntikko y'omusulo mu ssaawa ntono.

1. Engeri y’okutegeeramu ekituli ekizibiddwa¶

Teebereza ekituli ekizibiddwa amangu ddala singa:

• Zero omusulo gubadde gukulukutidde mu nsawo y’okukung’aanya mu ssaawa 2 ku 4 eziyise (wadde nga munywa amazzi mu ngeri eya bulijjo).
• Omuntu afuna okujjula okupya mu lubuto olwa wansi (suprapubic), okulumwa, oba okulumwa okuzimba ekibumba.
• Paradoxical "Catheter Bypassing" (Urine leaking AROUND the outside of the catheter): Abalabirira bangi balaba omusulo nga gunnyika ebitanda okwetooloola ebweru wa catheter tube ne balowooza mu bukyamu nti "Catheter ntono nnyo." Mu butuufu, okukulukuta okwetoloola ebweru wa catheter ("bypassing") kumpi bulijjo kiva ku catheter lumen being BLOCKED on the inside, ekiwaliriza ekibumba ekijjudde ennyo okugenda mu okuzimba okw’amaanyi okufuuwa omusulo okwetooloola ebweru wa tube.
• Mu mulwadde alina Obuvune bw’omugongo ku ddaala ly’ekifuba oba waggulu wa T6: Obulumi bw’omutwe obw’amangu okukuba, puleesa okulinnya okuva ku mmHg 20 ku 40+ waggulu w’entandikwa, omutima okukuba empola oba okudduka, okutuuyana ennyo n’okufuumuuka waggulu w’eddaala ly’obuvune, n’okuzimba ebizimba wansi w’eddaala ly’obuvune. Kino kili Obulwadde bwa Autonomic Dysreflexia, era omusulo oguzibiddwa kye kivaako #1 (ekivunaanyizibwa ku bitundu ebisukka mu 75 ku 85 ku buli 100 eby’okulumba kwonna okw’obuzibu bw’okuwulira (autonomic dysreflexia)).

2. Step-by-step safe external check for a blocked catheter (Omuntu yenna ky’ayinza okukola mu sikonda 60) .¶

Nga tonnagenda mu ddwaaliro oba okuyita nnansi w’ekitundu ow’amangu, kola kino okukebera okw’ebweru okw’ensonga 5 okutali kwa bulabe (okugonjoola ebizibiti by’empewo eby’ebyuma n’okunyiga amangu ddala):

1. Tuula omulwadde nga yeegolodde singa aba alina obuvune bw’omugongo ne Autonomic Dysreflexia: Okutuuza omuntu nga yeegolodde ku diguli 90 n’okulengejja amagulu ge kikozesa amaanyi ag’ekisikirize okukendeeza amangu ddala puleesa y’obwongo ey’akabi ng’okebera ekituli.
2. Bikkula era olondoole ekkubo lyonna erya catheter okuva ku mubiri okutuuka mu nsawo: Kebera wansi w’emifaliso, wakati w’ebisambi, ne wansi w’emitto gy’obugaali okukakasa nti omulwadde tatudde ku ttanka era nti tewali kinks ezikyusiddwa.
3. Kebera emiguwa gy’ensawo y’amagulu n’ebyuma ebinyweza catheter (StatLock): Sumulula emiguwa gyonna egy’amagulu egya laasitiki egy’amaanyi oba ekiwato ekinywevu mu buwale bw’omunda nga kinyigiriza ttanka.
4. Wansi ensawo y’amazzi wansi nnyo wansi w’omutindo gw’ekibumba (ebisambi): Kakasa nti ensawo ewaniridde mu ddembe wansi w’ebisambi (tewummuddeko ku mufaliso oba okusiba waggulu ku mugongo). Singa loopu empanvu eya ttanka ewanirira wansi ng’eyolekera wansi n’oluvannyuma n’elinnya n’edda waggulu ku nsawo, situla loopu eyeesigama mpola okumala sekondi 5 olwo omusulo ogusibye gukulukutire mu nsawo ne gumenya airlock yonna.
5. Kebera oba pulaagi ezirabika mu ddirisa ly’akaveera akatangaavu: Laba ekiyungo ekitangaavu ekituli we kisisinkanira ttanka y’ensawo y’amazzi:
6. Ebizimba ebinene ebimyufu ebiddugavu ("Clot Retention"): Singa ttanka ejjula ebizimba ebimyufu ebiringa jelly (ebitera okubaawo oluvannyuma lw’okulongoosebwa enseke [TURP], okulongoosebwa ekizimba mu kibumba, okuzimba omusaayi okuva mu masanyalaze, oba okusika omusuwa ogw’ekikangabwa), omusuwa gwa Foley ogw’omutindo omugonvu tegusobola kufulumya bikuta; omulwadde alina okugenda mu kitongole ky’abalwadde ab’amangu amangu ddala okuteekebwako ekyuma eky’enjawulo ekikaluba 22-to-24 French Three-Way Continuous Bladder Irrigation (CBI) Hematriuria Catheter n’okufulumya omusaayi mu ngalo n’empiso ya Toomey erimu ebituli ebinene.
7. Chalky white sand/grit oba thick yellow mucus: Kiraga mineral encrustation oba yinfekisoni biofilm okuziba ensonga ya catheter.

3. Amateeka amakulu ag’obukuumi: Kiki TOKIKOZESA ku catheter ezibiddwa oba esenguddwa¶

• TOGEZAAKO kufukirira oba kufukirira kituli ekizibiddwa okuggyako ng’otendekeddwa omusawo era ng’olina eddagala eriddaabiriza omunnyo/ekituli ekitaliimu buwuka n’empiso etaliimu buwuka: Okunaaba amazzi ga ttaapu agatali ga buwuka oba okusika ennyo n’empiso ku kasenge akazibiddwa ddala kiyinza okukutula ekisenge ky’ekibumba oba okukuba obuwuka butereevu mu kibumba (obuwuka obuleeta obulwadde). Singa otendekeddwa okukola okufuumuula okutali kwa buwuka mu ngeri ennyangu era amazzi ne gasisinkana okuziyiza okunywevu, yimiriza mangu; tokaka plunger.
• TOSIKA ku Foley catheter oba okugezaako okusala catheter tube okufulumya omukka mu balloon ekwatiddwa: Okusala shaft ya Foley catheter emirundi mingi kireetera akakutu akatono akafuuwa omukka munda mu bbugwe wa rubber okusiba nga kaggaddwa enkalakkalira kale balloon tesobola kufulumya. Omusawo oba nnansi omutendeke yekka akozesa vvaalu y’ebbali (nga erina empiso ya Luer-slip okuggya mL 10 ez’amazzi agataliimu buwuka) y’alina okuggyamu ekituli.
• Etteeka ery’amangu ery’essaawa emu ku bbiri singa Suprapubic Catheter egwa mu butanwa: Okwawukanako n’omusulo ogw’obutonde (ogusigala nga guggule), suprapubic catheter tract (omukutu gw’okulongoosa oguyita mu bbugwe w’olubuto ogwa wansi okuyingira mu kibumba) gutandika okukonziba n’okuggalawo nga guggaddwa mu ddakiika 30 ku 120 singa tube efuluma mu butanwa. Singa suprapubic catheter egwa, bikka akatundu akatono ak’olubuto ne gauze pad ennyonjo etali ya buwuka era genda mu kitongole ky’abalwadde ab’amangu oba omusawo w’omusulo omutendeke amangu ddala (mu ssaawa 1) olwo ttanka empya ekyusibwamu esobole okusereba obulungi okuyita mu tulakiti eriwo nga tennasibira kuggalwa.

Embeera ey’amangu ey’enjawulo: Okukuuma omusaayi mu ngeri ey’amaanyi (Gross Hematuria with Blood Clots) .¶

Omuntu bw’avaamu omusaayi munda mu nkola y’omusulo (okuva mu kulongoosa enseke oba ekibumba gye buvuddeko, okulumwa ekibumba, kookolo w’ekibumba, obulwadde bwa radiation cystitis, oba eddagala erikendeeza omusaayi), omusulo gw’omuntu gubaamu enziyiza eyitibwa urokinase egezaako okusaanuusa omusaayi omutono. Wabula omusaayi bwe guba gwa mangu, omusaayi guzimba munda mu kibumba ekibuguma ne gufuuka ebizimba ebinene, ebiringa kapiira, ebimyufu omuddugavu "ebiringa ekibumba" oba ebiringa envunyu.

Ebizimba bino bibbira okutuuka wansi w’ekibumba (the trigone) ne bikola ng’ekiziyiza bbaafu ya kapiira waggulu w’ensingo y’ekibumba (Acute Clot Retention).

• Engeri y’okulaba okusigala kw’omusulo: Omulwadde ayisa omusulo ogwa langi emmyufu oba enzirugavu eya burgundy ogulimu ebizimba ebimyufu ebirabika, n’addirirwa mu bwangu okusannyalala okulumwa ennyo mu lubuto olwa wansi n’obutasobola ddala kuyisa musulo (oba okuyisa ettondo lyokka ery’amazzi aga pinki okwetooloola ekizimba ekinene).
• Lwaki Clot Retention is a true hospital surgical emergency: Wadde okunywa amazzi oba okuteeka catheter eya bulijjo soft 14 oba 16 French Foley catheter tekijja kukola, kubanga soft catheters zigwa mangu ne ziziba nga zirimu clots. Mu kitongole ky’abalwadde ab’amangu, abasawo bateekamu 22 oba 24 French Three-Way Council oba Coude Irrigation Catheter ekikaluba, ne bafulumya n’engalo ebizimba byonna ebiringa kapiira okuva mu kibumba nga bakozesa omunnyo ogutaliimu buwuka n’empiso ya 60 mL eriko enkomerero y’omusulo okutuusa ng’edda litangaavu, era ne bayunga ensawo za liita 3 eza Continuous Bladder Irrigation (CBI) nti ayoza ekibumba obutasalako ebweru olwo ebizimba ebipya ne bitasobola kutondebwawo.

Ebibaawo mu kitongole ky’abalwadde ab’amangu: Okukebera ekibumba, okukendeeza ku puleesa, n’okufulumya amazzi mu mubiri oluvannyuma lw’okuziyiza¶

Okutegeera ebikolwa by’omubiri ebibiri oluvannyuma lw’okukendeera kw’omubiri ebibaawo amangu ddala ng’ekibumba ekigaziye kifulumiziddwa mu ddwaaliro kinnyonnyola lwaki abasawo balondoola abalwadde oluvannyuma lw’okuteeka ekituli:

1. Okukebera mu bwangu ku kitanda Ultrasound Bladder Scan n'okussaamu Catheter:
2. Nga atuuse, nnansi oba omusawo akola ultrasound bladder scan okumala sekondi 10 nga tewali bulumi ultrasound bladder scan ku lubuto olwa wansi okupima obuzito obutuufu obw’omusulo ogusibiddwa (mu ngeri entuufu 500 ku 2,000+ mililita) era n’ayingizaamu omusulo gw’omusulo ogusiigiddwa eddagala eritaliimu buwuka (ng’akozesa intraurethral 2% lidocaine anesthetic gel empiso nga tezinnabaawo eddakiika 5 okuziba omusulo n’okuwummuza omusulo, oba Coudé-tip catheter ekoona mpola okuseeyeeya obulungi ku prostate egaziye).
3. Weetegereze ku "Clamping the Catheter Every 500 mL": Mu byafaayo, ba nurse basomesebwa okusiba catheter oluvannyuma lw'okufulumya 500 mL olw'okutya nti okufulumya amazzi mu kibumba kyonna omulundi gumu kijja kuleetera okuvaamu omusaayi ("hematuria ex vacuo") oba okuzirika. Ebiragiro eby’omulembe ebikwata ku musulo n’okugezesebwa mu malwaliro mu ngeri ey’ekifuulannenge bikakasa nti okufulumya amazzi mu bujjuvu, obutasalako mu kibumba kyonna omulundi gumu tekirina bulabe era kisingako okusiba ekitundu: ate nga puleesa mu butonde ekka katono (okuggyawo ekirungo ekiruma eky’okusaasira) n’okuwunyiriza okutono okwa pinki mu musulo kuyinza okuva mu kukendeera kw’omusulo awatali kulowooza ku sipiidi y’okusiba, okuleka ekitundu ky’ekibumba nga kijjudde ewangaaza obulumi n’obulabe bw’okukwatibwa yinfekisoni.
4. Okutunuulira "Post-Obstructive Diuresis" (Omusulo ogufuluma mungi oluvannyuma lw'okufulumya amazzi okusigala okutambula obutasalako oba okw'amaanyi):
5. Omuntu bw’aba alina omusulo ogusukka mu mililita 1,000 ku 1,500 ogusibye mu kibumba kye (naddala okumala ennaku ng’asigala mu puleesa ey’olubeerera nga kirimu creatinine mu musaayi), ensigo zifiirwa obusobozi bwazo okugatta omusulo okumala akaseera oluvannyuma lw’okuzibikira okuwona.
6. Mu ssaawa 24 ezisooka oluvannyuma lw’okuteekebwamu ekituli, ensigo ziyinza okuyiwa mu bwangu omusulo ogusukka mu mililita 200 omumyufu, ogw’amazzi buli ssaawa emu okumala essaawa 2 ez’omuddiring’anwa (oba >miliita 3,000 mu ssaawa 24).
7. Wadde ng’okufulumya amazzi mu mubiri (mild diuresis) kumala kufulumya munnyo, amazzi, ne urea ebisukkiridde ebikuumiddwa, pathologic post-obstructive diuresis esobola okumala amangu omulwadde amazzi n’okuggyamu sodium, potassium, magnesium, ne phosphate mu mubiri gwe, ekivaako puleesa okukendeera n’okutambula kw’omutima. Omulwadde yenna ng’okufulumya amazzi mu kibumba mu kusooka kusukka mililita 1,000, omusulo gwe gusukka 200 mL/essaawa okumala essaawa 2, oba ng’alina obuvune obw’amaanyi mu kibumba ng’akeberebwa omusaayi atunuulirwa mu ddwaaliro ng’alondoola omusulo buli ssaawa n’okukeberebwa amasannyalaze nga tannadda waka.
8. Okutandikawo Alpha-1 Blocker (Tamsulosin oba Alfuzosin) okusobola okukola obulungi "Okugezesa awatali Catheter" (TWOC):
9. Ku basajja abalina obulwadde bwa benign prostatic hyperplasia (BPH) abadda awaka nga balina Foley catheter ey’ekiseera n’ensawo y’amagulu, abasawo ab’amangu bakuwa eddagala eriweebwa mu kamwa buli lunaku selective alpha-1A blocker (nga tamsulosin 0.4 mg oba alfuzosin 10 mg). Okumira eddagala lya alpha-blocker okumala waakiri ennaku 3 ku 7 nga omusawo w’omusulo tannaggyayo catheter kiwummuza ekinywa ekiseeneekerevu eky’enseke era kubisaamu emirundi ebiri emikisa gy’omusajja okusobola okufulumya omusulo mu ngeri eya bulijjo ku lulwe nga catheter efulumye.

Ebizibu bibiri eby’amangu eby’ebweru w’ekyama ebivaako okusiba omusulo mu ngeri ey’amaanyi: Paraphimosis ne Retroverted Gravid Uterus¶

Ng’oggyeeko okugaziya enseke, eddagala, n’okunyigirizibwa kw’omugongo, embeera bbiri ez’amangu ez’ebyuma zinyiga mu mubiri omusulo nga guggaddwa era byetaaga okumanyibwa amangu:

1. Paraphimosis ("The Foreskin Tourniquet" mu Basajja Abatakomole, Abalenzi, n'Abalwadde Abateekebwamu Catheter) .¶

Paraphimosis mbeera ya mangu entuufu ey’omusulo ekwata ekiseera ekitera okubaawo mu malwaliro, mu maka g’abakadde, oba awaka ng’olususu lw’omulwadde atakomole (prepuce) lusimbuddwa emabega w’omutwe gw’obusajja (the glans and coronal sulcus) nga bayonja, nga bateeka catheter, oba nga bakola emirimu gy’okwegatta, era left ne basimbulwa emabega nga tebannaba kugizza mu kifo kyayo embeera eya bulijjo mu maaso.

• Ekibaawo: Empeta ennywevu ey’olususu lw’omugongo oluzze emabega ekola ng’akapiira akayitibwa tourniquet okwetooloola ekikondo emabega w’omutwe gw’obusajja. Okukulukuta kw’emisuwa n’amazzi okuva mu glans n’olususu lw’omu maaso olw’ewala kuziyira, ekivaako olususu lw’omu maaso oku balloon mu doughnut-like collar of tense, translucent fluid swelling ate omutwe gw’obusajja guzimba, gufuuka dark dusky purple oba bluish-black, ne gunyiga omusulo okuggalwa (causing acute urinary retention and, mu ssaawa, ischemic glans necrosis/gangrene).
• Obujjanjabi obusookerwako obw'amangu n'okukendeeza ku ddwaaliro olw'obulwadde bwa Paraphimosis:
• Buli musajja oba mulenzi atakomole alina ekituli kya Foley ekiyingiziddwamu ALINA okuba ng’olususu lwe olw’omu maaso luseeyeeya mpola okudda mu maaso waggulu w’omutwe gw’obusajja amangu ddala ng’omusulo gumaze okuteekebwa mu kifo.
• Singa paraphimosis ekula, genda mu kitongole ky’abalwadde ab’amangu mu bwangu. Abasawo basiiga eddagala eribudamya ku mubiri (oba bakola dorsal penile nerve block), bazinga enkokola ezimba ne gaasi oba osmotic compress, basiiga steady circumferential manual compression (the "gloved hand squeeze") okumala eddakiika 5 ku 10 okusika amazzi g'okuzimba agakwatiddwa okuva mu mpeta y'olususu lw'omu maaso, n'oluvannyuma mpola n'osika endabirwamu emabega n’engalo zombi ensajja ng’osika olususu lw’omu maaso mu maaso waggulu w’omutwe gw’obusajja.

2. Nnabaana ow’olubuto azze emabega (Incarcerated Retroverted Gravid Uterus) (Wiiki z’olubuto okuva ku wiiki 10 okutuuka ku 16) .¶

Abakyala nga 15 ku buli 100 mu butonde balina nnabaana retroverted ("tilted backward"). Mu budde obwabulijjo, olubuto bwe lukula nga lusukka wiiki 10 ku 12, nnabaana asituka bulungi okuva mu kisambi n’ayingira mu lubuto.

Mu mbeera ezitatera kubaawo wakati wa wiiki 10 ne 16 ez’olubuto, nnabaana akula nga akyusiddwa emabega afuna okusiba (okusibirwa) wansi w’amagumba agawanvuye aga sacral promontory emabega w’ekisambi. Nga nnabaana asibiddwa agaziwa, asika omumwa gwa nnabaana nnyo mu maaso n’okudda waggulu emabega w’eggumba ly’omumwa gwa nnabaana, n’egolola n’okunyiga omusulo gw’omukazi nga guwanvuwa ku kifuba.

• Obubonero obw’okulabula: Omukyala ow’olubuto ku wiiki 10 ku 16 ng’ali lubuto azuukuka ku makya oba akawungeezi ng’alina obutasobola kufulumya musulo mu bwangu, mu bulumi, okujjula ekisambi, okulumwa omugongo ogwa wansi, oba okutonnya mu ngeri etali ya bulijjo.
• Ekifo eky'amangu Obuyambi obusookerwako ng'ogenda mu kitongole ky'abalwadde ab'amangu:
• Nga olindirira okutambuza okugenda mu OB/GYN n’okusunsula mu bwangu, okuwummulako mu mbeera ya okugulu-ekifuba (okufukamira ku kitanda ng’ekifuba n’ebibegabega biwummudde wansi ku mutto okumala eddakiika 10 ku 15) oba embeera ya Sims ey’ebbali eya kkono ekozesa amaanyi ag’ekisikirize okuyamba okukuba ekitundu ky’omu nnabaana ekizito mu maaso okuva ku sacrum, ate abasawo ab’amangu ne bateeka Foley omugonvu catheter okufulumya amazzi mu kibumba n’okukendeeza mpola nnabaana okuyingira mu lubuto.

Bwe kiba nti okuyingiza omusulo mu musulo KIKOZESEBWA DDALA: Okutaataaganyizibwa kw’omusulo mu ngeri ey’okulumwa¶

Wadde ng’okuteeka omusulo gwa Foley okuyita mu musulo gwe bujjanjabi obwa bulijjo eri ebitundu 99 ku 100 eby’abalwadde abasiba omusulo, waliwo embeera emu ey’okulumwa ennyo ng’okuyingiza omusulo gw’omusulo kigaaniddwa nnyo kubanga okuserengesa ttanka waggulu mu musulo ogukutuse kikyusa ekitundu ekikutuse ne kifuuka okuziba okujjuvu, okw’obulamu bwonna oba okusika omusulo okufuluma mu kifuba obulwadde bw’omusaayi:

Ebibuuzo ebitera okubuuzibwa¶

Ensonda zeekebeddwa¶

• American Urological Association (AUA, United States): Okuddukanya obubonero bw’omusulo ogwa wansi obuva ku Benign Prostatic Hyperplasia (BPH) ne Acute Urinary Retention Guideline ne Catheter-Associated Urinary Tract Care.
• European Association of Urology (EAU): Ebiragiro bya EU ku nzirukanya y’obubonero bw’omusulo gw’abasajja ogutali gwa busimu, okusigala kw’omusulo ogw’amaanyi, n’endwadde z’omusulo.
• National Institute for Health and Care Excellence (NICE, United Kingdom): Obubonero bw’omusulo ogwa wansi mu basajja: Enzirukanya (CG97) ne Obulwadde obukwatagana n’ebyobulamu: Okulabirira omusulo ogw’ekiseera ekiwanvu (CG139).
• Consortium for Spinal Cord Medicine (Paralyzed Veterans of America, United States): Okwekenenya n’okuddukanya obuzibu bw’okwefuga n’obuzibu obulala obw’okwefuga: Okulabirira okw’amangu okw’emisuwa gy’omusulo egyazibiddwa.
• Nyman MA, Schwenk NM, Silverstein MD (Mayo Clinic Proceedings): Okuddukanya okusigala kw’omusulo: okukendeeza amangu okusinziira ku kukendeeza mpolampola n’obulabe bw’ebizibu (okukakasa okufulumya amazzi mu kibumba mu bwangu mu bujjuvu tekirina bulabe era kisinga ku kusiba mu mitendera).

Ebiragiro ebikwatagana nabyo¶

• Autonomic dysreflexia mu kulabirirwa okw’amangu olw’obuvune bw’omugongo
• Obulwadde bwa Cauda equina syndrome ne acute spinal cord compression bendera emmyufu
• Obulumi obw’amaanyi mu kibumba amayinja vs. ekibumba ekizibiddwa (urosepsis) .
• Exertional rhabdomyolysis, obuvune obw’amaanyi mu kibumba, n’omusulo omuddugavu
• Okutebenkeza okumenya ekisambi n’okufuga okuvaamu omusaayi munda
• Ennamba z’amangu okusinziira ku nsi