Tlhokomelo ya Maemo a Tshoganyetso ya go Tshwara ga Motlhapo o o Bogale le Tlhokomelo ya Tshoganyetso ya Khethetere e e Thibegileng¶

Acute urinary retention (AUR) ke go palelwa ka tshoganyetso, go go botlhoko go ntsha motlhapo mo setlheng le fa setlha se tletse, se otlolla ka bonako se se nang le dimililitara di le 500 go ya go di feta 1,500 (di-ounces di le 17 go ya go di le 50) tsa motlhapo o o tshwaregileng. Se se potlakileng ka go lekana ke tlhobolo e e thibegileng thata e e nnang mo teng ga moroto (Foley) kgotsa tlhobolo e e kwa godimo ga tlhogo, koo go nang le diminerale, mamina a makima, go tlhotlhorega ga motšhini, kgotsa go tlhotlhorega ga madi go thibelang tšhupu ya go ntsha metsi mo tlhogong. Fa motlhapo o sa kgone go tswa mo setlheng, kgatelelo ya mo setlheng e a tlhatloga ka bonako, mme seno se baka go tlhotlhorega go go botlhoko ga karolo e e kwa tlase ya mpa (suprapubic), go tlhatloga ga thulaganyo ya methapo e e ikemetseng (go tlhatloga thata ga kgatelelo ya madi kgotsa go tsenya botshelo mo kotsing go sa kgone go itlhalosa mo balwetseng ba ba gobetseng mothapo wa mokwatla), kgatelelo ya mokwatla e e yang kwa godimo e e tswalang diphilo ka bobedi (morago ga diphilo kgobalo e e masisi ya diphilo le go tlhokafala ga metsi mo matlhakoreng a mabedi), le bolwetsi jwa motlhapo.

Maikarabelo a gago a ka bonako fa motho a sa kgone go rota kgotsa a na le tšhupu e e thibegileng e e tsenang mo teng ke go emisa go nwa dieledi tsotlhe ka bonako (go nwa metsi a mantsi fa go tswa ga senya go thibegile go gakatsa go atologa go feta selekanyo ga senya le go utlwa botlhoko), go tlhatlhoba bolwetse jwa methapo letshwao la cauda equina (setlhabi sa mokwatla se se nang le go utlwa botlhoko mo saleng kgotsa go nna bokoa mo leotong) le go sa kgone go itlhalosa (tlhogo e e opang thata le kgatelelo e kgolo ya madi mo molwetseng yo o gobetseng mo mokwatleng), dira tlhatlhobo ya tšhupu ya kwa ntle ya tšhupu ya metsotswana e le 60 (go bofolola tšhupu e e sothegileng, go bofolola mabanta a a gagametseng a maoto, le go folosa kgetsi ya go ntsha metsi kwa tlase ga selekanyo sa senya) fa tšhupu e setse e gogilwe dithapo mo tšhupu**, mme o ye kwa lephateng la maemo a tshoganyetso ka bonako go ya go fokotsa kgatelelo ya senya se se senang megare.

Dira se jaanong¶

1. Emisa go nwa metsi otlhe le diedi ka bonako: Fa tsela ya go tswa ga senya kgotsa tšhupu e thibegile, go nwa metsi mangwe le mangwe a o a nwang go sefa ka diphilo go tsena mo setlheng se se tshwaregileng, go otlolla ditlhale tsa mesifa ya detrusor go ya pele le go gakatsa di-spasm tse di botlhoko tsa suprapubic.
2. Leletsa ditirelo tsa kalafi tsa tshoganyetso ka bonako fa go na le difolaga tse dikhibidu tsa methapo, tsa septic, kgotsa tsa kgobalo e e kotsi thata: Leletsa nomoro ya gago ya tshoganyetso ya selegae (911 kwa United States le Canada, 112 go ralala Kopano ya Yuropa, 999 kwa United Kingdom, 000 kwa Australia) kgotsa tlhola lenaane la rona la dinomoro tsa tshoganyetso fa go sa kgone go rota go tsamaya le:
3. Kgobalo ya mokwatla e e kwa godimo ga T6 e e nang le tlhogo e e opang thata, sefatlhego se se hibidu/se se mofufutso, kgotsa kgatelelo ya madi e e kwa godimo (Go sa kgone go itlhalosa, maemo a tshoganyetso a a bakang seterouku).
4. Botlhoko jwa mokwatla o o kwa tlase, go tlhotlhorega mo sehubeng/maragong ("saddle anesthesia"), kgotsa bokoa/go tlhotlhorega mo maotong (Bolwetse jwa Cauda Equina).
5. Letshoroma (>=didikirii tsa Celsius di le 38.0 / didikirii tsa Celsius di le 100.4), go roroma ga sedidi, go tlhakana tlhogo, kgotsa go tsewa ke sedidi (Urosepsis).
6. Go robega ga letheka la bosheng, kgobalo ya straddle, kgotsa madi a a rothang go tswa kwa ntlheng ya motlhapo (go thubega ga motlhapo; o seka wa leka go tsenya tlhobolo go fitlha go dirwa urethrogram ya go boela kwa morago).
7. Fa motho a na le tšhupu e e nnang mo teng ya Foley kgotsa ya suprapubic e e emisitseng go ntsha metsi, dira Tlhotlhomiso ya Ditšhupu tsa Kwa Ntle ya Metsotswana e le 60 gone jaanong:
8. Unkink: Latedisa tšhupu yotlhe go tswa mo mmeleng go ya kwa kgetsaneng; tlhamalatsa dikhuti dipe tse di bogale, dikhuti, kgotsa dithapo fa molwetse a ntseng kgotsa a robetse mo tšhupu.
9. Unclamp: Netefatsa gore tlelampe epe ya polasetiki ya go relela kgotsa belefo ya flip-flo ya khethetere ga e a tlogelwa e tswetswe ka phoso.
10. Lokolola dithapo tsa maoto: Bofolola dithapo tse di gagametseng tsa Velcro leg-bag tse di ka tswang di tshwaratshwara lumen e e bonolo ya silicone.
11. Fokotsa kgetsi ka fa tlase ga dinoka: Sutisa kgetsi ya go ntsha metsi kwa tlase ka fa tlase ga selekanyo sa senya (motlhapo ga o ka ke wa elela go ya kwa godimo kgatlhanong le maatlakgogedi; kgetsana e e ikhutsitseng mo materaseng wa bolao e dira airlock e e emang go ntsha metsi).
12. O SE KE wa ntsha tšhupu ya Foley e e nnang mo teng kwantle ga go ntsha mowa mo balunung e e tshwarang mo teng, mme O SE KE wa tlhotlhora sepe mo teng ga tšhupu: Tšhupu ya Foley e e nnang mo teng e tlhomamisitswe mo teng ga senya ke balunu e e tletseng metsi ya dimililitara di le 10 e e bogolo jaaka tamati ya tšheri. Go goga tlhobolo kwa ntle ka balunu e buduletswe go kgaoganya lela la setlha le mothapo wa moroto, go dira gore go tswe madi a mantsi mo ditshikeng.
13. O se ka wa gatelela thata mo karolong e e kwa tlase ya mpa e e atolositsweng (Credé maneuver e kotsi mo go thibeleng): Go gatelela ka maatla mo setlheng se se atolositsweng thata, se se thibegileng go tlhatlosa kgatelelo ya mo teng ga senya, go pateletsa moroto o o tshwaetsegileng go boela kwa morago mo diphilong (vesicoureteral reflux a), mme go ka
14. Eya kwa lephateng la tshoganyetso la bookelo ka bonako fa go se na motlhapo o o fetang mo diureng di le 4 go ya go di le 6 tsa go tshwarwa ga botlhoko (kgotsa diura di le 1 go ya go di le 2 tsa tšhupu e e thibegileng): Go tsenngwa ga tšhupu e e senang megare ka bonako go imolola botlhoko mo metsotswaneng e le 30 mme go sireletsa mesifa ya senya le diphilo tse di otlogang mo kgobalong.

flowchart TD
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    StopDrink --> CheckNeuro{"2. Tlhola Difolaga tse di Khibidu tse di Botlhokwa: Kgobalo ya Mokwatla wa Mokwatla + Go Opa ga Tlhogo/BP e e Kwa Godimo (Dysreflexia e e Ikemetseng), Go tlhotlhorega ga Setulo/Bokoa jwa Leoto (Cauda Equina), Letshoroma/Go tsidifala, kgotsa Kgobalo ya Pelvic?"}
    CheckNeuro -->|Yes| CallEMS["Leletsa Ditirelo tsa Maemo a Tshoganyetso (911 / 112 / 999) ka bonako"]
    CheckNeuro -->|No| HasCath{"3. A Molwetse o na le Khathetara ya Foley kgotsa ya Suprapubic e e nnang mo teng ga jaana?"}
    HasCath -->|Yes: Blocked Catheter| CheckTube["Taboga Tlhotlhomiso ya Ditšhupu ya Metsotswana e le 60: Tlhamalatsa Dikink, Bula Ditlelempe, Lokolola Dithapo, Lepeletsa Kgetsana kwa Tlase ga Dinoka"]
    HasCath -->|No Catheter| UrgentED["Go Isa ka Bofefo kwa Lefapheng la Maemo a Tshoganyetso go ya go Sekaseka Senya le go Fokotsa Kgatelelo ya Tšhupu e e Senang Mogare"]
    CheckTube --> Draining{"4. A Motlhapo o Simolotse go Elela mo Kgetsaneng mo Metsotsong e le 5?"}
    Draining -->|No / Still Blocked or Bypassing| UrgentCath["Batla Mooki wa Maemo a Tshoganyetso / Tlhokomelo ya Bookelo ka bonako go Tlhatswa kgotsa go Fetola Khathetere e e Senang Mogare (O Se ka wa Goga Balunu)"]
    Draining -->|Yes| Monitor["Tlhokomela Mmala wa Motlhapo, Matlhotlhora le Mothamo wa Motlhapo ka kelotlhoko"]

Goreng go tshwarwa ga motlhapo go go tseneletseng go diragala: Dilo tse di tlwaelegileng tse di bakang mo banneng, mo basading le mo baneng¶

Ka tlwaelo, go rota (go rota) go tlhoka ditiro tse pedi tse di tsamaisanang tse di laolwang ke mothapo wa lerapo la mokwatla wa sacral (S2, S3, le S4 ditshika tsa parasympathetic) le lefelo la go rota la pontine la kutu ya boboko: lebota la mesifa ya senya (mesifa ya detrusor) e tshwanetse go kopana, fa mesifa ya pro-1 di-adrenergic**) di tshwanetse go iketla le go bulega ka nako e le nngwe. Go tshwara motlhapo go go botlhoko go tlhasela nako le nako fa lefelo le le tswalang motlhapo le tswalwa ka mmele KGOTSA go ngotlega ga tshika/mesifa go palelwa:

Go Tshwara Motlhapo go go Bogale kgatlhanong le go go Sa Foleng: Go Lemoga "Go sa Itshware Motlhapo go Elela" (Ke ka ntlha yang fa go elela ga motlhapo GO SA REYE gore senya ga se na sepe)¶

Nngwe ya dikgopolo tse di phoso tse di kotsi thata mo malapeng le mo batlhokomeding ke go tsaya gore ka gonne motho a ntsha moroto o monnye metsotso mengwe le mengwe e le 20 kgotsa a kolobisa dipedi tsa gagwe tsa go sa kgone go itshwara, ga go kgonege gore a nne le go boloka moroto.

Tota e bile, go fetisa moroto o monnye kgapetsakgapetsa (dimililitara di le 30 go ya go di le 50 ka nako) kgotsa go tsholola moroto ka metlha o sa itirele kwantle ga go imolola go tlala ga mpa e e kwa tlase ke letshwao le le tlwaelegileng la Go sa kgone go itshwara ga moroto ka ntlha ya go boloka moroto o o tseneletseng:

Tharabololo ya mathata a tshoganyetso a Tšhupu e e Thibegileng e e Nnang mo teng (Foley kgotsa Suprapubic)¶

Dimilionemilione tsa batho ba nna kwa gae ka tlhobolo ya urethral (Foley) e e nnang mo teng ya nako e telele kgotsa tlhobolo ya suprapubic (tlhobolo e e tsenang mo setlheng ka tlhamalalo ka stoma e nnye ya leroba la selotlolo mo mpeng e e kwa tlase fela fa godimo ga lerapo la pubic). Ka gonne dibakateria tse di jaaka Proteus mirabilis di dira di-catheter tsa nako e telele mme di ntsha enzyme urease, di fetola moroto go nna alkaline mme di tlhotlhore dikristale tsa struvite le calcium phosphate ("go tsenngwa ga di-catheter") tse di ka thibang di-eyelets tsa di-catheter kwa ntlheng ya di-ur.

1. Tsela ya go lemoga tšhupu e e thibegileng e e tsenang mo teng¶

Belaela gore tlhobolo e thibegile ka bonako fa:

• Motlhapo wa lefela o tshologetse mo kgetsaneng ya go kokoanya mo diureng di le 2 go ya go di le 4 tse di fetileng (le fa go nwa dieledi ka tlwaelo).
• Motho o nna le go tlala go gošwa ga karolo e e kwa tlase ya mpa (suprapubic), go utlwa botlhoko, kgotsa go tlhotlhorega ga senya go go botlhoko.
• Go Kganetsa "Catheter Bypass" (Motlhapo o dutla go dikologa bokafantle jwa tšhupu ka metlha): Batlhokomedi ba le bantsi ba bona motlhapo o kolobetsa dishiti tsa malao go dikologa bokafantle jwa tšhupu ya tšhupu mme ba akanye ka phoso gore "Tlhupu e nnye thata." Tota e bile, go dutla go dikologa tšhupu ka metlha). e e bakiwang ke go THIBIWA ga lumen ya catheter ka fa teng, e pateletsa senya se se tletseng ka tsela e e botlhoko go tsena mo di-spasm tse di bogale tse di tshololang moroto go dikologa bokafantle jwa tšhupu.
• Mo molwetse yo o nang le Kgobalo ya Mokwatla mo maemong a T6 kgotsa kwa godimo ga one: Tlhogo e e opang ka tshoganyetso, kgatelelo ya madi e e tlhatlogang ka 20 go ya go 40+ mmHg kwa godimo ga selekanyo sa motheo, go itaya ga pelo go go bonya kgotsa go go tabogang, go fufula thata le go tlhotlhorega go feta selekanyo sa kgobalo, le go tlhotlhorega ga diganse kwa tlase ga selekanyo sa kgobalo. Se ke Go sa kgone go itlhalosa, mme tšhupu e e thibegileng ya motlhapo ke yone #1 e e bakang (e e bakang diperesente di feta 75 go ya go 85 tsa ditlhaselo tsotlhe tsa dysreflexia ya autonomic).

2. Tlhotlhomiso ya kwa ntle e e babalesegileng kgato ka kgato ya go bona gore a go na le tšhupu e e thibegileng (Se mongwe le mongwe a ka se dirang mo metsotswaneng e le 60)¶

Pele ga o ya kwa bookelong kgotsa o leletsa mooki wa baagi wa maemo a tshoganyetso, dira tlhatlhobo eno ya kwa ntle ya dintlha di le 5 e e babalesegileng (e e rarabololang di-airlock tsa metšhini le di-kink ka bonako):

1. Nna molwetse a tlhamaletse fa a na le Kgobalo ya Mothapo wa Mokwatla le Autonomic Dysreflexia: Go nna motho a tlhamaletse ka didikirii di le 90 le go lepeletsa maoto a gagwe go dirisa maatlakgogedi go fokotsa ka bonako kgatelelo ya madi e e kwa godimo e e kotsi ya boboko fa o ntse o tlhola tšhupu.
2. Birolola le go latedisa tsela yotlhe ya tšhupu go tswa mo mmeleng go ya kwa kgetsaneng: Tlhola ka fa tlase ga dikobo, fa gare ga dirope, le ka fa tlase ga dikhushene tsa setulo sa maotwana go netefatsa gore molwetse ga a nna mo tšhupu le gore ga go na di-kink tse di sothegileng.
3. Hlahloba mabanta a kgetsana ya maoto le disebediswa tsa ho tiisa khethetere (StatLock): Lokolla mabanta afe kapa afe a thata a elastic a maoto kapa mabanta a thata a diaparo tsa ka hare a hatellang tjhupu.
4. Fokotsa kgetsi ya go ntsha metsi kwa tlase thata ga selekanyo sa senya (dinoka): Netefatsa gore kgetsi e lepeletse ka kgololesego ka fa tlase ga dinoka (o se ke wa ikhutsa mo materaseng kgotsa wa gokelelwa kwa godimo mo seporo sa bolao). Fa loop e telele ya ditšhupu e lepelela kwa tlase go ya kwa fatshe mme morago ga moo e tlhatlogela gape kwa godimo kwa kgetsaneng, tsholetsa loop e e ikaegileng ka bonolo metsotswana e le 5 gore moroto o o tshwaregileng o elele mo kgetsaneng mme o thube airlock epe fela.
5. Tlhola dipolaka tse di bonalang mo fensetereng ya polasetiki e e bonalang: Leba segokaganyi se se bonalang fa khethetere e kopanang teng le tšhupu ya kgetsi ya go ntsha metsi:
6. Matlhotlhora a madi a a bohibidu jo bontsho jo bo tseneletseng ("Go Tshwara Matlhotlhora"): Fa tšhupu e tletse ka matlhotlhora a madi a mahibidu a a fifetseng a a tshwanang le jeli (a a tlwaelegileng morago ga karo ya lela la setlha [TURP], karo ya tlhagala ya senya, cystitis ya marang, kgotsa go gogwa ga tšhupu e e utlwisang botlhoko), tšhupu e e tlwaelegileng e e tshesane ya Foley drain ga e kake; molwetse o tshwanetse go ya kwa lephateng la maemo a tshoganyetso ka bonako go ya go bewa Catheter ya Hematriuria e e gagametseng ya 22-go-24 ya Fora ya Ditsela Tse Tharo tsa Nosetso ya Senya (CBI) e e kgethegileng le go ntsha madi a a tshologang ka diatla ka sering ya Toomey e e nang le bore jo bogolo.
7. Motlhaba o mosweu wa tšhoko/grit kgotsa mamina a a serolwana se sekima: E supa go tlhotlhorega ga diminerale kgotsa biofilm ya tshwaetsego e e thibang ntlha ya khethetere.

3. Melao e e botlhokwa ya pabalesego: Se o sa tshwanelang go se dira ka tšhupu e e thibegileng kgotsa e e ntshitsweng¶

• O SE KE wa leka go tlhatswa kgotsa go nosetsa tšhupu e e thibegileng ntle le fa o katisitswe ke ngaka mme o na le letswai le le senang megare/tharabololo ya go tlhokomela tšhupu le sering e e senang megare ya ntlha ya tšhupu: Go tlhatswa metsi a a senang megare a thepe kgotsa go kgoromeletsa thata ka sering kgatlhanong le metsi a a thibegileng gotlhelele ka tlhamalalo mo diphilong (bacteria). Fa o katisitswe go dira tlhatswa e e bonolo e e senang megare mme seeledi se kopana le kganetso e e tiileng, ema ka bonako; le ka motlha o se ke wa pateletsa plunger.
• O SE KE wa goga tšhupu ya Foley kgotsa wa leka go sega tšhupu ya tšhupu go ntsha mowa mo balunung e e kgomaretseng: Go sega šafote ya tšhupu ya Foley kgapetsakgapetsa go dira gore kanale e nnye ya go budulela mowa mo teng ga lebota la raba e tswalelwe ruri gore balunu e se ka ya ntsha mowa. Ke ngaka fela kgotsa mooki yo o katisitsweng yo o dirisang belefo ya letlhakore (e e nang le sering ya Luer-slip go goga 10 mL ya metsi a a senang megare) yo o tshwanetseng go tlosa tlhobolo.
• Molao o o Potlakileng wa Diura di le 1 go ya go di le 2 fa Khathetere ya Suprapubic e wela kwa ntle ka phoso: Go farologana le mothapo wa tlhago wa moroto (o o nnang o bulegile), tselana ya khethetere ya suprapubic (thanele ya karo e e fetang mo leboteng le le kwa tlase la mpa go tsena mo setlheng) **e simolola go ngotlega le go tswalega fa e goga ka phoso. Fa tšhupu ya suprapubic e ka wela kwa ntle, khurumetsa stoma e nnye ya mpa ka sethibela-gauze se se phepa se se senang megare mme ye kwa lephateng le le gaufi la maemo a tshoganyetso kgotsa mooki yo o katisitsweng wa urology ka bonako (mo lobakeng lwa ura e le 1) gore tšhupu e ntšhwa ya go emisetsa e ka relela ka pabalesego mo pampitshaneng e e leng teng pele ga yone e tswalwa.

Maemo a tshoganyetso a a kgethegileng: Go Boloka Madi a a Bogale (Hematuria e e Feletseng e e nang le Madi a Madi)¶

Fa motho a tswa madi mo teng ga tsela ya motlhapo (ka ntlha ya karo ya bosheng ya lela la setlha kgotsa ya senya, go utlwa botlhoko mo diphilong, kankere ya senya, radiation cystitis, kgotsa diokobatsi tse di fokotsang madi), motlhapo wa motho o na le enzyme e e bidiwang urokinase e e lekang go phatlalatsa madi a mannye. Le fa go ntse jalo, fa madi a tswa ka bonako, madi a tlhotlhorega mo teng ga senya se se bothitho go nna dithishu tse dikima, tse di tshwanang le rabara, tse di bohibidu jo bontsho "tse di tshwanang le sebete" kgotsa tse di tshwanang le seboko.

Di-clot tseno di nwela kwa tlase ga senya (trigone) mme di dira jaaka sethibo sa bata sa rabara mo godimo ga molala wa senya (Acute Clot Retention).

• Kafa o ka lemogang Clot Retention: Molwetse o fetisa moroto o mohibidu o o galotseng kgotsa o o fifetseng wa burgundy o o nang le di-clot tse dihibidu tse di bonalang, mme morago ga moo ka tshoganyetso ke di-spasm tse di botlhoko tsa go tlhotlhorega ga mpa e e kwa tlase le go sa kgone go fetisa moroto gotlhelele (kgotsa go fetisa fela lerothodi la seedi se se pinki go dikologa legogo le legolo).
• Ke ka ntlha yang fa Clot Retention e le tshoganyetso ya nnete ya karo ya bookelo: Go nwa metsi kgotsa go baya tšhupu e e tlwaelegileng e e boleta ya 14 kgotsa 16 ya French Foley ga go kitla go dira, ka gonne di-catheter tse di boleta di phutlhama ka bonako mme di thibane ka di-clot. Mo lephateng la maemo a tshoganyetso, dingaka di tsenya 22 kgotsa 24 French Three-Way Council kgotsa Coude Irrigation Catheter e e thata, di gogela ka diatla matlhotlhora otlhe a madi a a tshwanang le rabara go tswa mo setlheng di dirisa saline e e senang megare le sering ya 60 mL ya ntlha ya tlhobolo go fitlha senya se se boelang se le phepa, mme Nosetso (CBI)** e e tswelelang go tlhatswa senya gore di-clot tse dišwa di se ka tsa bopega.

Se se diragalang kwa lephateng la maemo a tshoganyetso: Go sekaseka senya, go fokotsa kgatelelo ya senya, le go ntsha metsi morago ga go thibega ga senya¶

Go tlhaloganya ditsibogo tse pedi tsa mmele tsa morago ga go fokotsa kgatelelo ya madi tse di diragalang fela fa senya se se atologileng se sena go ntshiwa metsi kwa bookelong go tlhalosa lebaka la go bo dingaka di baya balwetse leitlho morago ga go ba tsenya tšhupu:

1. Go Sekaseka Senya ka Ultrasound ka Bofefo le go Tsenngwa ga Tšhupu:
2. Fa mooki kgotsa ngaka e goroga, e dira tshekatsheko ya senya sa ultrasound e e senang botlhoko ya metsotswana e le 10 mo godimo ga mpa e e kwa tlase go lekanya selekanyo se se tlhomameng sa motlhapo o o tshwaregileng (ka tlwaelo dimililitara di le 500 go ya go di le 2 000+) mme e tsenya motlhapo o o logeditsweng o o senang megare gel ya go bolaya bogatsu** e e tlhabelwang metsotso e le 5 pele ga nako go dira gore mothapo wa moroto o nne bogatsu le go repisa sphincter, kgotsa catheter ya Coudé-tip e e kobegileng ka bonolo go relela ka thelelo mo godimo ga lela la setlha le le godileng).
3. Ela tlhoko ka ga "Go Tshwara Catheter Mongwe le Mongwe 500 mL": Go ya ka hisitori, baoki ba ne ba rutwa go tshwara catheter morago ga go ntsha 500 mL ka ntlha ya go tshaba gore go ntsha senya sotlhe ka nako e le nngwe go tla baka go dutla madi ("hematuria ex vacuo") kgotsa go idibala. Dikaelo tsa segompieno tsa urology le diteko tsa kalafi tse di sa rulaganngwang di netefatsa gore go ntsha metsi ka botlalo, go go tswelelang pele ga senya sotlhe ka nako e le nngwe go babalesegile e bile go gaisa go tshwara ka bontlhabongwe: fa kgatelelo ya madi ka tlhago e wela tlase go sekae (e tlosa tlhogo e e botlhoko ya kutlwelobotlhoko) le go tlhotlhorega go go nnye ga motlhapo go go senang motlhapo go ka diragala go tlogela halofo ya senya e tletse go lelefatsa botlhoko le kotsi ya tshwaetsego.
4. Go ela tlhoko "Post-Obstructive Diuresis" (Go ntsha moroto o montsi morago ga go ntsha motlhapo o o sa foleng kgotsa o o tshwarwang thata):
5. Fa motho a nnile le dimililitara di feta 1 000 go ya go 1 500 tsa motlhapo tse di tshwaregileng mo setlheng sa gagwe (bogolo jang mo malatsing a le mantsi mo go tshwareng ga kgatelelo e e kwa godimo ka creatinine e e kwa godimo mo mading), diphilo di latlhegelwa ke bokgoni jwa tsone jwa go kokoanya motlhapo ka nakwana morago ga gore go thibana go imololwe.
6. Mo diureng tsa ntlha tse 24 morago ga go tsenngwa ga tšhupu, diphilo di ka nna tsa tshologela ka tshoganyetso dimililitara di feta 200 tsa moroto o o bosetlha, o o metsi ura nngwe le nngwe mo diureng di le 2 ka go latelana (kgotsa >3,000 milliliters mo diureng di le 24).
7. Le fa diuresis e e botlhofo e ntsha fela letswai le le feteletseng le le bolokilweng, metsi le urea, go ntsha metsi morago ga go thibela metsi go ka fedisa metsi mo molwetseng ka bonako le go amoga mmele wa gagwe sodiamo, potasiamo, magnesiamo, le phosphate, go baka go fokotsega ga kgatelelo ya madi le go sa itekanelang ga pelo. Molwetse mongwe le mongwe yo motlhapo wa gagwe wa ntlha o fetang 1,000 milliliters, yo motlhapo wa gagwe o fetang 200 mL/ura ka diura di le 2, kgotsa yo o nang le kgobalo e e botlhoko ya diphilo mo ditlhatlhobong tsa madi o lemogwa kwa bookelong ka go latedisa motlhapo ka ura le go tlholwa ga electrolyte pele ga a ya kwa gae.
8. Go Simolola Sethibela-Alpha-1 (Tamsulosin kgotsa Alfuzosin) sa "Teko e e Atlegileng kwantle ga Tšhupu" (TWOC):
9. Mo banneng ba ba nang le bolwetse jo bo seng kotsi jwa go oketsega ga lela la setlha (BPH) ba ba yang gae ka tšhupu ya nakwana ya Foley le kgetsi ya leoto, dingaka tsa maemo a tshoganyetso di ba naya sethibela-alpha-1A se se tlhophilweng (se se jaaka tamsulosin 0.4 mg kgotsa alfuzosin 10 mg) se se nowang letsatsi le letsatsi. Go nwa alpha-blocker bonnye malatsi a le 3 go ya go a le 7 pele ga ngaka ya motlhapo e ntsha tšhupu go repa mesifa e e borethe ya lela la setlha mme go menaganya kgonagalo ya gore monna a kgone go rota ka tlwaelo ka boene gabedi fa tšhupu e tswa.

Maemo a tshoganyetso a mabedi a kwa ntle a dirwe tsa tlhakanelodikobo a a bakang go tshwarwa ga moroto ka bonako: Paraphimosis le Popelo e e Boileng e e Boelang Morago¶

Mo godimo ga go godisa lela la setlha, melemo le go gatelelwa ga mothapo wa lerapo la mokwatla, maemo a tshoganyetso a mabedi a a rileng a metšhini a tshwaraganya mothapo wa moroto ka mmele mme o tlhoka go lemogiwa ka bonako:

1. Paraphimosis ("Tourniquet ya Letlalo la Dithoto" mo Banneng ba ba sa Rupang, Basimane, le Balwetse ba ba Tsenngwang ka Tšhupu)¶

Paraphimosis ke boemo jwa tshoganyetso jwa mmatota jo bo tlhokang nako jo bo diragalang gantsi kwa dikokelong, kwa magaeng a bagodi, kgotsa kwa gae fa letlalo la molwetse yo o sa rupang (prepuce) le gogelwa kwa morago ka fa morago ga tlhogo ya bonna (glans and coronal sulcus) ka nako ya go phepafatsa, morago ntle le go e busetsa mo seemong sa yone se se tlwaelegileng sa kwa pele**.

• Go diragalang: Palamonwana e e gagametseng ya letlalo la bonna le le gogetsweng morago e dira jaaka tourniquet ya rabara go dikologa shaft fela ka fa morago ga tlhogo ya bonna. Go tswa ga ditshika le lymphatic go tswa mo glans le letlalong la tlhogo le le kgakala go a hupediwa, go dira gore letlalo la tlhogo le tlhotlhorege go nna kholara e e tshwanang le donut ya go ruruga ga seeledi se se gagametseng, se se bonaletsang fa tlhogo ya setho sa bonna e ruruga, e fetoga go nna phepole e e fifetseng e e fifetseng kgotsa e ntsho e e botala jwa legodimo, mme e tswale motlhapo (urine) diura, go bola ga glans/gangrene**).
• Thuso ya Ntlha ya Ka bonako le Phokotso ya Bolwetse jwa Paraphimosis kwa Bookelong:
• Monna mongwe le mongwe yo o sa rupang kgotsa mosimane yo o tsentsweng tšhupu ya Foley O TSHWANETSE go dira gore letlalo la gagwe la tlhogo le relele ka bonolo go boela kwa pele mo godimo ga tlhogo ya tlhogo ya bonna ka bonako fela fa tšhupu e sena go tsenngwa.
• Fa go ka nna le paraphimosis, ya kwa lephateng la tshoganyetso ka bonako. Dingaka di dirisa gel ya go bolaya bogatsu (kgotsa di dira boloko ya methapo ya penis ya mokwatla), di phuthela kholara e e rurugileng ka gauze kgotsa ka osmotic compress, di dirisa kgatelelo e e tlhomameng ya diatla ("go gatelela ka diatla ka ditlelafo") metsotso e le 5 go ya go e le 10 go gatelela letlalo la fluid ka bonolo kgoromeletsa glans kwa morago ka menwana ya kgonope ka bobedi fa o ntse o gogela letlalo la tlhogo kwa pele mo godimo ga tlhogo ya setho sa bonna.

2. Popelo e e Boelang Morago e e Tshwerweng (Dibeke tsa Boimana 10 go ya go 16)¶

Mo e ka nnang diperesente di le 15 tsa basadi ka tlholego ba na le popelo e e boelang kwa morago ("e e sekametseng kwa morago"). Ka tlwaelo, fa boimana bo ntse bo gola go feta dibeke di le 10 go ya go di le 12, popelo e tlhatloga ka thelelo go tswa mo lethekeng go tsena mo mpeng.

Mo mabakeng a a sa tlwaelegang fa gare ga dibeke di le 10 le di le 16 tsa boimana, popelo e e golang e e boelang kwa morago e a wedged (incarcerated) ka fa tlase ga marapo a a tlhomameng a sacral promontory kwa morago ga letheka. Fa popelo e e tshwaregileng e ntse e atologa, e kgoromeletsa molomo wa popelo ka bogale kwa pele le kwa godimo ka fa morago ga lerapo la tlhogo, e otlolla le go tshwaratshwara motlhapo wa mosadi o le sephaphathi kgatlhanong le symphysis ya tlhogo.

• Matshwao a tlhagiso: Mosadi yo o imileng yo o mo dibekeng tse 10 go ya go tse 16 tsa boimana o tsoga mo mosong kgotsa thapama ka go sa kgone go rota ka tshoganyetso, go go botlhoko, go tlala ga letheka, go utlwa botlhoko mo mokwatleng o o kwa tlase, kgotsa go elela ga metsi go go ikganetsanang.
• Thuso ya Ntlha ya Boemo jwa Ka bonako fa o le mo loetong go ya kwa Lefapheng la Maemo a Tshoganyetso:
• Fa o ntse o letetse go isiwa kwa OB/GYN le go tlhatlhoba ka tshoganyetso, go ikhutsa mo boemong jwa lengole-sehuba (go khubama mo bolaong ka sehuba le magetla a ikhutsitse kwa tlase mo mosamong metsotso e le 10 go ya go e le 15) kgotsa boemo jwa Sims jo bo kafa molemeng go dirisa maatlakgogedi go thusa go ntsha popelo e e bokete go tswa mo fundus ya tshoganyetso Foley catheter go ntsha senya le go fokotsa popelo ka bonolo go tsena mo mpeng.

Fa go tsenngwa ga tšhupu mo motlhapong go GANETSE THATA: Go Kgorelediwa ga Motlhapo go go Tshwenyang¶

Le fa go tsenya tšhupu ya Foley mo mothapong e le kalafi e e tlwaelegileng ya diperesente di le 99 tsa dikgetsi tsa go boloka motlhapo, go na le boemo bo le bongwe jo bo masisi jwa kgobalo e mo go jone go tsenya tšhupu ya motlhapo go thibetsweng thata ka gonne go relela tšhupu mo mothapong o o gagogileng go fetola go gagoga go go sa felelang go nna motlhapo o o feletseng, hematoma:

Dipotso tse di bodiwang kgapetsakgapetsa¶

Metswedi e tlhotlhomisitswe¶

• Mokgatlho wa Motlhapo wa Amerika (AUA, United States): Taolo ya Matshwao a Motlhapo o o kwa Tlase a a Amanang le Benign Prostatic Hyperplasia (BPH) le Kaelo ya go Boloka Motlhapo o o Bogale le Tlhokomelo ya Motlhapo e e Amanang le Catheter.
• Mokgatlho wa Yuropa wa Urology (EAU): Dikaelo tsa EAU ka ga Taolo ya Matshwao a Mothapo wa Motlhapo o o kwa Tlase wa Banna a a sa Bakeng Methapo, Go Boloka Motlhapo ka Bogale, le Ditshwaetso tsa Urological.
• Setheo sa Bosetšhaba sa Boitekanelo le Tlhokomelo ya Boleng jo bo kwa Godimo (NICE, United Kingdom): Matshwao a Tsela e e kwa Tlase ya Motlhapo mo Banneng: Taolo (CG97) le Ditshwaetso tse di Amanang le Tlhokomelo ya Boitekanelo: Tlhokomelo ya Nako e Telele ya Khathetere ya Motlhapo (CG139).
• Kgolagano ya Kalafi ya Mothapo wa Lerapo la Mokwatla (Bagale ba Ntwa ba ba Suleng Ditho ba Amerika, United States): Tlhatlhobo le Taolo ya Dysreflexia ya Boikgopotso le Dikgobalo Tse Dingwe Tsa Boikgopotso: Tlhokomelo e e Bogale ya Dikhathetere tsa Motlhapo tse di Thibegileng.
• Nyman MA, Schwenk NM, Silverstein MD (Dithulaganyo tsa Tleliniki ya Mayo): Taolo ya go boloka moroto: go fokotsa kgatelelo ka bonako fa e bapisiwa le ka iketlo le kotsi ya mathata (go netefatsa gore go ntsha metsi ka bonako mo setlheng go babalesegile e bile go botoka go feta go tshwara ka dikgato).

Dikaedi tse di tsamaelanang¶

• Dysreflexia e e ikemetseng mo tlhokomelong ya tshoganyetso ya kgobalo ya mothapo wa lerapo la mokwatla
• Letshwao la Cauda equina le difolaga tse dikhibidu tsa go gatelelwa ga mothapo wa lerapo la mokwatla
• Setlhabi se segolo sa letlapa la diphilo kgatlhanong le diphilo tse di tshwaetsegileng tse di thibegileng (urosepsis)
• Rhabdomyolysis ya go dira thata, kgobalo e e masisi ya diphilo, le motlhapo o montsho
• Go tlhomama ga thobego ya pelvic le go laola go dutla madi mo teng
• Dinomoro tsa tshoganyetso go ya ka dinaga