Instrumental study of bladder

To determine bladder capacity and the presence of residual urine catheters are used.
Catheters are soft - rubber, elastic - of dense silk fabric impregnated with a mixture of rubber and varnish or plastic and finally metal. Soft catheter Nelaton is a rubber tube with a length of about 25 cm in diameter of 6-8 mm (№ 18-24 on a scale of charger). Cystic the end of the catheter is rounded off and ends blindly; at the distance of 1-1,5 cm from the end of it has a side of the oval window. Peripheral catheter ends cross cut (Fig. 16).
Rubber catheter can be easily carried out through normal the urethra into the bladder. When BPH is better to use the dense rubber catheter with conical curved beak (Fig. 17, a) - catheter Timan or elastic catheter with curved cylindrical bill at the end (Fig. 17,6) - catheter Mercier.
Metal catheter is a hollow tube that consists of three departments: 1) arm (pavilion), 2) rod and 3) of the bill. In the beak of a catheter there are one or two side window. Male metal catheter (Fig. 17 in) in length 30 cm has a curved beak, female metal catheter length 12-15 cm has a short, slightly curved beak (Fig. 17, d).

Fig. 16. Rubber catheter (Nelaton).
Fig. 17. Catheters.
a - catheter of solid rubber tapered curved beak (Timan); b - flexible catheter with a curved beak (Mercier); in - mens metal catheter; g - female metal catheter.

In the pavilion of the catheter has scallop, which determine the direction of the beak.
Catheterization of the bladder as surgical intervention is carried out in aseptic conditions. Rubber, metal and plastic catheters are sterilized by boiling. Catheters with silk basis sterilized in pairs formalin or in solution oxycyanides mercury (1:1000). The outer opening of the urethra washed cotton ball dipped in the solution of sublimate, or oxycyanides mercury 1:1000, of rivanol 1:1000.
The introduction of a rubber catheter is easy. Tweezers rubber catheter capture slightly above the window, pavilion catheter is held between the V and IV fingers. Well lubricated catheter is introduced into the urethra and slowly pushed into him. The conduct of the catheter through the membranous urethra may be difficult due to spasm of the external sphincter. In such cases it is necessary to wait a little, ask the patient to breathe deeply, relax the muscles of the stomach and crotch and, gradually overcoming the obstacle to hold the catheter into the bladder. That the catheter is passed into the bladder, evidenced by the appearance of his urine.
To determine the amount of residual urine catheterization to produce immediately after the patient help. The capacity of the bladder is determined by its content is indifferent fluid through the catheter using Janet's syringe (Fig. 18) or from a mug esmarkha until the urge to urinate. Physiological bladder capacity 250 - 300 ml. Rubber catheter may be left in the bladder for a long time in the form of so-called permanent catheter (a catheter demeure). The catheter is fixed to the penis gauze strips or band (Fig. 19).

Fig. 18. The Janet's syringe for irrigation of the bladder.
Fig. 19. Fixation of a permanent catheter.
Fig. 20. Capitate catheters, Malco (a), Mezzera (b).

To drain the bladder through suprapubic fistula use capitate rubber catheters, Pizzera or Maleko held in the bubble without any fixation (Fig. 20).
With the introduction of metal catheters and Buga in the urethra in men is the patient in a horizontal position on the back. The doctor becomes the left of the patient. Metal catheter or curved bougie take the right hand of the pavilion and beak, downward-directed parallel to the left inguinal fold. The left hand pull penis and without violence spend a catheter into the urethra to bulbous part. Then the free end of the catheter with a penis move to the midline of the abdomen, after which the pavilion catheter gently down. Bill catheter is held under the pubic articulation in prostatic Department of the urethra and later in the bladder.