Urethroscopy

Ureteroscopy is a method of research of the urethra (the urethra) with an optical instrument - ureteroscope. Apply urethroscopy two systems: urethroscopy Valentine (Fig. 1) with the Central lighting and irrigation urethroscopy goldsmith.
Indications: chronic urethritis, foreign body, diverticula urethra, ulcers, tumors, cysts. In acute urethritis ureteroscopy is contraindicated. Using the tube of ureteroscopy possible to carry out medical procedures: the electrocoagulation, lubrication seed tubercle the Liapis, removal of foreign bodies and others.
A ureteroscopy holds a doctor, assisted by a nurse, who should know the features and the research methods.

urethroscopy Valentine
Fig. 1. Urethroscopy Valentina: 1 - urethral pliers to remove foreign bodies; 2 - tubes; 3 - obturator; 4 - nanonositeli; 5 - arm with a switch; 6 - optical apparatus Kaufman; 7 - probes platera (with a wound on the end of wool);
ureteroscopy
Fig. 2. The urethra (ureteroscopy): 1 - hanging Department (Central figure in the form of transverse cracks); 2 - membranous Department (Central figure tochkoobraznye form).

For artroskopii patient is placed at urology chair. The outer opening of the urethra is treated with a disinfectant. Tube of urethroscope with mandrel grease with glycerin and, holding the rod, thumb enter the tube into the bladder to the external urethral sphincter. For inspection of the rear urethral urethroscopy promote on overcoming spasm of the external sphincter, and bent down to the bottom of the peripheral end of the tube, reach the inner hole of the urethra. Locking tube left hand, the right to remove the rod, cotton pads suck the urethra (urine and mucus in the tube impose lighting and optical parts. A ureteroscopy always have back-to-front. Having examined the back of the urethra, the tube gradually withdraw and examine its front part.
For correct orientation when artroskopii it is necessary that in the field of view of urethroscope was the so-called Central figure of the urethra: a small segment of the urethra, apart tube, takes the form of a funnel, a wide part of which is adjacent to the edges of the tube, and the top directed towards the bladder. The deepest part of the funnel is the "Central figure". In the field of seed tubercle she has a semicircular shape, in the membranous part of the urethra she tochkoobraznye, in the area of bulbous part and the head is the vertical slit, the rest of the over hanging Department is incompletely closed cross the gap (Fig. 2). In normal mucosa of the urethra wet, shiny, smooth, in the back part of the urethra pink, anterior to yellowish-white.
Urethroscopy after artroskopii washed and cleaned. A viewing tube and auxiliary tools are sterilized by boiling, optical parts and appliances, alcohol, then other disinfectants, such as lowered urethroscopy disassembled into the solution oxycanta mercury of 1 : 1000 for 20 minutes or sterilized pairs formalin. Keep urethroscopy in a dry place.

dry and irrigation ureteroscopy
Fig. 1-6. Dry ureteroscopy. Fig. 1. Normal mucosa hanging part of the urethra. Fig. 2. Normal appearance promezhnost-bulbous part of the urethra. Fig. 3. The normal form of the front of the seed of tubercle. Fig. 4. Soft infiltrate in the anterior wall of the urethra. Fig. 5. The defeat of glandular apparatus in a stage of soft infiltration. Fig. 6. Papilloma of the urethra.
Fig. 7 - 12. Irrigation ureteroscopy. Fig. 7. Look normal seed bump in the moment of ejaculation. Fig. 8. Seed tubercle able hyperemia. Fig. 9. Polyp in utriculus masculinus. Fig. 10. Polyp on the top seed tubercle. Fig. 11. Be adenoma prostate gland. Fig. 12. Proliferating urethritis posterior urethra (for seed tubercle).

The urethra can be viewed in its entirety by urethroscope. There are two types of artroskopii - dry and irrigation.
Dry ureteroscopy is used for inspection of both the front and back of the urethra, irrigation and for inspection only the back of the urethra.
Dry urethroscopy consists of a set of metal tubes (the tubes) in length from 13 to 15 cm, diameter from № 21 to # 27 on the scale of charger. For artroskopii women used the tube length 5-6 see
Each tube is equipped with obturator of the appropriate calibre. Before the introduction of the tube in the urethra into it insert obturator, conical end of which extends slightly from the center hole of the tube (Fig. 12), protecting the mucous membrane from damage thin edge of the tube. Tube grease with glycerin and
enter the external sphincter. If you want 6cMOtpefb the rear part of the urethra, lower the peripheral end of the tube downward, at the same time, lightly pushing it further into the urethra. Overcoming the resistance of the external sphincter, promote the tube by 1.5-2 cm, until the back edge of seed tubercle. Obturator removed.
Following the end of the urethra tube gradually subsided in the form of shallow craters, which can be viewed by typing in the tube miniature bulb mounted on the end of a thin rod.
The opposite end of the rod (the holder) is inserted into the handle is connected by a wire with lighting network through the transformer, which reduces the voltage up to 2-3 volts. On the handle there is a switch.
Gradually pushing the tube, examine in detail through him the urethra to the external opening. When needed the urethral lumen drain from mucus and glycerin using a special probe with cutting at the end of that wound wool.
The visible area of the urethra is a circle, the center of which forms a dark gap, the so-called Central figure, which is spasica in a funnel the lumen of the urethra. From the Central figures in the form of radii to the periphery of the field of vision stretch gentle folds of mucous membrane (Radialnaya striation, Fig. 13).

Fig. 13. Dry ureteroscopy. Normal mucosa anterior urethra (tender Radialnaya folding).

The color of the mucous membrane of red-yellow. The closer to the outer hole, the color yellow. In the prostatic portion of the urethra, you can see the speaker on the back of her seed mound, on the turntable which is visible utriculus masculinus (Fig. 14). Over seed tubercle Central figure has a Crescent shape, perineal of the urethra it has the form of vertical and closer to the outer hole is horizontal slit. On the upper wall of the cavernous part of the urethra can see the holes morganii sinus glands Littre as small dark spots.

dry ureteroscopy
Fig. 14. Dry ureteroscopy. Seed tubercle

Seed tubercle and prostate urethra can be considered in more detail through irrigation urethroscopy built on the cystoscope (see Cystoscopy) and differs from it so that the viewing window is not on the front and on the rear panel of the peculiarities of irrigation system (Fig. 15).

Fig. 15. Irrigation urethroscopy for the posterior urethra.