BOUGIES

METAL AND OTHER BOUGIES

Clutton’s urethral bougie

Identification points

· It is solid metal instrument with a curve end near the tip.

· The handle is flat and shaped like a violin.

· The other end is blunt.

· The size is written on the handle.

Why is the tip of this instrument blunt?

As the tip is blunt, there is a lesser chance to injure the urethra during a normal and false passage.

USES

· The blunt tip flows easily into the urethra.

· Lubrication is used.

· The curve conforms to the normal anatomical size and shape of the male urethra near the bladder.

· The upper denomination indicates the diameter of the tip (in mm). 6/10 denotes that the tip is 6 mm in diameter and the base 10 mm.

Lister’s bougie

Identification points

· The tip is olive pointed.

· The shaft is more curved.

· The handle is round like a coin.

· The size is marked in English scale.

How to use the Lister’s bougie?

· The instrument is lubricated with sterile KY gelly and passed in urethra with the convex curbe towards the patient.

· The bougie passes with its own weight and reaches the bulbar urethra. At this point, one has to rotate through 180° and depress the bougie when the instrument follows natural curve of urethra and the tip enters the bladder.

Introducer

Identification points

· It is stiff wire instrument with a curvature like a metal bougie and has a blunt tip.

· The handle is of the shape of large elongated ring.

Uses

· This wire instrument can be introduced into the rubber urethral catheter.

· The stiffened rubber catheter can now be introduced like a bougie.

Other Bougies

Filiform bougies are fine soft malleable-gum elastic instruments that are used to treat strictures. These are passed up to the strictures.

Uses

· More than one can be passed. These bougies are graduated in French scale (charriere).

· It is usual to start with 10F, and negotiation is begun till one of them, on rotation, passes through the strictures.

· Some have a screw for large bougie.

· The filiform acts as a guide for this screw on dilator which passes.

· The advantage of this bougie is that there is less risk of trauma to the urethra.

 

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PROBES AND DIRECTORS

PROBES AND DILATORS

What are the features and uses of probes and dilators?

Probes are used to gain entry through small openings to get information about their depth, direction and size; they are usually blunt ended.

Dilators are used to investigate the patency and dilate hollow tubular passages.

Infection, trauma and surgical accidents can result in healing by second intention in hollow organs; this results in strictures.

Dilators are usually made of metal or gum elastic.

Agreed gauge has been utilized to ensure uniform size in all the sets.

This also helps the surgeon to choose the correct size-dilator.

As dilatations are done gradually over a period of time, the surgeon records the degree of dilation achieved, so as to start at the next level on the subsequent attendance or corticosteroids can also be used to minimize oedema and fibrosis.

The dilators in common use are as follows:

· Lister

· Clutton

· Turner-Warwick

· Filiform (Canny-Ryall) bougie

· Jackson oesophageal bougie

· Neoplex

 

 

· Bake’s bile duct

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RETRACTORS 2

SELF RETAINING RETRACTORS

These retractors have at least two blades joined by a bar

or a hinge joint.

It is thus possible to create lateral pressure against both

margins of the wound.

This pressure helps to retain the retractor in the wound

for the entire duration of the operation.

The pressure is constant and adjustable.

Both hands of the assistant are thus free for other tasks

in the procedure.

The retractors in use are:

Travers

Norfolk

Balfour

Jolls

Alms

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RETRACTORS 1

WOUND RETRACTORS

What are the features and uses of wound retractors?

Good exposure is one of the requisites of successful surgery. 

Instruments designed specifically to improve exposure are called wound retractors. These can be hand-held or self-retaining. 

The Handle of the retractors is held by the assistant, the retracting end is usually at a right angle to this. It is smooth, rounded with no sharp corner or edge to avoid injury to the tissues. 

The choice of the retractor can be estimated from the depth to which this retracting end can go.

               The varieties in use are as follows:

&l  Langenbeck

   ;  Ollier

&   Morris

&   Kelly

&   Deaver

&   Lloyd-Davies

Self-retaining retractors, i.e. 

Travers, 

Norfolk, 

Norwich, 

Balfour, 

Alms and 

Jolls have at least two blades joined by a hinge joint or bar. It is thus possible to create lateral pressure against both margins of the wound.

        This helps to retain the retractor in position throughout the duration of the operation.

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CATHETERS AND DRAINS

CATHETERS

The Foley catheter is a plastic two-lumen tube with an integral inflatable balloon. The balloon is inflated via a small channel.

Suprapubic cystostomy is an alternative way of draining the urinary bladder. The Malecot catheter is well suited for this purpose. It is a rubber or latex tube with wings at the tip. The de Pezzer catheter is based on a similar principal except that instead of wings, it has a bulbous end that can be straightened and recoiled back when the wire introducer is removed.

The catheters used are as follows:

·        Foley

·        Gibbon

·        Malecot

·        De Pezzer

·        Tiemann

Catheter is a tube designed for relieving retention of urine.

·        The tip is blunt and closed

·        There is one opening above the tip.

·        The upper end is open.

·        It can be made of rubber or latex rubber.

How is the catheter introduced?

·        The catheter is sterilized.

·        The area around the penis, glans, scrotum and groin is cleaned with Savlon.

·        The surgeon washes hands and wears sterile gloves.

·        The area is draped with the sterile towel.

·        The tip is dipped in sterile lubricant.

·        The catheter is introduced into the bladder and the urine collected in sterile kidney tray.

DRAIN

The different types of drain in use are as follows:

·        Secured tube

·        Corrugated

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