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Ghid practic n urologie / Ctlin Pricop, Cristian
Costache, Dan Mischianu. - Iai : Editura Gr.T. Popa,
2015
Bibliogr.
ISBN 978-606-544-298-6
Refereni tiinifici:
Prof. univ. dr. Gabriel Ungureanu - U.M.F. Grigore T.
Popa Iai
Prof. univ. dr. Adrian Covic - U.M.F. Grigore T. Popa
Iai
Editura Gr. T. Popa

Universitatea de Medicin i
Farmacie Iai
Str. Universitii nr. 16
Editura Gr. T. Popaeste acreditat de CNCSIS - Consiliul
Naional al Cercetrii tiinifice din nvmntul Superior
Toate drepturile asupra acestei lucrri aparin autorului i
Editurii Gr.T. Popa" Iai. Nici o parte din acest volum nu
poate fi copiat sau transmis prin nici un mijloc, electronic
sau mecanic, inclusiv fotocopiere, fr permisiunea scris
din partea autorului sau a editurii.
Tiparul executat la Tipografia Universitii de Medicin i
Farmacie "Gr. T. Popa" Iai str. Universitii nr. 16, cod.
700115, Tel. 0232 301678
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Weill F, Bihr E, Rohmer F /XOWUDVRQRJUDSKLH UHQDOH, Zeltner

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Brenner BM, Reltore FE, -The kydney 5 Edition,Saunders WB,

1996
Brewster S, Craunston D, Noble J, Reynard J Urology

A handbook for medical students, Bios ScientificPublishers, Ltd.
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Calomfirescu N, Voinescu V Tratamentul endoscopic al

stricturilor uretrale, Editura Academiei Romne
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&XP VSXQHDP DQWHULRU XQ LVWRULF FRPSOHW ELQH IFXW HVWH
Luteotropina (LH)
RJOLQGD HYROXLHL FD]XOXL L SUHPL]a LPSRUWDQW D XQHL HSLFUL]H

FRUHFWH%LOHWXOGHLHLUHGLQVSLWDOWUHEXLHVRIHUe medicului curant
VDX GH DOW VSHFLDOLWDWH SRVLELOLWDWHD GH D WL FURQRORJLF WRDWH
Prolactina
GDWHOHLPSRUWDQWHvQHYROXLDEROLL
7UHEXLH V DYHP JULM V QRWP FX JULM antecedentele
10 100 ng/l
Corticotropina (ACTH)
Somatotrop (STH)
4 20 Ul/l
4 200 Ul/l
9 40 Ul/l
8 200 Ul/l
0,7 10,7 mcg/l
2,3 15,9 mcg/l
0 10 mcg/l
2 5 mcg/l
personale vQSULPXOUkQGFHOHXURORJLFHFKLDUGDF aparent, nu au
Tireotropina (TSH)
ROHJWXUGLUHFWFXVXIHULQDDFWXDO$VWIHOHSLVRDGHOHUHSHWDWH
7LURLG
de iQIHFLHXULQDUGLQDQWHFHGHQWH (mai ales cu Proteus, Piocianic,
&DOFLWRQLQ
< 100 pg/ml
Klebsiella), tratate de cele mai multe ori incorect sau incomplet, pot
Tiroxina
45 120 mcg/l
H[SOLFD DSDULLD vQ WLPS D OLWLD]HL FRUDOLIRUPH; sau eliPLQULOH
Triiodotironina
0,6 1,8 mcg/l
spontane de calcul la un pacient litiazic pot forma o idee despre
Paratiroide
QDWXUDFDOFXOLORULSRWHQLDOXOUHFLGLYDQWDOEROLL
Parathormon
2DOWSUREOHPSHVWHFDUHGLQJUDEVDXQHWLLQ, se trece
100 400 pg/ml
Suprarenale
XRUHVWHSUREOHPDUHDFLLORUDOHUJLFH 9RPQRWDGHFLFXPD[LP
Aldosteron (clinostatism)
sHULR]LWDWH UHDFLLOH DOHUJLFH FXQRVFXWH OD antibiotice DWHQLH PDL
(ortostatism)

0,5 4,0 mUl/l
25 450 pM/l
110 860 pM/l
280 700 nM/l
Cortizol
$
)2$,$'(2%6(59$,($3$&,(178/8,852/2*,&
I.
AGL
300 700 mg/l
DOHV OD SDFLHQLL FX UHSHWDWH HSLVRDGH GH LQIHFLH vQ DQWHFHGHQWH
Acizi biliari
0 4,3 mcg/ml
FDUHDXSULPLWDQWLELRWLFHGLYHUVHvQFRPELQDLLPDULLUHSHWDWHL
70 115 mg/dl
la VXEVWDQHOHGHFRQWUDVWLRQLFHDXUHSXWDLDGH a produce astfel
20 100 mcg/24h U
GH UHDFLL DOHUJLFH XQHRUL FX PDQLIHVWUL VHYHUH 6XQW VLWXDLL
Lactat
600 2400 mcg/dl
SDUWLFXODUH FDUH QHFHVLW DWHQLD FHOXL FDUH vQWRFPHWH IRDLD
Fosfolipide
150 250 mg/dl
pacientului urologic. Vom exemplifica ntrebarile obligatorii
Trigliceride
40 160 mg/dl
DGUHVDWHvQGRXVLWXDLLPDLIUHFYHQWvQWlnite vQSUDFWLF
*OXFR]
Markeri tumorali n urologie
a.
Rinichi
WXPRULOHYH]LFDOHIXPWRU"GHFkWWLPSLFkWHLJUL
pe zi? a lucrat n mediu toxic (industria cauciucului,
3+,IRVIRKH[R] L]RPHUD]
15 75 Ul/l
SLHOULHL
9H]LFDXULQDU
SUHOXFUDUHD SHWUROXOXL HWF FkL DQL"
antecedente
TPA (antigenul celular
b.
Prostata
(n
perspectiva
eventualei
LQWURGXFHULDLQVWLODLLORUFX%&*
< 95 Ul/l
polipeptidic)
TBC?
/LWLD]Dparinii cu litiaz renal? eliminator de calculi?

FH FRPSR]LLH DYHDX FDOFXOLL HOLPLQDL" DIHFLXQL
PSA (antigenul specific prostatic)
< 4 Ul/l
HQGRFULQRORJLFH" LPRELOL]DUH SUHOXQJLW OD SDW" PLHORP
patologic
> 10 Ul/l
multiplu?
3$3IRVIDWD]DSURVWDWLFDFLG
< 2 mcg/dl
Testicul
8OO
AFP (alfafetoproteina)
-+&*JRQDGRWURILQDFRULRQLF
< 5 Ul/l
XPDQ
631 JOLFRSURWHLQVSHFLILF
sarcinii)
tratament
leucemie?
cronic
cu
limfoame?
corticosteroizi?
boala Paget?
vitamina
D,
preparate de calciu, diuretice? consum exagerat de

carne, brnzeturi, sare, sucuri cu zahar?
$WXQFLFkQGQRWPLVWRULFXOXQXLSDFLHQWWUHEXLHVDYHPvQ
YHGHUHLVLWXDLDFLQGLYLGXOSRDWHWULDQLFXXQVLQJXUULQLFKLIU
0,5 1 mcg/l
3DUDPHWULLXULQDULSHQWUXHOXFLGDUHDFRPSR]LLHLOLWLD]HLUHQDOH
Amoniac
35 50 mM/24h
Acid uric
2,4 4,5 mM/24h
Calciu
2.5 8 MMOL/24h
Magenziu
0.5 12 MMOL/24h
Acid oxalic
< 0,5 mM/24h
pH
57

a avea simptome deosebite. Rinichiul unic congenital sau

IXQFLRQDO WUHEXLH DYXW vQ YHGHUH DWXQFL FkQG GLVFXWP FX XQ
SDFLHQWFXDQXULHREVWUXFWLYLQWHUYHQLWGLQVHQLQ
Examinarea pacientului urologic constituie tema unui alt
FDSLWRO DO OXFUULL LQ V PHQLRQH] F H[DPHQXO SH DSDUDWH L
VLVWHPHYDILIFXWFRUHFWLFRPSOHWGXSUHJXOLOHvQYDWHOD
Semiologie n anul III.
6WDJLXOGH8URORJLHVHGRYHGHWHXQEXQSULOHMGHDYHULILFD

)2$,$'(2%6(59$,($3$&,(178/8,852/2*,&
I.
vQ SUDFWLF QRLXQLOH GREkQGLWH OD &DUGLRORJLH 1HIURORJLH
Proteine
Ftiziolologie ntruct PXOWLSDFLHQLvQYkUVWFXDIHFLXQLXURORJLFH

SUH]LQWFRPRUELGLWL+7$GLDEHWWXOEXUULGHULWPHWFFDUHSRW
66 87 g/l
Proteine totale
< 100 mg/l
LQIOXHQD DWLWXGLQHD WHUDSHXWLF GHFLVLY 'H DOWIHO VWXGHQLL VXQW
< 150 mg/24h
VIWXLL V FLWHDVF FX DWHQLH concluziile examenului interclinic
Albumine
32 50 g/l
eIHFWXDW GH FROHJLL LQWHUQLWL VDX DQHVWH]LWL L SH SDUFXUVXO
1 - antitripsina
1,90 3,50 g/l
VWDJLXOXLVPRQLWRUL]H]HLHYROXLDDIHFLXQLORUFDUGLRpulmonare
Ceruloplasmina
coexistente la pacientul urologic aflat n grija lui.
150 600 mg/dl
Feritina
7RDWHDFHVWHREVHUYDLLWUHEXLHVVHUHJVHDVFPHWLFXORV
23 350 mcg/l
17 270 mg/l
Haptoglobina
1,0 3,2 g/l
Ig A
0,5 3,3 g/l
Ig D
3 400 mg/dl
foarte
Ig E
60 700 mcg/l
LPSRUWDQWWUHEXLHVPHQLRQPFvQFDGUXOREOLJDLLORUSUDFWLFHDOH
Ig G
7,5 15,2 g /l
VWXGHQLORU UHYLQH L FRPSOHWDUHD HYROXLHL FD]XULORU Q UXEULFD
Ig M
0,6 2,2 g/l
DOWXUDW FHOHL vQ FDUH PHGLFXO GH VDORQ QRWHD] PHGLFDLD
2 - microglobulina
< 2,5 mg/l
WUHEXLHVF FRQVHPQDWH SXQFWHOH SULQFLSDOH DOH HYROXLHL SDFLHQWXOXL
Transferina
2,04 3,74 g/l
n acea zi.
ELFO
notate, n IRDLDGHREVHUYDLHvQRUGLQHFURQRORJLFvQWU-RPDQLHU
FODUFRQFLVHOLJLELOLSUHFLV
Referindu-ne
la
acest
document
medico-legal
Q IRDLD GH REVHUYDLH VXQW GHDVHPHQHD QRWDWH L

codificate toate manevrele medicale sau chirurgicale efectuate
SDFLHQWXOXLSHSDUFXUVXOLQWHUQULL. ncepnd de la recolatrea de
DQDOL]H L HOHFWURFDUGLRJUDPD FDUH VH HIHFWXHD] GH UXWLQ OD WRL
SDFLHQLL FRQWLQXQkG FX LQYHVWLJDLL LPDJLVWLFH HFRJUDILH 5596
UIV, CT, UPG, Rx. toracic, probe ventilatorii, etc.) consulturi
LQWHUFOLQLFH L LQWHUVSLWDOLFHWL GXS FD] GDU L LQWHUYHQLL
FKLUXUJLFDOHFDUHSRWVILHXQLFHVDXVXFFHVLYHPXOWLSOHvQFDGUXO
52 65.1 %
Albumine
1 - globuline
1 3%
2 - globuline
9.5 14.4 %
- globuline
6 9.8 %
- globuline
10.7 20.3 %
/LSLGHLPHWDEROLL
WRWDO
Bilirubina
Colesterol
0 1,1 mg/dl
GLUHFW
0.05 0.3 mg/dl

120 200 mg/dl
total
DFHOHLDL LQWHUQUL 7RDWH DFHVWH GDWH PHGLFDOH VXQW QRWDWH vQ
liber
45 85 mg/dl
RUGLQHFURQRORJLFvQIRDLDGH RVHUYDLH
HDL
55 100 mg/dl
LDL
0 130 mg/dl
&HWUHEXLHPHQLRQDWODHYROXLH"
x
VWDUHD JHQHUDO D SDFLHQWXOXL EXQ VDWLVIFWRDUH

)2$,$'(2%6(59$,($3$&,(178/8,852/2*,&
I.
LQIOXHQDW
8 130 Ul/l
)RVIDWD]DDOFDOLQ
Colinesteraza
34 104 U/L
2500 8500 Ul/l
2800 4700 Ul/l
Creatinkinaza
26 170 U/L
CK - MB
0 - 25 U/L
- GPT
10 71 U/L
6 42 U/L
M
F
25 100 mg/dl
GLDH
GOT
GPT
< 4 Ul/l
M
5 18 Ul/l
F
M
5 15 Ul/l
5 23 Ul/l
5 19 Ul/l
GLXUH]DWHQVLXQHDDUWHULDOSXOVXOHYHQWXDOGHILFLWXOGH
puls!)
aspectul macroscopic al urinei (sau al lichidului de lavaj

SRVWRSHUDWRUODSDFLHQLLRSHUDLFODVLFVDXHQGRVFRSLF
OD FHL RSHUDL FODVLF DVSHFWXO SDQVDPHQWXOXL LQILOWUDW

SXUXOHQW KHPDWLF FXUDW L HYHQWXDOHOH PDQHYUUL DOH
tubului de dren (mobilizarea tubului de dren, scurtarea sau
suprimarea lui);
DSDULLD XQHLHYHQWXDOHUHDFLLDOHUJLFHvQFXUVXOVSLWDOL]ULL
ODDQWLELRWLFHVXEVWDQGHFRQWUDVW
PDQHYUHOH GLDJQRVWLFH SUDFWLFDWH vQ ]LXD UHVSHFWLY

(cistoscopie,
LDH
135 214 U/L
HBDH
68 140 Ul/l
LAP
11 35 Ul/l
Lipaza
13 60 U/L
)$DFLG
5 14 Ul/l
Parametrii renali
M
3,4 7,0 mg/d

< 800 mg/24H U
Acid uric
2,4 5,7 mg/dl
< 700 mg/24h U

10 50 mg/dl
Uree
M
F
&UHDWLQLQ
ureteral,
ureteropielografie
UHWURJUDGXUHWURJUDILHHWF
,DWPDLMRVXQH[HPSOXODXQSDFLHQWFX785-P, fost purtator
de sonda 4 saptamini,ziua a II-a postoperator:
Data
12.01.2013
(YROXLH
Tratament
1. Sulperazon fl II
6WDUHJHQHUDOEXQDIHEULO
2. Gentamicina f III
'LXUH]POXULQXRU
3. Algocalmin f III
KHPDWLF
4. )UD[LSDULQI,
5. Ser Glucozat 10%
2000ml
3DFLHQWXOL-a
6. Ser Fiziologic
1000ml
reluat tranzitul pentru gaze.
7. Diazepam tb I
7ROHUDQGLJHVWLYEXQ7$
18 35 g/24h U
0,7 1,3 mg/dl
0.6 1.2 mg/dl
0,5 1,7 g/24h

cateterism
= 140/75 puls= 78b/min.
$
II.
EXAMENUL CLINIC AL APARATULUI UROGENITAL
Indice Quick
II. EXAMENUL CLINIC AL APARATULUI UROGENITAL

([SRUDUHD FOLQLF D DSDUDWXOXL XURJHQLWDO WUHEXLH V
GHFXUJ ILUHVF GH VXV vQ MRV DGLF GLQVSUH ORMHOH UHQDOH VSUH
&,
Parametrii ASTRUP
IHPHL 'LQ VWDUW DFHVW H[DPHQ DUH GRX ODWXUL FH WUHEXLH XUPDULWH
pO2
FXDWHQLH
pCO2
patologice ce vor fi descrise de pacient;

b) Latura RELHFWLY care FRQVW vQ H[DPHQXO IL]LF LQVSHFLH
SDOSDUHSHUFXLHHIHFWXDWUHVSHFWLYXOXLSDFLHQW
([DPHQXORELHFWLYYDFXSULQGHJUDGXDODVHVXESXQFWH
1) Explorarea PLFLXQLL;
2) ([SRUDUHDFOLQLFDrinichilor
17 24 sec
0.8 1.3
INR
UHJLXQHD KLSRJDVWULF L EXUVHOH VFURWDOH VDX UHJLXQHD JHQLWDO OD
a) Latura VXELHFWLY ce cuprinde totalitatea elementelor
> 70 %
arterial
65 105 mmHg
venos
30 60 mmHg
arterial
31 44 mmHg
venos
38 53 mmHg
pH
7,34 7,44
Bicarbonatul standard
24 28 MMOL/L
Baze exces
- 2,5 - + 2,5 mM/l
6DWXUDLDDUWHULDOvQR[LJHQ
95 98 %
Parametrii plasmatici/serici
(OHFWUROLL
3) A zonei hipogastrice
4) A XUHWUHLLDSHQLVXOXL
oligoelemente
98 107 MMOL/L
140 280 mM/24h
Clor
5) A scrotului LDFRQLQXWXOXLVFURWDO
6) A perineului, prostatei L YH]LFXOHORU VHPLQDOH
3,5 5,1 MMOL/L
Potasiu
35 90 mM/24h U
(tactul rectal);
8.5 10.2 mg/dl
Calciu total
0,65 1,05 MMOL/L
EXAMENUL 0,&IUNII
Acesta presupune F YRP LQYLWD SDFLHQWXOSDFLHQWD V
2,47 8,88 mM/24h U
Magneziu
XULQH]H vQ IDD QRDVWU SULOHM FX FDUH SRW IL HYLGHQLDWH SUH]HQD
135 144 mM/l
unor VHFUHLLXUHWUDOHSDWRORJLFH De asemenea este prilejul de a

YL]XDOL]D H[LVWHQD WXOEXUULORU PLFLRQDOH L D PRGXOXL FXP VH
120 220 mM/24h U
Sodiu
PDQLIHVWHOH jet urinar ntrerupt, jet n doi timpi, jet deformat
16 49 mM/24h U
UVXFLW vPSUDWLDW ILOLIRUP FX SLFWXU VDX SLHUGHUHD

QHFRQWURODWDXULQLL ([DPLQDWRUXOYDYHGHDLFRQVHPQDvQIRDLD
Fosfat, anorganic
GHREVHUYDLHLaspectul urinii8ULQDOLPSHGHJDOEHQFULVWDOLQ
VH GHRVHEHWH GH XULQD WXOEXUH SLXULF GLQ LQIHFLLOH XULQDUH YH]L

A
C
0,81 1,53 mM/l

1,16 1,9 mM/l
16 49 mM/24h U
Enzime
- amilaza
28 100 U/L
$
II.
ILJ ,, VDX XULQD EUXQ URLDWLF GLQ KHPDWXULD PDFURVFRSLF

YH]LILJ,,5DUHRULSRWILRELHFWLYDWHLSQHXPDWXULDSDUWLFXODU
2 - 10 mm/h
de exemplu, fistulelor uro-intestinale, chiluria iar daca pacientul
5 15mm/h
HVWH VXILFLHQW WLPS VXE REVHUYDLH SXWHP HYDOXD ROLJXULD VDX
13 17 g/dl
poluria.
11,5 16 g/dl
40 54 %
37 47 %
4,5 6,5 x 10 /l
F
MCV- volumul mediu eritrocitar
3,9 5,3 x 10 /l
80 100 fl
MCH +JHULWURFLWDU
27 32 pg
MCHC Hg HULWURFLWDUPHGLH
32 36 g/dl
VSH
Hb
Ht
Eritrocite
Leucocite
6
6
Adult
4 10 x 10 /l
Copil
6 15 x 10 /l
Sugar
6 18 x 10 /l
3
3
150 450 x 10 /l
0 5 mg/l
0.02 - 0.5 ng/ml
50 75 %
Trombocite
CRP
Procalcitonina
Neutrofile
Eozinofile
05%
Bazofile
02%
Monocite
5 10 %
Limfocite
25 40 %
Reticulocite
0.5 - 2.5 %
Timp de sngerare
2 5 min
$QWLWURPELQ,,,
80 120 %
Fibrinogen
2 4 g /l
Plasminogen
80 120 %
7LPSXOSDULDOGHWURPERSODVWLQ
20 40 sec
Timpul Quick
11 16 sec
$

II.
Fig. II.7 Diagnosticul Hematuriei macroscopice proba celor 3 pahare
2. EXAMENUL CLINIC AL RINICHILOR

'LVSXQHUHD DQDWRPLF D ULQLFKLORU HVWH FHO PDL DGHVHD
FDX]D XQXL H[DPHQ FOLQLF VUDF vQ LQIRUPDLL GDWRULW SR]LLHL
anatomice.
Cu toate acestea:
a) ,QVSHFLDUHJLXQLLOREDUHSRDWHHYLGHQLD
x Cicatrici ORPEDUH PDUWRUH DOH XQRU RSHUDLL
efectuate anterior
x 3R]LLD DQWDOJLF a pacientului - SRVLELO GDWRUDW
XQHLVXSXUDLLSHULQHIUHWLFH
x ([LVWHQD edemului L D URHLL tegumentelor
DFHOHLDL UHJLXQL SUHPRQLWRU ILVWXOL]ULL XQHL
VXSXUDLL DQWHULRU DPLQWLWH VLWXDLH FOLQLF UDU
ntlnit)
x 0DULUHD L GHIRUPDUHD regiunii lombare cel mai
adesea unilateral (n tumorile renale, chisturile
UHQDOH PDL YROXPLQRDVH GDU L ELODWHUDO OD
SDFLHQLLVODELFXPDODGLHSROLFKLVWLF
b) 3DOSDUHD ULQLFKLXOXL UPkQH FHD PDL SOLQ GH
LQIRUPDLLPHWRG GHH[SORUDUHXUPULQGX-se depistarea
unui rinichi mare FHO PDL DGHVHD WXPRUDO ORPED SOLQ
SRVLELO D VH GDWRUD L XQHL WXPRUL UHWURSHULWRQHDOH XQHL
pionefroze, sau unui hematom renal posttraumatic),
PRELOLWDWHDDQRUPDO DULQLFKLXOXLvQWkOQLWXQHRULvQSWR]D
UHQDOL, mai cu seDPDD-QXPLWXOVHPQDOFRQWDFWXOXL
ORPEDUFXEDORWDUHDEGRPLQDOGLQWXPRULOHUHQDOH
Sunt cunoscute de la semiologie cele trei procedee clasice:
x Guyon: SDOSDUHD ELPDQXDO FDUH SHUFHSH
EDORWDUHDULQLFKLXOXLLFRQWDFWXOVXORPEDU
x Glenard: palparea cu R VLQJXU PkQ FDUH
SHUFHSH ULQLFKLXO L PRELOLWDWHD VD vQ WLPSXO
PLFULORUUHVSLUDWRULL
x Israel: SDOSDUHDELPDQXDOvQGHFXELWODWHUDO
c) 3HUFXLD rinichiului - practic nu se mai face n contextul n
FDUH H[DPLQDUHD HFKRJUDILF GH H[HPSOX QH DGXFH PXOW
!
XII. CAIETUL STAGIULUI DE UROLOGIE
5HQDODVLPSO
8URJUDILH
&7501

7UDWDPHQWPHGLFDPHQWRV
7UDWDPHQWXURORJLF

3DUWLFXODULWLDOHFD]XOXL

&RFOX]LLFRPHQWDULL

$
Caietul stagiului de urologie

1XPHVLSUHQXPH)2
Vrsta DQL
6H[
0RWLYHOHLQWHUQULL
$+&
$3)
$33

&RQGLLLGHYLDLPXQF
&RPSRUWDPHQWHIXPDWDOFRROHWF
MedicatLHGHIRQG
Istoricul bolii:

Analize efectuate:
6DQJH

8ULQD

8URFXOWXUD
(FKRJUDILH
$!
II.
PDL PXOWH LQIRUPDLL GHFkW FODVLFD PDQHYU *LRUGDQR

SUH]HQWVDXDEVHQWYH]LILJ,,
)LJ,,&ROLFDQHIUHWLF L. Lger, Semiologie Chirurgicale, Masson et

Cie, 1964; p. 391
d) $VFXOWDLD regiunii lombare OD FDUH SUHD PXOL DX

UHQXQDW - L D UHJLXQLL DEGRPLQDOH DQWHULRDUH SRDWH
depista, la un pacient hipertensiv, zgomotul de suflu sau
GHXUXLWXUFRQWLQXLSXWHUQLFSDUWLFXODUXQHLVWHQR]HGH
DUWHU UHQDO VDX LOXVWUDWLY SHQWUX R ILVWXOD UHQDO DUWHULRYHQRDV
3. EXAMENUL CLINIC AL ZONEI HIPOGRASTRICE (VEZICA
URINARA)
'DWRULWD SURLHFLHL VDOH UHWURVLPIL]DUH vQ UHJLXQHD
KLSRJDVWULF YH]LFD XULQDU FkQG HVWH JRDO HVWH QHYL]XDOL]DELO
QHSDOSDELOQHSHUFXWDELO/DXQSDFLHQWVODE JOREXOYH]LFDOHVWH
YL]LELOLSDOSDELOYH]LILJ,,

II.
)LJ,,5HWHQLDDFXWGHXULQ
ntre FDX]HOH UHWHQLHL GH XULQ ne gndim la hiperplazia

EHQLJQ D SURVWDWHL DGHQRPXO GH SURVWDW FDQFHUXO GH SURVWDW
(CaP), tumorile vezicale superficiale, situate n apropierea colului
YH]LFDO SORQMDQWH
vQVSUH XUHWUD SURVWDWLF WXPRULOH YH]LFDOH
5HQDODVLPSO
8URJUDILH
&7501

7UDWDPHQWXURORJLF


&RFOX]LLFRPHQWDULL

infiltrative cu sediu trigonaO VDX SHULFHUYLFDO SUHFXP L OLWLD]D

YH]LFDOYH]LILJ,,

$
II.

Nume VLSUHQXPH)2
Vrsta DQL
6H[
0RWLYHOHLQWHUQULL
$+&
$3)
$33

&RQGLLLGHYLDLPXQF
MedicatLHGHIRQG
,VWRULFXOEROLL

Analize efectuate:
SanJH

8ULQD

8URFXOWXUD
(FKRJUDILH
$
Fig. II.14- QWUHUXSHUHDMHWXOXLXULQDUGDWRULWOLWLD]HLYH]LFDOH
,QVSHFLD UHJLXQLLKLSRJDVWULFHYL]XDOL]HD]XQHRULPDLDOHVSHQWUX
SULYLULOH DYL]DWH SUH]HQD XQHL GHIRUPUL URWXQGH-RYRLGDOH VLWXDW
PHGLDQ QHGHSODVDELO vQ GHFXELW ODWHUDO FX D[XO PDUH SH OLQLD
SHULRPELOLFDO XQHRUL QHGXUHURDV VSRQWDQ L OD SDOSDUH DOWHRri
DWkW GH ELQH WROHUDW vQFDW SDFLHQWXO QLFL QX LL IDFH SUREOHPH
(evident greu de observat la obezi).
Palparea UHJLXQLL KLSRJDVWULFH VXPDW FX SHUFXLD respectivei
UHJLXQLL SRDWH V HYLGHQLH]H DFHDVW HQWLWDWH FURQLF JOREXO
YH]LFDOYH]LILJ,,)
5HWHQLD DFXW GH XULQ 5$8 VDX UHWHQLD FURQLF GH XULQ
LQFRPSOHWVDXFRPSOHWL]DWDXFDH[SUHVLHFOLQLFDFHODLQXPLWRU
comun: globul vezical DFXW VDX LQVWDODW FURQLF JORE YH]LFDO
PRDOH SH R YH]LF GHWUXVRU LQHILFLHQW Echografia ne este de
PDUH DMXWRU vQ D HYDOXD UHJLXQHD KLSRJDVWULF VL FRQLQXWXO
vezical (mai ales reziduul vezical!).
4..EXAMENUL CLINIC AL PENISULUI SI AL URETREI
,QVSHFLD SHQLVXOXLSRDWHYL]XDOL]DGLYHUVHVLWXDLLfimoza
FRQJHQLWDOGRELQGLW hipospadiasVDXPDLSRDWHILYL]XDOL]DWL
YDULDQWD GHVFKLGHULL PHDWXOXL XUHWUDO SH IDD GRUVDO D SHQLVXOXL

II.
epispadias. Acesta poate fi penian sau total variant extrofiei
5HQDODVLPSO
8URJUDILH
&7501

7UDWDPHQWXURORJLF


&RFOX]LLFRPHQWDULL

YH]LFDOHJUHXUH]ROYDELOFKLUXUJLFDO
7RW DFWXO LQVSHFLHL FOLQLFH DWHQWH SRDWH YL]XDOL]a
uretroragia scurgerea de snge la nivelul meatului uretral ntre
PLFLXQLYH]LILJ,,
Fig. II.15.Uretroragia.
sau uretroreea SUH]HQD VHFUHLHL XUHWUDOH SXUXOHQWH vQ LQIHFLL

XUHWUDOHDQWHULRDUHXUHWULWDFXWSUH]HQDXQRUtumorete sesile,
cel mai adesea papilomatoase la nivelul fosei naviculare
SURFLGHQWH OD QLYHOXO PHDWXOXL VDX PLFRUDUHD FDOLEUXOXL
respectivului meat uretral stenoza de meat, GH FDX]
inflamatorie sau posttraumatica.
3UH]HQD
XQRU
traiecte
fistuloase
peniene
sau
penoscrotale cu punct de plecare uretral (marturie a unor abcese

periuretrale fistulizate) nu este greu de vizualizat.
/D IHO GH VLPSOX HVWH GH Y]XW L GDF SDFLHQWXO
DGROHVFHQWXO VDX WkQUXO EUEDW VH DIO vQ LPSRVLELOLWDWHD GH D-L
GHFDORWD SUHSXXO VLWXDLH FOLQLF QXPLW ILPR]; VDX GXS R
GHFDORWDUH QX PDL SRDWH DGXFH SUHSXXO vQ VLWXDLD DQWHULRDU
SDUDILPR]. Cu VLJXUDQ F OD IHO GH XRU SRW IL YL]XDOL]DWH L

$$
II.

1XPHVLSUHQXPH)2
Vrsta DQL
6H[
0RWLYHOHLQWHUQULL
$+&
$3)
$33

&RQGLLLGHYLDLPXQF
MedicatLHGHIRQG
,VWRULFXOEROLL

Analize efectuate:
6DQJH

8ULQD

8URFXOWXUD
(FKRJUDILH
$
H[LVWHQD XQRU VXSXUDLL EDODQR-SUHSXLDOH balanopostitele sau

FKLDUSUH]HQDXQRUFDOFLILFULODDFHVWQLYHO
Palparea SHQLVXOXL SRDWH V VHVL]H]H FHO PDL DGHVHD
SUH]HQD LQGXUDLHL SODVWLFH a corpilor FDYHUQRL PDODGLD
/D3H\URQLHDGLFH[LVWHQDXQRU]RQHGXUHULJLGHODQLYHOXO
FRUSLORU FDYHUQRL FDUH IDF LQWURPLVLXQHD GLILFLO GLQ FDX]D
UHFXUEULLSHQLVXOXLHUHFW
3DWRORJLDXUHWUDODIHPLQLQ SRDWHFRQVWDvQUDUHFD]XULL
n:
- stenoze de meat uretral
- leziuni inflamatorii
- HFWURSLRQXOGHPXFRDVXUHWUDO vizualizabil sub forma
XQHL WXPRUHWH URLL-YLRODFHH SURODEDWH LUHGXFWLELOH D SRULXQLL
DQWHULRDUHDXUHWUHLQRPLQDOL]DWGUHSWpolip de meat uretral
- fistulele uretrale vizualizate prin examen cu valvele.
5. (;$0(18/ &/,1,& $/ 6&5278/8, , $/ &21,1878/8,
68.
,QVSHFLD L SDOSDUHD WUHEXLH V VH DGUHVH]H DWkW
vQYHOLXOXLVFURWDOFkWLFRQLQXWXOXLVX
Vom cerceta :
- Posibila PULUH GH YROXP a hemiscrotului: GXUHURDV n
inflaPDLLOH HSLGLGLPXOXL WHVWLFXODU L vQ WUDXPDWLVPH RUKLepididimare; QHGXUHURDV vQ WXPRUL WHVWLFXODUH L HSLGLGLPDUH
KLGURFHOLGLRSDWLFKHPDWRFHOVDXFKLVWHHSLGLGLPDUHSHUVLVWHQGH
canal peritoneo-vaginal (hidrocel comunicant).
- 3UH]HQD unui orificiu fistulos prin care se scurge puroi n cazul
unui abces orhiepididimar fistulizat la scrot;
- 3UH]HQD semnelor inflamatorii (rubor, tumor, calor, dolor) n
HSLGLGLPLWHLRUKLHSLGLGLPLWH

II.
- Inegalitatea FHORU GRX EXUVH VFURWDOH FX HYHQWXDO, lipsa unui
5HQDODVLPSO
8URJUDILH
&7501

Tratament urologic:


&RFOX]LLFRPHQWDULL

WHVWLFXO GLQ EXUV $FHDVWD VH QXPHWH criptorhidie ELODWHUDO

SkQODGLQFD]XULYH]LILJ,,FkQGWHVWLFXOXO este oprit pe
WUDLHFWXOSHFDUHvQPRGQRUPDODUWUHEXLVvOXUPH]HGHVFHQVXV
testis) sau ectopie WHVWLFXODU GDF WHVWLFXOXO VH JVHWH SH XQ
traiect aberant.
- $IHFLXQL YDVFXODUH varicocel idiopatic, torsiune de cordon
VSHUPDWLFPDQLIHVWDWSULQHGHPVFURWDO
- Tumorile solide (testiculare, epididimare) sau lichide (chiste de
epididim, de cordon);
- Hernia inghino-VFURWDO vera sau KHUQLH SULQ SHUVLVWHQD
canalului peritoneo-vaginal.
EXUVHORU VFURWDOH HIHFWXDW vQ RUWR-
Palparea
L
FOLQRVWDWLVPFRQVWDWLvQWUHWHHOHPHQWHOHVHPLRORJLFH GHVFULVH
anterior:
x
Anorhidia
uni-
VDX ELODWHUDO DEVHQD HSLGLGLPXOXL
SUH]HQDKLGDWLGHL0RUJDJQL
(OHPHQWHOH
GH
GLDJQRVWLF DOH
GLIHULWHORU
DIHFLXQL
inflamatorii specifice (TBC, sifilis, gonoree) sau nespecifice;

(Vezi fig. II.17)
3DOSDUHDWHVWLFXODUYDSUHFL]DFRQVLVWHQDVDRPRJHQIHUP
UHQLWHQW YROXPXO VXSUDIDD VHQVLELOLWDWHD DWURILD VDX FKLDU
DEVHQD DFHVWXLD FRQJHQLWDO VDX SRVW FKLUXUJLFDO 3DFKHWHOH
vasculare dilatate n cazul varicocelului au fost comparate cu
LQWHVWLQHOH GH SDVUH 1X VH YD RPLWH QLFL SDOSDUHD RULILFLXOXL
inghinal superficial tocmai pentru a preciza posibilele variante de
KHUQLHLQJKLQDO

$
II.

Nume VLSUHQXPH)2
Vrsta DQL
6H[
0RWLYHOHLQWHUQULL
$+&
$3)
$33

&RQGLLLGHYLDLPXQF
MedicatLHGHIRQG
,VWRULFXOEROLL

Analize efectuate:
SanJH

8ULQD

8URFXOWXUD
(FKRJUDILH
$
Fig II.17. (OHPHQWH GH GLDJQRVWLF DOH GLIHULWHORU DIHFLXQL LQIODPDWRULL RUKLepididimare.
6.EXAMIN$5($ 3(1,68/8, 35267$7(, , $ 9(=,&8/(/25

SEMINALE
7XHXO UHFWDO - TR presupune examenul organelor
JHQLWDOH L XULQDUH LQWHUQH SURVWDW YH]LFXOH VHPLQDOH XUHWU
YH]LFXULQDU
,QGLFDLLOH75 QXVXQWVWULFWOHJDWHGHSDWRORJLDXURORJLF
GH DFHHD LPSRUWDQD GDWHORU FOLQLFH RELQXWH FkW L WHKQLFD GH
HIHFWXDUH DX LPSRUWDQ PXOWLGLVFLSOLQDU 3HQWUX D H[HPSOLILFD
DFHDVWD PHQLRQP vQ FRQWLQXDUH FkWHYD VSHFLDOLWL vQ FDUH
examenul este recomandat:
x
75 HIHFWXDW GH FKLUXUJXO FH SUDFWLF FKLUXUJLD

DEGRPLQDO VDX DEGRPLQR-SHOYLQ GLJHVWLYD fundul
GH VDF 'RXJODV GXUHURV LSWXO IXQGXOXL GH VDF
$
II.
SHULWRQHDO GLQ SHULWRQLWH VDX SHOYL-SHULWRQLWH LQGXUDLD

Douglas-XOXL FDUH GXS SXQFLRQDUH SRDWH FRQfirma
H[LVWHQD KHPRSHULWRQHXOXL VILQFWHUXO L FDQDOXO DQDO
SHQWUX ILVWXOH VDXL VXSXUDWLL DQR-perianale, hemoroizii,
FRUSL VWUDLQL HQGRUHFWDOL FRQLQXWXO GLJHVWLY DVSHFWXO
VFDXQXOXL VDX D PDWHULLORU IHFDOH UPDVH SH PQX
PHOHQVDXUHFWRUDJLHFDYLWDWHDUHFWDOWXPRU
x
TR efectuat de urolog permite explorarea prostatei,

veziculelor seminale, uretrei posterioare FDQG H[LVW XQ
cateter uretral L D YH]LFLL XULQDUH QH LQWHUHVHD]
UDSRDUWHOH DQDWRPLFH VXSOHHD VDX ULJLGLWDWHD SHUHWHOXL
sensLELOLWDWHD L PRELOLWDWHD DFHVWRUD 3HQWUX H[SORUDUHD
SURVWDWHL VH LPSXQH SDOSDUHD ELPDQXDO PkQD VWkQJ
FXSULQ]kQGKLSRJDVWUXOLDUPkQDGUHDSW UHSUH]HQWDWGH
indexul examinator XUPHD] PLFUL WUDQVYHUVDO L
ORQJLWXGLQDOHEOkQGHHIHFWXDWGXSFOLVPHYDFXDWRULHL
HYDFXDUHD YH]LFLL XULQDUH &HOH PDL EXQH LQIRUPDLL OH
RELQHPDWXQFLFkQGIDFHPWXHXOUHFWDOVXEUDKLDQHVWH]LH
TR efectuat de ginecolog SRDWHRIHULLQIRUPDLLOHJDWHGH

VWDWLFD SHOYLQ ERPEDUHD LQGXUDUHD VDX VHQVLELOLWDWHD
fundului de sac Douglas (pelviperitonite, hemoperitoneu,
WXPRDUH RYDULDQ VDXL VDUFLQ HFWRSLF FRPSOLFDWH vQ
HYROXLHLQIRUPDLLOHRIHULWHGH('5LFRURERUDWHGH(DV,
SRW VWDELOL VLPSOLILFD GLDJQRVWLFXO GLIHUHQLDO L SRW HYDOXD
mai corect stadiul evolutiv al bolii.
TR
efectuat
hormonoterapia
de
oncologul
care
conduce
5HQDODVLPSO
Urografie:
&7501

7UDWDPHQWXURORJLF


&RFOX]LLFRPHQWDULL

GLQ FDQFHUXO GH SURVWDW VDXL
FKLPLRWHUDSLD VLVWHPLF GLQ WXPRULOH YH]LFDOH LQILOWUDWLYH

II.
SRDWHILXWLOvQPRQLWRUL]DUHDHYROXLHLEROLLVWDGLXOORFDOL]DW

1XPHVLSUHQXPH)2
Vrsta DQL
6H[
0RWLYHOHLQWHUQULL
$+&
$3)
$33

&RQGLLLGHYLDLPXQF
MedicatLHGHIRQG
,VWRULFXOEROLL

Analize efectuate:
6DQJH

8ULQD

8URFXOWXUD
(FKRJUDILH

sau local avansat);

x
TR efectuat de gastroenterolog DMXW OD GLIHUHQLHUHD

+'6 KHPRUDJLH GLJHVWLY VXSHULRDU PHOHQ GH +',
KHPRUDJLH GLJHVWLYH LQIHULRDU UHFWRUDJLH L SRDWH
OPXUL GDF FDX]D DQR-UHFWDO H[SOLF VkQJHUDUHD
UHFWRFROLWDKHPRUDJLFSROLSR]FROR-UHFWDOGLYHUWLFXOLW
WXPRU DQR-UHFWDO XQHRUL FRODERUDUHD FKLUXUJXOXL FX
JDVWURHQWHURORJXOILLQGEHQHILF
75 HIHFWXDW GH FKLUXUJXO GH FKLUXUJLH LQIDQWLO este

DEVROXW REOLJDWRULX DWXQFL FkQG QH DIOP vQ IDD XQXL
VLQGURP RFOX]LY vQ RFOX]LD LQWHVWLQDO FX PHFDQLVP GH
invaginare);
TR efectuat de medicul de familie (nu n mod sistematic)

SRDWH DMXWD OD GLIHUHQLHUHD XQHL DIHFLXQLL XURORJLFH 5&8
FX JORE YH]LFDO GH XQD JLQHFRORJLF XWHU ILEURPDWRV
WXPRDUH RYDULDQ 7XHXO UHFWDO HIHFWXDW GH PHGLFXO GH
familie a ajutat in descoperirea a 17% din cazurile de
QHRSODVP GH SURVWDW vQ )UDQD vQ QWRWGHDXQD TR
VHIDFHFXDFRUGXOSDFLHQWXOXLLFXEOkQGHHXQHRULLVXE
anestezie loco-UHJLRQDO FXWkQG V QX DJUDYP VDX V
DPSOLILFPVXIHULQDFOLQLF
Contraindicatiile TR sunt:
x
5HIX]XOH[DPHQXOXLGHFWUHEROQDY
$EVHQD UHFWXOXL L D FDQDOXOXL DQDO DPSXWDLH DEGRPHQSHULQHDOGHUHFW
6XSXUDLL DQR-SHULQHDOH vQ ID]D DFXW ILVXUL DQDOH

DVVRFLDWH FX VSDVP VILQFWHULDQ KHPRURL]L FRPSOLFDL
WURPERIOHELWKHPRURLGDOVWHQR]DUHDRULILFLXOXLDQDOVDX

II.
VFOHUR]DUHD FDQDOXOXL DQDO SRVWLQIHFLRDV VDX SRVW

UDGLF OH]LXQL WUDXPDWLFH DQR-perineale (perversiuni
VH[XDOHFRUSLVWULQLHQGRUHFWDOLQWURGXLvQVFRSHURWLF
Tehnica de examinare:
x
'XS HYDFXDUHD YH]LFL XULQDUH VRQG HYDFXDWRULH i a

DPSXOHL UHFWDOH FOLVP HYDFXDWRULH VH SRDWH HIHFWXD
EROQDYXOXLvQVHGDLHLVHSDUFXUJXUPWRDUHOHHWDSH
3R]LLDEROQDYXOXL
x
Decubit dorsal FX SLFLRDUHOH vQ DEGXFWLH L VHPLIOH[LH

SR]LLD vQ GHFXELW ODWHUDO GUHSW DWXQFL FkQG GXS TR
XUPHD]
HIHFWXDUHD
XQXL
H[DPHQ
XOWUDVRQRJUDILF
endorectal +/- PBP).

x
3R]LLD JLQHFRORJLF PDQHYUD SRDWH IL H[HFXWDW L GH

DOLVSHFLDOLti la finele examenului ginecologic);
3R]LLD JHQX-SHFWRUDO JHQX-FXELWDO
cu
pacient
VSULMLQLW SH FRDWH L JHQXQFKL FHYD vQ JHQXO UXJFLXQLL

PDKRPHGDQH IRORVLW PDL DOHV FkQG H[DPLQDWRUXO DUH
degetul scurt;
x
3R]LLD FX SDFLHQWXO FXOFDW SH VSDWH, cu membrele

inferioare flectate pe bazin, gambele flectate pe coapse
FHOHGRXPHPEUHILLQGXRUvQGHSUWDWH
/DSDFLHQLYkUVWQLFLJUHX PRELOL]DELOL SR]LLDRUWRVWDWLFD

FXWUXQFKLXOIOHFWDWLVSULMLQLWGHRPDVVDXXQSDWSRDWH
fi de ales.
Elementele
semiologice
care
trebuie
analL]DWH L
FRQVHPQDWH VH DIO vQ WDEHOXO SURWRFROXO WXHXOXL UHFWDO YH]L
5HQDODVLPSO
8URJUDILH
&7501

7UDWDPHQWXURORJLF


&RFOX]LLFRPHQWDULL

tabelul II.1)
!

II.

1XPHVLSUHQXPH)2
Vrsta DQL
6H[
0RWLYHOHLQWHUQULL
AHC:
$3)
$33

&RQGLLLGHYLDLPXQF
MedicatLHGHIRQG
,VWRULFXOEROLL

Analize efectuate:
6DQJH

8ULQD

8URFXOWXUD
(FKRJUDILH
!
7$%(/,,3URWRFROXOWXHXOXLUHFWDO
$186,5(&7
1
Tonus
normal
diminuat
sfincterian
2
,QGXUDLH
Da
Nu
3
Noduli
Da
Nu
4
)RUPDLXQH Da
Nu
7XPRUDO
5
Polipi
Da
Nu
6
Carcinom
Da
Nu
inelar
7
)LVXU
Da
Nu
DQDO
8
Abces anal
Da
Nu
9
Fistule
Da
Nu
anale
10 6FOHUR]
Da
Nu
DQDO
11 Hemoroizi
Da
Nu
SUH]HQL
35267$7
12 6XSUDID
1HWHG
1HUHJXODW
Crescut
13
Simetrie
6LPHWULF
$VLPHWULF
14
Accentuat
ters
15
DQ
median
Contur
Neted
Rugos
16
Margini
terse
17
0ULPHD
prostatei
&RQVLVWHQD
Bine
delimitat
1RUPDO
0ULW
0LFRUDW
(ODVWLF
'XU
Moale
0RELO
$GHUHQW
18
19
Mobilitatea
mucoasei
ID
GH
SURVWDW
20
Sensibilitate
la
durere
1RGXOLSUH]HQL
Localizarea
nodulilor
3UH]HQD ]RQHORU
indurate
dureroase
0XFRDVDUHFWDO
Sensibilitatea
GXUHURDV
D
HVXWXULORU
invecinate
21
22
23
24
25
Nedecelabil
GXUHURDV
1HGXUHURDV
Da
Lob drept
Nu
Lob stng
Da
Nu
0RELO
Da
)L[
NU

3VWRDV
)OXFWXHQW
II.
(WDSHOH VXFFHVLYH DOH H[DPHQXOXL GXS SURWHMDUHD

GHJHWXOXL H[DPLQDWRUXOXL FX PQX L OXEULILHUHD VD FX YDVHOLQ
presupun:
-
vQGHSUWDWHD
SOLXULORU
DQDOH,
evaluare
tonusului
VILQFWHUXOXLDQDO6HPQXOFODSHWHLGHSLDQ
-
H[SORUDUHD FRQLQXWXOXL HQGRUHFWDO
L HYLGHQLHUHD
traiectelor fistuloase, a hemoroizilor, sau a tumorilor rectale,

DPSXODUHVDXLDFRUSLORUVWULQLUHFWDOL
- H[SORUDUHDVXFFHVLYa uretrei posterioare FDUHQHFHVLW
un reper uretral VRQG VDX GLODWDWRU PHWDOLF D SURVWDWHL
FRQIRUPDLHVLPHWULHVHQVLELOLWDWHRPRJHQLWDWHIRORVLQGPLFUL
EOkQGH ORQJLWXGLQDOH L WUDQVYHUVDOH GLPHQVLXQL DSUR[LPDWLYH
H[LVWHQDVDXWHUJHUHDDQXOXLPHGLDQ
- a vezicii urinare (cu eventual semn al KHPDWXULHL
SURYRFDWH GHVFULVH GH 3URI 'U 2 )UDQNH L D IXQGXOXL GH VDF
Douglas
-
lumenului
rectal
WXPRUL VWHQR]DQWH SROLSR]
UHFWRFROLFUHFWRFROLWXOFHUR-KHPRUDJLFIOHJPRQGHIRVLschioUHFWDOILVWXOL]DWvQOXPHQXOUHFWDO
La sfrit WUHEXLH V H[DPLQP PQXD H[WUDV GLQ
lumenul rectal) DVSHFWXO PDWHULLORU IHFDOH L DVSHFWXO VkQJHOXL
YHFKL vQ PHOHQ L SURDVSDW vQ UHFWRUDJLH DWXQFL FkQG DFHDVWD
HVWH SUH]HQW 7UHEXLH V DGXJP F YH]LFXOHOH VHPLQDOH QX VH
SDOSHD] vQ PRG QRUPDO VH SDOSHD] GRDU vQ FD] GH YH]LFXOLW
WXPRU GH YH]LFXOH VHPLQDOH VDX vQ FD] GH FDQFHU SURVWDWLF
5HQDODVLPSO
8URJUDILH
&7501

7UDWDPHQWXURORJLF


&RFOX]LLFRPHQWDULL

YH]LFXOLQFDSGHWDXU - coarnele fiind veziculele seminale).

,,,(;3/25$5($,0$*,67,&1852/2*,(
,,,(;3/25$5($,0$*,67,&1852/2*,(
Nume si SUHQXPH)2
Vrsta DQL
6H[
0RWLYHOHLQWHUQULL
$+&
$3)
$33

&RQGLLLGHYLDLPXQF
MedicatLHGHIRQG
,VWRULFXOEROLL

Analize efectuate:
6DQJH

8ULQD

8URFXOWXUD
(FKRJUDILH

Tehnici de explorare
1.
ECOGRAFIA
5H]XOWDW DO GH]YROWULL WHKQRORJLHL VRQDUHORU vQ FHO GH-al

Doilea Razboi Mondial, echografia e n zilele noastre una dintre
cele mai utilizate PHWRGH GH H[SORUDUH LPDJLVWLF (FRJUDILD
SHUPLWHRELQHUHDXQRULQIRUPDLLIRDUWHXWLOHPHGLFXOXLFRQWULEXLQG
GHDVHPHQLODVWDELOLUHDXQXLGLDJQRVWLFUDSLG(VWHRPHWRGFDUH
QHFHVLW R LQYHVWLLH LQLLDO GDU DSRL HVWH QHFRVWLVLWRDUH VH SRDWH
practicDvQFRQGLLLGHFOLQLFDPEXODWRULXVDXFDELQHWGHPHGLFLQ
GH IDPLOLH PDWHULDOHOH FRQVXPDELOH VXQW SXLQH L LHIWLQH SRDWH IL
HIHFWXDW L IU SUHJWLUH OD SDFLHQL vQ FROLF FKLDU L OD IHPHL
gravide, putnd fi utilizatFXVXFFHVvQFRQWURDOHOH SDFLHQLORU
3ULQGHILQLLHHFRJUDILDHVWH
- RPHWRGvQWLPSUHDORIHULQGLPDJLQLGLQDPLFHGDUHVWH
RPHWRGVXELHFWLYLGHSHQGHQWGHH[DPLQDWRU
(FKRJUDILDDUHLRVHULHGHOLPLWHFDUHWUHEXLHFXQRVFXWH
HVWH DUWHIDFWRJHQ FkWHRGDW JUHX GH HIHFWXDW L SRDWH SUH]HQWD
erorLODSDFLHQLLVXSUDSRQGHUDOL
Q FHHD FH SULYHWH DSDUDWXO UHQR-urinar, ecografia poate
H[DPLQD SUDFWLF RULFH UHJLXQH PDL SXLQ XUHWHUHOH LOLDFH ILLQG
LQGLFDWFDVFUHHQLQJvQDQDOL]DSDWRORJLHL]RQDOH
Ecografele pot fi dotate cu diverse tipuri de transductore.
Q SUDFWLFD XURORJLF FHO PDL DGHVHD VXQW QHFHVDUH WLSXUL GH
transductori: transductor convex de 2,5 - 3,4-5 MHz care este util
vQLQYHVWLJDUHDRUJDQHORUDEGRPLQDOHULQLFKLYH]LFSURVWDWFkQG
VHIRORVHWHFDOHDWUDQVDEGRPLQDOHWFWUDQVGXFWRUOLQLDUGH
MHz util pentru organe aflate imediat sub piele (testicule, uretra,
HWFLVRQGHHQGRUHFWDOHFHSHUPLWUHDOL]DUHDXQRUSXQFLL-biopsii.

,,,(;3/25$5($,0$*,67,&1852/2*,(
3H OkQJ H[SORUDUHD XOWUDVRQRJUDILF FODVLF FDUH RIHU

date limiWDWHvQDQXPLWHSDWRORJLLFkQGPHGLFXOWUHEXLHVDSHOH]H
la computer-tomografie sau RMN pentru un diagnostic ct mai
H[DFWRLQYHVWLJDLHUHFHQWDSDUXWHUHSUH]HQWDWGHHFRJUDILDFX
VXEVWDQ GH FRQWUDVW $FHDVWD XWLOL]HD] PLFURVIHUH GH
perfluorocarbRQ VDX D]RW FH VH DGPLQLVWUHD] LQWUDYHQRV vQ
FLUFXODLD VLVWHPLF Q SUDFWLFD XURORJLF DFHDVWD LQYHVWLJDLH H
IRORVLW SHQWUX GLDJQRVWLFDUHD WXPRULORU UHQDOH FKLWLORU UHQDOL
FRPSOLFDLDQJLRPLROLSRDPHORUVDXa infarctelor/ischemiei renale.
a. (FRJUDILDUHQDO este indicat n :
- LQIHFLLDOHWUDFWXOXLXULQDU
- hematurie
- REVWUXFLL
- mase tumorale
- calculi
- anomalii congenitale (chisturi renale, etc.)
- LQVXILFLHQUHQDOLQGLIHUHQWGHFDX]
- monitorizarea rinichiului transplantat
- JKLGDUHDSXQFLHLSHUFXWDQHGLDJQRVWLFH sau terapeutice
- VWXGLXO DUWHUHORU UHQDOH L DO UDPXULORU ORU vQ HFRJUDILD 'RSSOHU
color.
Ea poate decela DQRPDOLLOH GH IRUP SR]LLH QXPU
GLPHQVLXQH L VWUXFWXU DOH ULQLFKLXOXL LQGLFDLLOH DFHVWHL H[DPLQUL
fiind numeroase.
6H WLH F GLPHQVLXQLOH UHQDOH YDULD] QRUPDO vQWUH -12
cm lungime, 5- FP OLPH L DSUR[LPDWLY FP JURVLPH FX R
5HQDODVLPSO
8URJUDILH
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7UDWDPHQWXURORJLF


&RFOX]LLFRPHQWDULL

GLIHUHQGHOXQJLPHvQWUHFHLGRLULQLFKLGHPD[LPFP
n decursul procedurii parenchimul renal ne apare
hipoecogen FRPSDUDWLYFXVLQXVXOUHQDOLDUJURVLPHDOXLLQGLFHOH
$
$
,,,(;3/25$5($,0$*,67,&1852/2*,(
SDUHQFKLPDWRVWUHEXLHVILHPLQLPPPPHGLRUHQDO-25 mm
1XPHVLSUHQXPH)2
Vrsta DQL
6H[
0RWLYHOHLQWHUQULL
$+&
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$33

&RQGLLLGHYLDLPXQF
MedicatLHGHIRQG
,VWRULFXOEROLL

Analize efectuate:
6DQJH

8ULQD

8URFXOWXUD
(FKRJUDILH
la poli.
(FRJUDILD SRDWH GHSLVWD IRUPDLXQL vQORFXLWRDUH GH VSDLX
FX
VWUXFWXU
OLFKLGLDQ
WUDQVVRQLF
VROLG
KLSHU
VDX
KLSRHFRJHQLPL[WFXVDXIUFDOFLILFUL
7XPRULOH UHQDOH SRW IL EHQLJQH VDX PDOLJQH L SRW IL
GHSLVWDWH HFRJUDILF vQ SURSRULH GH - FKLDU L DWXQFL FkQG
sunt de numai 1-2 cm.
Diagnosticul ecografic al litiazei se poate face atunci cnd
calculii au peste 3-PPLDSDUFDLPDJLQLLQWHQVHFRJHQHFXFRQ
GHXPEUSRVWHULRULQGLIHUHQWGHQDWXUDORUELRFKLPLF
+LGURQHIUR]D +1 vPEUDF HFRJUDILF XQ DVSHFW DSDUWH
FX GLODWDLL FDOLFHDOH FRQIOXHQWH vQWU-R ]RQ FHQWUDO - calicele
GLODWDWH FRQIOXHD] vQ ED]LQHWXO GLODWDW 'DF VH DVRFLD] L
dilatarea ureterului SRDUWQXPHOHGH ureterohidronefroza (UHN.)
b. Ecografia vezicii urinare (VU)
(FRJUDILD HVWH PHWRGD GH SULP LQWHQLH vQ H[DPLQDUHD
VU.
Abordul
poate
fi
suprapubian,
endocavitar
(ecografie
WUDQVXUHWUDO HQGRYH]LFDO WUDQVUHFWDO VDX WUDQVYDJLQDO (VWH

HVHQLDOVHIHFWXPHFKRJUDILDFkQGYH]LFDHVWHSOLQSHQWUXDQH
IHULGHLQWHUSUHWULHURQDWH(FRJUDILDSHUPLWHGHFHODUHD
- unor anomalii parietale (tumori vegetative sau infiltrative,
diverticuli intramurali)
- D FDOFXOLORU D FRUSLORU VWULQL LQWUDYH]LFDOL IUDJPHQWH GH
VRQGVRQGGRXEOH-
- a diverticulilor
- PDOIRUPDLLORU MRQFLXQLL XUHWHUR-vezicale (megaureter,
ureterocel)
- reziduului vezical.
$
,,,(;3/25$5($,0$*,67,&1852/2*,(
5HDOL]DW GH XQ HFKRJUDILVW FX H[SHULHQ HFKRJUDILD

'RSSOHU D YH]LFLL XULQDUH vQ FROLFD UHQDO SRDWH SXQH vQ HYLGHQ
SUH]HQDVDXDEVHQDHOLPLQULLXULQLLSHRULILFLLOHXUHWHUDOH. De
DVHPHQL SUH]HQD WZLQNOLQJ-XOXL FkQG VH XWLOL]HD] HFKRJUDILD
'RSSOHUSRDWHFUHWHVHPQLILFDWLYUDWDGHWHFWULi calculilor ureterali
pelvini.
c. Ecografia prostatei LDYH]LFXOHORUVHPLQDOH
3URVWDWD VH HYLGHQLD] HQGRFDYLWDU WUDQVUHFWDO VDX OD
baza
vezicii
urinare
cazul
ecografiei
transabdominale,
suprapubiene.
6HSRWHYLGHQLD
- hipertrofia de SURVWDW
- DEFHVHOHIRUPDLXQLOHFKLVWLFH
- OLWLD]DSURVWDWLF
- patologia veziculelor seminale (agenezie, hipoplazie
UHVSRQVDELOHGHVWHULOLWDWHPDVFXOLQFKLVWXULHFWD]LLFDOFLILFUL
(FRJUDILD HQGRUHFWDO RIHU FHOH PDL SUHFLVH date,
putndu-VH HIHFWXD PVXUWRUL OLQHDUH L YROXPHWULFH UHDOH 6H
IRORVHWHSHQWUXLQYHVWLJDUHDOH]LXQLORUVXVSHFWHGHRDUHFHpermite
LHIHFWXDUHDSXQFLHL-biopsie prostatice.
d. Ecografia uretrei masculine
/DQLYHOXOXUHWUHLVHSRWHYLGHQLD
- stricturi
- calculi
- diverticuli.
8UHWUD vQ VWDUH GH YDFXLWDWH QX VH LGHQWLILF HFRJUDILF
5HQDODVLPSO
8URJUDILH
&7501

7UDWDPHQWXURORJLF


&RFOX]LLFRPHQWDULL

'XSXPSOHUHDQWHURJUDGVDXUHWURJUDGVHYL]XDOL]HD]OXPHQXO
WUDQVVRQLFPUJLQLWGHSHUHLLKLSHUHFRJHQL
e. (FRJUDILDWHVWLFXODU
$

,,,(;3/25$5($,0$*,67,&1852/2*,(
(FRJUDILDWHVWLFXODUHVWHXWLOL]DWSHQWUXH[DPLQarea:

Nume si SUHQXPH)2
Vrsta DQL
6H[
0RWLYHOHLQWHUQULL
$+&
$3)
$33

&RQGLLLGHYLDLPXQF
MedicatLHGHIRQG
,VWRULFXOEROLL

Analize efectuate:
6DQJH

8ULQD

8URFXOWXUD
(FKRJUDILH

- hidrocelului,
- tumorilor testiculare
- FKLWLHSLGLGLPDUL
- VXSXUDLLWHVWLFXODUHKHPDWRFHOLDDOWRUOH]LXQL
- examinarea testiculului ectopic.
n mod normal testiculul este ovoid, de aproximativ 3,5 cm lungime
LFPOLPHFXRHFRJHQLWDte medie. Mediastinul apare ca o linie
HFRJHQ SDUDOHO FX HSLGLGLPXO &DSXO HSLGLGLPXOXL HVWH VLWXDW
ODWHUDO GH SROXO VXSHULRU DO WHVWLFXOXOXL L DUH XQ GLDPHWUX GH -15
mm.
2.
RADIOGRAFIA RENALA SIMPLA (RRS)
sau radiografia
DEGRPLQDO VWDQGDUG poate aduce LQIRUPDLL DVXSUD SDWRORJLHL

reno-uretero-YH]LFDOHIUDXWLOL]DVXEVWDQHGHFRQWUDVW &DHWDS
REOLJDWRULHvQWHKQLFDXURJUDILFSHRUHQDOVLPSOVHXUPUHWH
SUHJWLUHD LQWHVWLQXOXL SR]LLRQDUHD SDFLHQWXOXL L D FDVHWHL
DOHJHUHDFRUHFWDHOHPHQWHORUGHH[SXQHUHLGHYHORSDUH
3RDWHHYLGHQLDSUH]HQDGH
- RSDFLWL VXJHVWLYH SHQWUX LPDJLQL GH FDOFXOL GDF VXQW
SURLHFWDWH SH DULD VLVWHPXOXL SLHORFDOLFHDO XUHWHU YH]LF
,QWHUSUHWDUHDFRUHFWVHIDFHFRURERUkQGGDWHOHGHOD556FXFHOH
de la UIV.
- PRGLILFUL LVDX OH]LXQL RVWHRDUWLFXODUH la nivelul scheletului
investigat
- metastaze osoase ODED]LQVDXFRORDQ
x
556 VH HIHFWXHD] FX SDFLHQWXO vQ GHFXELW SH
filme 30/40 considerndu-VHDILFRUHFWH[HFXWDWDWXQFLFkQGVXQW

vizibile vertebrele lombare, cu apofizele transverse, coastele a XI-a
L D ;,,-D PXFKLL SVRDV FX PDUJLQHD ORU H[WHUQ GHVHQDW QHW
$$
,,,(;3/25$5($,0$*,67,&1852/2*,(
RSDFLWLOH UHQDOH RDVHOH LOLDFH L PDUJLQHD VXSHULRDU D VLPIL]HL
5HQDODVLPSO
8URJUDILH
&7501

Tratament medicamentos:
7UDWDPHQWXURORJLF


&RFOX]LLFRPHQWDULL

pubiene.
x
&D HWDS REOLJDWRULH vQ WHKQLFD XURJUDILF SH R
UHQDO VLPSO VH XUPUHWH SUHJWLUHD LQWHVWLQXOXL SR]LLRQDUHD

SDFLHQWXOXL L D FDVHWHL DOHJHUHD FRUHFW D HOHPHQWHORU GH
H[SXQHUHLGHYHORSDUHSRDWHHYLGHQLDSUH]HQDGHJD]ODQLYHOXO
WXEXOXLGLJHVWLYHVWHELQHVDDPkQPvQDFHVWHFRQGLLLLQMHFWDUHD
VXEVWDQHLGHFRQWUDVWLVDSUHJWLPPDLELQHSDFLHQWXOvQDOWD]L
3.
UROGRAFIA INTRAVENOASA (UIV)
3UHVXSXQHHIHFWXDUHDUDGLRJUDILHi renale simple + UIV +

FLVWRJUDILD

FLVWRXUHWURJUDILD
PLFLRQDO
L
FLVWRJUDILD
SRVWPLFLRQDOUH]LGXXO
x
a.
SUHJWLUHDSDFLHQWXOXL
PHGLFDPHQWRDV antialergice, antihistaminice,
sedative, cortizon;
b.
GLHW IU DOLPHQWHFDUHvQPRGIUHFYHQWSURYRDF
IODWXOHQ GXOFLXUL ODFWDWH IUXFWH OHJXPH EXWXUL GXOFL

FDUERJD]RDVH/LPLWDUHDFRQVXPXOXLGHDSFXRUHvQDLQWHGH
XURJUDILHHVWHEHQHILFFRQFHQWUULLVXEVWDQHLGHFRQWUDVW
x
6XEVWDQH GH FRQWUDVW 6'& FX RVPRODULWDWH
VF]XW QRQLRQLFH ,RSDPLUR 8OWUDYLVW 2PQLSDTXH PO-300, 0,8 $WHQLH OD UHDFLLOH DOHUJLFH FDUH SRW PHUJH GH OD IRUPH
PRGHUDWHJUHXULFOGXUURHDORFDOODORFXOLQMHFLHLXUWLFDULH
SkQ OD UHDFLL JHQHUDOH VHYHUH VWDUH OLSRWLPLF GLVSQHH
expiratorie, bronhospasm).
8URJUDILD LQWUDYHQRDV 8,9 XUPUHWH UDGLRJUDILF
eliminarea de SDC prin rinichi:
x
la 5 min WHVW IXQFLRQDO - HOLPLQDUH VLPHWULF
ELODWHUDOHJDO
$

,,,(;3/25$5($,0$*,67,&1852/2*,(

1XPHVLSUHQXPH)2
Vrsta DQL
6H[
0RWLYHOHLQWHUQULL
$+&
$3)
$33

&RQGLLLGHYLDLPXQF
Comportamente ( IXPDWDOFRROHWF
MedicatLHGHIRQG
,VWRULFXOEROLL

Analize efectuate:
6DQJH

8ULQD

8URFXOWXUD
(FKRJUDILH

la 20 min film morfologic SLHORFDOLFHDO L

XUHWHUDO FDOLFHOH L ED]LQHWXO VXQW YL]LELOH SOLQH GH
XULQ DPHVWHFDW FX VXEVWDQ GH FRQWUDVW QFHS V
VH YDG L SRULXQL GLQ XUHWHU vQ FRUHODLH FX
SHULVWDOWLFDXUHWHUDO
Cistografia UHSOHLHPLFLRQDOSRVWPLFLRQDO
Manevre din timpul examenului:

Se poate face si UIV n decubit ventral pungile stagnante se
RSDFLILD]PDLELQHLDUGDFLPDJLQLOHQXVXQWFODUHVHSRDWHIDFH
R FRPSUHVLXQH H[HUFLWDW OD QLYHOXO VWUkPWRULL VXSHULRDUH D
pelvisului. Aceasta manevr HVWH FRQWUDLQGLFDW OD SHUVRDQH vQ
YkUVW DIHFLXQL REVWUXFWLYH UHQR-ureterale
sau
vezicale,
traumatisme ale aparatului urinar &kWHRGDWD SRDWH IL QHFHVDU

UHLQMHFWDUHD vQ FXUVXO DFHOXLDL H[DPHQ D XQHL QRL GR]H GH
VXEVWDQGHFRQWUDVWSHQWUXDPHOLRUDUHDFDOLWii imaginii.
x
&OLHHWDUGLYH la 1h, 2h sau mai mult (daca la 24 h
ULQLFKLXO QX HOLPLQ ULQLFKL PXW XURJUDILF VH IDF vQ IXQFLH GH
JUDGXO GLVWHQVLHL vQ VFRSXO SUHFL]ULL VHGLXOXL REVWUXFLHL XQHRUL vQ
procubit.
Urografia n perfuzie VH XWLOL]HD] OD SDFLHQLL FX XUHPLH
PRGHUDWLQMHFWkQGX-VHPO.JFRUSGHVXEVWDQUDGLRRSDF
GLOXDL vQ GH[WUR] $GPLQLVWUDUHD GH GLXUHWLF )XURVHPLG
GXSILOPXOGHODPLQVHLQMHFWHD]LYILROHGH)XURVHPLG
L VH IDF FOLHH GLQ vQ PLQ WLPS GH PLQ (VWH LQGLFDW vQ
GLDJQRVWLFXO IXQFLRQDO DO KLGURQHIUR]HL FRQJHQLWDOH Urografia
PLQXWDW
test
Ravasini
XWLOL]DW vQ VWXGLXO WHQVLXQLL
UHQRYDVFXODUH FRQVW vQ HIHFWXDUHD GH ILOPH GLQ PLQXW vQ PLQXW
vQFHSkQGGHODVIkULWXODGPLQLVWUULL VXEVWDQHLGHFRQWUDVW6'&
4.
INVESTIGATIILE
RADIOLOGICE
$
RETROGRADE
ALE
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APARATULUI URINAR
$WXQFL FkQG H[DPHQXO 8,9 QX UHXHWH V IXUQL]H]H GDWH

VXILFLHQWH GLDJQRVWLFXOXL L VXQW HIHFWXDWH GH XURORJ vPSUHXQ FX
medicul
radiolog:
uretroJUDILD UHWURJUDG XUHWHURSLHORJrafia,
SLHORJUDILDDQWHURJUDG
a. 8UHWURJUDILDUHWURJUDG
HVWH XWLOL]DW vQ GLDJQRVWLFDUHD REVWDFROHORU XUHWUDOH vQ
FRPSOHWDUHD XQHL XURJUDILL FUHLD vL OLSVHWH WLPSXO PLFLRQDO
WUHEXLHHIHFWXDWOHQWSHQWUXDQXVHproduce extravazat spongiocavernos n timpul manevrei;
x Dac DQWHULRU HVWH PRQWDW R FLVWRVWRPLH VH SRDWH
realiza o uretrografie bipolar (antero- L UHWURJUDG), injectnd
FRQFRPLWHQW VXEVWDQ GH FRQWUDVW 8UHWURJUDILD UHWURJUDG e
UHFRPDQGDW V VH HIHFWXH]H FkQG VH ULGLF VXVSLFLXQHD XQHL
UXSWXUL WUDXPDWLFH GH XUHWU vQDLQWH GH D WHQWD LQVHULD XQHL VRQGH
uretro-YH]LFDOH DWXQFL FkQG DFHDVW PDQHYU H QHFHVDU VL
FLVWRVWRPLDVXSUDSXELDQQXSRDWHILUHDOL]DW
b. &LVWRJUDILDUHWURJUDG
x opacifierea retroJUDGDYH]LFLLXULQDUHGLQFHvQFHPDL
SXLQ XWLOL]DW XWLO VWXGLHULL UHIOX[XOXL YH]LFDO GDU L FkQG VH
VXVSLFLRQHD]RUXSWXUSHUIRUDLHYH]LFDO
c. Ureteropielografia (UPG) LSLHORJUDILD
x GXS FDWHWHUL]DUHD RULILFLXOXL XUHWHUDO FX R VRQG
&KHYDVVX VH LQMHFWHD] VXEVWDQD GH FRQWUDVW RELQkQGX-se
opacifierea uretero-pielo-FDOLFHDO
x SHQWUX RELQHUHD SLHORJUDILHL VH LQWXEHD] RULILFLXO
5HQDODVLPSO
Urografie:
&7501

7UDWDPHQWXURORJLF


&RFOX]LLFRPHQWDULL

XUHWHUDO L VH DVFHQVLRQHD] XQ FDWHWHU XUHWHUDO VWDQGDUG SkQ OD

QLYHOXO MRQFLXQLL SLHORXUHWHUDOH XQGH VH YD LQMHFWD VXEVWDQD GH
FRQWUDVWUH]XOWkQGSLHORJUDILDUHWURJUDG
$!

,,,(;3/25$5($,0$*,67,&1852/2*,(

1XPHVLSUHQXPH)2
Vrsta DQL
6H[
0RWLYHOHLQWHUQULL
$+&
$3)
$33

&RQGLLLGHYLDLPXQF
MedicatLHGHIRQG
,VWRULFXOEROLL

Analize efectuate:
6DQJH

8ULQD

8URFXOWXUD
(FKRJUDILH
!
x VXEIOXRURVFRSLHLPDJLQHD835HVWHGLQDPLFSRDWHIL
DPSOLILFDW SUHOXFUDW vQUHJLVWUDW GLQDPLF VDX VWDWLF FRQWULEXLQG
decisiv la stablirea diagnosticului;
835 HVWH IRORVLW SHQWUX GLDJQRVWLF vQ OLWLD]D UHQRWUDQVSDUHQW VWHQR]H XUHWHUDOH GH GLIHULWH HWLRORJLL WXPRUL
uroteliale
uretero-pielo-caliceale;
rinichi
mut
urografic
QHIXQFLRQalWURPER]GHDUWHUUHQDO
5.
5$',2*5$),$ 38/021$5 vQ XURORJLH HVWH QHFHVDU vQ
evaluarea preoperatorie a pacientului (leziuni pleuroSXOPRQDUH HWF L vQ HYDOXDUHD SRVWRSHUDWRULH GXS
nefrectomie, etc.).
6.
7202*5$),$&20387(5,=$7
0HWRGD FRQVW vQ SRVLELOLWDWHD GH D GLIHUHQLD SULQ
VHFLXQL D[LDOH GH JURVLPH UHJODELO HVXWXUL FX GHQVLWL GLIHULWH

situate n contact unele cu altele.
x
$X IRVW FRGLILFDWH vQ GH QXDQH GH JUL FkWH XQD
SHQWUX ILHFDUH XQLWDWH FRQYHQLRQDO GH GHQVLWDWH vQWUH 1000 UH

XQLWL +RXQVILHOG FHD PDL PDUH GHQVLWDWH SRVLELO FRPSDFW
RVXOXL L - 8+ FHD PDL PLF GHQVLWDWH vQ FRUSXO RPHQHVF
DHUXO'HQVLWDWHDDSHLHVWHHJDOFX8+)LHFDUHRUJDQDUHOLPLWH
GH GHQVLWDWH QRUPDO OD ULQLFKL -30 - XULQ -30, iar pentru
JUVLPHDSHULUHQDOvQWUH-L-60 UH.
x
3ULQLQWHUPHGLXO&7VHHOXFLGHD]ULQLFKLXOQHIXQFLRQDO
OD 8,9 VH FHUFHWHD] SDFLHQWXO XUHPLF FDQFHUXO UHQDO WHVWLFXOXO

ectopic, pacientul politraumatizat sau traumatismul renal solitar.
&7IUVXEVWDQGH contrast: leziuni calcificate renale,
KHPRUDJLFHH[WUDYD]ULXULQDUH deoarece administrarea de SDC
poate masca unele leziuni.
&7 FX VXEVWDQ GH FRQWUDVW aduce L LQIRUPDLLOH
$
,,,(;3/25$5($,0$*,67,&1852/2*,(
IXQFLRQDOH DOWXUL GH FHOH PRUIRORJLFH $YDQWDMXO PDUH HVWH F VH
5HQDODVLPSO
8URJUDILH
&7501

7UDWDPHQWXURORJLF


&RFOX]LLFRPHQWDULL

poate face prin CT o stadializare corect TNM n cazul tumorilor

retroperitoneale (extinderea tumorii? ganglioni invadati? metastaze
la distanta?)$VWD]L VH UHDOL]HD] manevre minim invazive sub
FRQWURO WRPRJUDILF SXQFLD FKLVWXULORU UHQDOH SDQFUHDWLFH SXQFLH
biRSVLHJDQJOLRQDUVDXWXPRUDO
7.
5(=21$1$0$*1(7,&18&/($5
/DED]DDFHVWHLLQYHVWLJDLLVWDXSURSULHWLOHQXFOHLORUGH
KLGURJHQ GLQ FRUS (QHUJLD HPLV GH DWRPLL GH KLGURJHQ HVWH
FROHFWDW L WUDQVIRUPDW SULQ YDULDWH SURJUDPH GH FRPSXWHU vQ
imaginL $FHVWH LPDJLQL VXQW UHIOHFWDUHD GHQVLWLL KLGURJHQXOXL vQ
GLIHULWH HVXWXUL DOH FRUSXOXL FDUH SRDWH IL PRGLILFDW GH GLIHULWH
VWUL IL]LFH FKLPLFHPRGLILFUL FHOXODUH VDX vQFUFWXU OLFKLGLDQ
FDUDFWHULVWLFLOH HVXWXOXL Q XURORJLH DSOLFDLLOH FOLQLFH VH UHIHU OD
PDOIRUPDLL
FRQJHQLWDOH
SDWRORJLH
YDVFXODU
VWDGLHUHD
neoplasmului FkQG HYDOXDUHD &7 QX HVWH FRQFOXGHQW 6LQJXUD

VXEVWDQ GH FRQWUDVW XWLOL]DW HVWH DFLG *G-DTPA (gandolinium
dietilen triamono-penacetil).
Avantajele RMN
Dezavantajele
RMN
&RQWUDLQGLFDLLOH501
Imagine n orice
9LWH]PLFGH
3DFLHQLFXDQHYULVP
GHVIXUDUH
Claritatea imaginii
este, uneori,
LQIHULRDUFHOHL
RELQXWHSULQ&7
intracranian
plan (transvers,
sagital, coronal)
Cmp larg de
vedere
Contrast tisular
bun
Clipurile metalice puse

intraoperator
Fragmente metalice
intraoculare
3XUWWRULLFXLPSODQWXUL
mecanice, electrice sau
magnetice (pacemaker,
biostimulatoare,
neurostimulatoare etc)
,PDJLQHIU
expunere la
UDGLDLLLRQL]DQWH
$

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1XPHVLSUHQXPH)2
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6H[
0RWLYHOHLQWHUQULL
$+&
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$33

&RQGLLLGHYLDLPXQF
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,VWRULFXOEROLL

Analize efectuate:
SanJH

8ULQD

8URFXOWXUD
Echografie:

,QGHSHQGHQ
IDGHRSHUDWRU
8.
Sarcina este o
FRQWUDLQGLFDLHUHODWLY
,19(67,*$,,/($1*,2*5$),&(1852/2*,(
n scop diagnostic: HTA reno-YDVFXODU PDV UHQDO

GLDJQRVWLFGLIHUHQLDOvQWUHQHRSODVPLWXPRUEHQLJQULQLFKLPXW
XURJUDILF KHPDWXULH GH HWLRORJLH QHSUHFL]DW GRQDWRU SHQWUX
WUDQVSODQWUHQDOULQLFKLJUHIDWQHIXQFLRQDO
n scop LQWHUYHQLRQDO angioplastii endoluminale de
DUWHU UHQDO HPEROL]DUH VHOHFWLY vQ VFRS KHPRVWDWLF D UDPXULL
DUWHULDOH vQ KHPDWXULL VSROLDQWH WXPRUDOH WHUDSLD FLWRVWDWLF
LQWUDDUWHULDO
SHVWXGLD]WUHLID]HGLVWLQFWH
, )D]D DUWHULDO SXQH vQ HYLGHQ trunchiul arterial,
marile ramuri arteriale, apoi a arteriolelor mici interlobare. n caz de
blocaj arterial cirFXODLHFRODWHUDOH[WUDUHQDO
II.)D]D SDUHQFKLPDWRDV GXS
5-8
sec
(permite
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Fig.III. 9,10 - RRS+UIV, calcul n ureterocel drept, IUUVXQHW

suprajacent nalt

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Analize efectuate:
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uree 36 mg/dl; creatinina 0,92 mg/dl
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prostatectomia

radical

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IX.
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TRANSPLANTAT
n perioada SRVWRSHUWDWRULH LPHGLDW urmarirea pacientului
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FKLUXUJLFDO XURVWRPLD L UROXO DFHVWHLD vQJULMLUHD VWRPHL L
dispozitivele utilizate; SDFLHQLL SRW IL vQYDL SUHRSHUDWRU V-L
vQJULMHDVF VWRPD L V-L VFKLPEH GLVSR]LWLYXO FROHFWor.
6WDELOLUHD SUHRSHUDWRULH D ORFXOXL vQ FDUH YD IL SODVDW VWRPD HVWH XQ
HOHPHQWLPSRUWDQWSHQWUXDVLJXUDUHDHWDQHLWLLLDVFKLPEULLIDFLOH
a sistemului colector.
ngrijirea postoperatorie
Fig.III. 26 - 8,9ULQLFKLvQSRWFRDY+1UDPGUHSW
,PHGLDW GXS LQWHUYHQLD FKLUXUJLFDO VWRPD WUHEXLH V ILH

$
,,,(;3/25$5($,0$*,67,&1852/2*,(
$SDULLD GXUHULORU GXS SHQVDUHD QHIURVWRPLHL impune,

DOWXUL GH FDOPDQWH GHSHQVDUHD QHIURVWRPLHL L XUPULUHD DWHQW D
VLWXDLHL3HORFXOQHIURVWRPLHLVHDWDHD]RSXQJFROHFWRDUH vezi
capitolul dedicat urostomiilor - LDUvQFD]XOvQFDUHFDQWLWDWHDGHXULQ
HYDFXDWHVWHPLFDFHDVWDYDILvQORFXLWFXXQSDQVament steril. La
externare orificiul prin care s-a introdus sonda de nefrostomie este
aproape cicatrizat dar va mai avea poate nevoie de pansament unadoua zile.
VI.
85(7(526&23,$5752*5$' GLDJQRVWLFVDX
WHUDSHXWLF
6H FRQVLGHU OD RUD DFWXDO F GXS efectuarea unei
XUHWHURVFRSLL FDUH D GHFXUV XRU IU WUDXPDWL]DUHD H[FHVLY D

XUHWHUXOXL L IU GHVFRSHULUHD XQHL OH]LXQL XUHWHUDOH VHPQLILFDWLYH
Fig.III.27 - UIV, rinichi drept malrotat, rinichi stng GXSOLFLWDWHSLHORFDOLFHDOL
XUHWHUDOFRPSOHW
GDWRUDWH FDOFXOXOXL FDOFXOLORU PRQWDUHD XQHL VRQGH -- OD VIkULWXO

inteUYHQLHL QX HVWH QHFHVDU GDU, pentru singuran marea
majoritatea a urologilor insera o sonda JJ , mai ales dac prelucrarea
calcului a fost dificila/exista zone de edem important.
QPDMRULWDWHDFD]XULORULQVHULDXQHLDVWIHOGHVRQGHHVWHXWLO
protejnd pacientul de dureri lombare, datorate edemului mucoasei
XUHWHUDOH OD ORFXO LPSDFWXOXL $D vQFkW SDFLHQWXO YD SUVL VDOD GH
endoscopie cu :
-SHUIX]LDLQWUDYHQRDV
-sonda JJ
3
-VRQGD)ROH\VLPSOFXEDORQDXOJRQIODWFXFP .
(YROXLD SRVWRSHUDWRULH HVWH VLPSO vQ JHQHUDO GDU asistenta
DUH DFHOHDL REOLJDLL SULYLQG PRQLWRUL]ULOH GHMD SUHFL]DWH 7$ SXOV
WHPSHUDWXUFDQWLWDWHLDVSHFWXOXULQLL

IV. INSTRUMENTARUL N UROLOGIE
6XSULPDUHDILUHORUGHVXWXUD-a zi constituie unul din gesturile

SUHPHUJWRDUH H[WHUQULL QX vQDLQWH GH D prezenta cODU L SH

vQHOHVXO ILHFUXLD ULJRULOH VLWXDLHL GH SDFLHQW FX ULQLFKL XQLF
chirurgical: regim alimentar, consum lichidian abundent, evitarea
WUDXPDWLVPHORU vQ UHJLXQHD ORPEDU FX ULQLFKLXO VQWRV FRQWURDOH
Fig.IV.1 - sonda Nelaton
periodice, etc.
V.
1()52/,72720,$3(5&87$1$7 (NLP)
6IkULWXO LQWHUYHQLHL SHQWUX DERUG SHUFXWDQDW DO FDOFXOLORU HVWH
PDUFDWSULQLQVHULDLfixarea sondei de nefrostomie la tegumentele
Fig.IV.2. Sonda Tiemann
regiunii lombare. Pacientul va avea:

- SHUIX]LDLQWUDYHQRDV
-o VRQG )ROH\ VLPSO SULQ FDUH VH H[WHULRUL]HD] sonda
Fig.IV.3 Sonda Foley
XUHWHUDOVLPSOPRQWDWvQWLPSXOSURFHGXULLvQED]LQHW
- SXQJDFROHFWRDUHDWDDWGHWXEXOGHQHIURVWRPLH
3H WRDW GXUDWD WUDVSRUWXOXL OD VDORQ L LQVWDODUHD vQ SDW
DVLVWHQWD YD YHJKHD V QX VH PRELOL]H]HGHFXSOH]H VRQGHOHSXQJLOH
Fig.IV.4 Sonda Foley cu dublu curent
colectoare. CDLvQFD]XOLQWHUYHQLLORUSUH]HQWDWHDQWHULRU7$SXOVXO
WHPSHUDWXUD GLXUH]D FROHFWDW vQ SXQJD GH QHIURVWRPLH L vQ SXQJD
DWDDW VRQGHL )ROH\ 2ULFH VkQJHUDUH PDVLY H[WHULRUL]DW vQWU-una
VDX FHOH SXQJL FROHFWRDUH WUHEXLH V DWUDJ DWHQLD DVXSra unei
OH]LXQL FDUH LPSXQH VXSUDYHJKHUHD DWHQW VDX UHLQWHUYHQLD XUJHQW
(chiar nefrectomie la nevoie!).
3ULPD ]L SRVWRSHUDWRU LPSXQH HYDOXDUHD SULQ UDGLRJUDILH UHQDO
Fig.IV.5 Cystofix
VLPSO LVDX HFKRJUDILH UHQDO D SRVLELOHORU IUDJPHQWH OLWLD]LFH

restante sau migrate.
'DFVHGHFLGHFXQDOWWLPSGHDERUGQXHVWHQHFHVDUXWLOVH
va proceda la pensarea nefrostomiei SHQWUX GH RUH L XOWHULRU OD
VXSULPDUHDQHIURVWRPLHLLDVRQGHLYH]LFDOHXUHWHUDOH

Fig.IV.6 Cateter ureteral standard

ORPEDU
9RU IL PRQLWRUL]DWH FX DWHQLH DOWXUL GH SDUDPHWULL YLWDOL
Fig.IV.7 Cateter ureteral Chevassu
revenirea
pacientului
de
sub
efectul
anesteziei
L
cantitatea/aspectul lichidului venit GH SH WXEXO GH GUHQ L GLXUH]D monitorizm de acum un pacient cu rinichi unic!. Orice evacuare
DEXQGHQWGHOLFKLGKHPDWLFVXJHVWLYSHQWUXRVQJHUDUHDFWLYGLQ
ORM PDL DOHV vQ FRQWH[WXO VFGHULL 7$ L DFFHOHUULL SXOVXOXL WUHEXLH
LPHGLDW UDSRUWDW RSHUDWRUXO OXkQG GHFL]LD HYHQWXDO D XQHL
UHLQWHUYHQLLVDOYDWRDUH (derapajul unei ligaturi pe vas important!).
Posibilele efecte adverse ale anesteziei generale vor fi
PRQLWRUL]DWHLWUDWDWHUDSLGFRQIRUPLQGLFDLLORUPHGLFXOXLDQVWH]LVW/D
dispoziia acestuia se pot recolta analize pentru o evaluare ct mai
H[DFW D HYHQWXDOHORr
dezechilibre
hidro-ionice.
Ca
L OD
DGHQRPHFWRPLD WUDQVYH]LFDO VH YRU PRQLWRUL]D FX PDUH DWHQLH WRL

SDUDPHWULL 7$ SXOV WHPSHUDWXU GLXUH] YROXPXO L DVSHFWXO
lichidului evacuat prin tubul de dren).
Prima zi postoperator VH PRELOL]HD] tubul de dren L VH
VFKLPESDQVDPHQWXOVXEDFHODLSUHFDXLLGHDVHSVLHLDQWLVHSVLH
Fig.IV.8 GUHQDMLQWHUQDOULQLFKLXOXLFXDMXWRUXOVRQGHLGRXEOH-
(YROXLD VLPSO VH FDUDFWHUL]HD] SULQ VFXUWDUHD SURJUHVLY L

vQGHSUWDUHD WXEXOXL GH GUHQ D -a zi postoperator, vQ FRQGLLLOH vQ
care lichidul sero-KHPDWLFHYDFXDWGLQORPEHste n cantitate din ce n
FHPDLPLF
Tot atunci ziua 5 VHVXSULPLVRQGD)ROH\FHHDFHIDFHFD
PRELOL]DUHD SDFLHQWXOXL V QX PDL ILH vQVRLW GH LQFRQYHQLHQWH
5HOXDUHD DOLPHQWDLHL L D FRQVXPXOXL GH OLFKLGH VH YD IDFH GXS
regulile generale, o DOLPHQWDLH FRPSOHW FX prnzuri mici fiind
Fig.IV.9 sonda Foley pentru nefrostomie
SRVLELO GXS FH SDFLHQWXO L-a reluat tranzitul intestinal pentru

materii fecale si gaze.
!

postoperator, monitorizarea LVFKLPEDUHDSDQVDPHQWXOXLKLSRJDVWULF

FRQVWLWXLH JHVWXULOH VSHFLILFH SULPHL ]LOH SRVWRSHUDWRULL 3HQVDUHD L
ulterior, extragerea tubului pentru lavaj vezical, UPkQ vQ VDUFLQD
urologului a doua / a treia zi postoperator. Scurtarea tubului de dren
Fig.IV.10 Cistoscop explorator
prevezical se face progresiv, ncepnd cu ziua a 2-a postoperator.

'DF GXS VXSULPDUHD DFHVWXL WXE VH FRQVWDW HYDFXUL GH XULQL
KHPDWLFH VDX FKHDJXUL HVWH XWLO V VH LQVWDOH]H SHQWUX R SHULRDG
VFXUWXQODYDMSULQVRQGD)ROH\GHDFHHDHVWHELQH VXWLOL]PGHOD
nceput sonda cu triplu curent!). 'HJRQIODUHDEDORQDXOXLVRQGHL)ROH\
Fig.IV.11- cistoscop operator
VHYDIDFHODLQGLFDLDRSHUDWRUXOXLvQIXQFLHGHVSHFLILFXOLQWHUYHQLHL
LHYROXLa cazului.
De obicei, n ziua 4-5 postoperator, att tubul de dren ct L
splintul vezical sunt suprimate, GDUDVWDSUHVXSXQHXUPULUHD]LOQLFD
SDQVDPHQWXOXL SOJLL RSHUDWRULL VH SRDWH HYDFXD XQ VHURP VDX PDL
JUDY SDQVDPHQWXO VH LQILOWUHD] XULQDU VHPQDOL]kQG ILVWXOD YH]LFR-
Fig IV.12 - Uretrotom
FXWDQDW Ziua a 6-a postoperator impune recoltarea unei

uroculturi pe sonda Foley.
2HYROXLHnormal permite suprimarea firelor de la piele n ziua a
7-DSRVWRSHUDWRULDVRQGHL)ROH\vQ]LXDD-a / a 10-a postoperator;
DVLVWHQWD YD PRQLWRUL]D FX DWHQLH YROXPXO L DVSHFWXO XULQLL
postoperator!
IV.
Fig.IV.13 Rezectoscop
NEFRECTOMIA
DXS LQWHUYHQLD HIHFWXDW VXE DQHVWH]LH JHQHUDO SDFLHQWXO
SUVHWHVDODGHRSHUDLHvQGUHSWkQGX-se spre VHFLDGHUHDQLPDUH,

DYkQGDOWXULGH:
- perfuzia i.v.,
- VRQGD)ROH\VLPSO
- SXQJ FROHFWRDUH FXSODW OD WXEXO GH GUHQ GLQ UHJLXQHD
!
Fig.IV.14 Litotritor mecanic

tratarea unei stricturi uretrale cu ocazia TUR-9 MXVWLILF H[WHrnarea

SDFLHQWXOXL FX VRGD OD GRPLFLOLX SHQWUX R GXUDW GH WLPS YDULDELO OD
IHOFDLLQFD]XO785-P.
3HWRDWGXUDWDSXUWULLVRQGHLODIHOFDGXS785-P, pacientul
YD IL vQYDW V vL LJLHQL]H]H VRQGD YH]LFDO SULQ VSOWXUL FX DS L
WDPSRQ FX VSXn antibacterian, nu cu alcool medicinal! $OWXUL GH
Fig.IV.15 - Nefroscop
DQWLELRWHUDSLH PVXULOH GH DQWLVHSVLH L LJLHQ SHUVRQDO VXQW

HVHQLDOH SHQWUX SUHYHQLUHD XQHL LQIHFLL XULQDUH LQWUDVSLWDOLFHWL GH
PXOWHRULFXJHUPHQLPXOWLGURJUH]LVWHQL
III.
ADENOMECTOMIA TRANSVEZIC$/
Este o intervenLHFKLUXUJLFDOGHVFKLV GHFLLPSOLFvQJULMLULPDL
DPSOH DYkQG vQ YHGHUH FRPSOH[LWDWHD LQWHUYHQLHL 'H OD VDOD de

Fig IV.16 Ureteroscop semirigid
RSHUDLHSDFLHQWXOSOHDFFX:
- R SHUIX]LH LQWUDYHQRDV L GHVLJXU UHFRPDGULOH PHGLFXOXL
DQHVWH]LVWSULYLQGYROXPXOLULWPXOSHUIX]LLORU
- VRQG)ROH\ (FX WULSOXFXUHQWWUDFLRQDWj OD6DOYDULVODYDM
YH]LFDO KLSRJDVWULF SULQ VSOLQW PRQWDW LQWUDRSHUDWRU L SXQJ
FROHFWRDUHDGDSWDWODWXEXOGHGUHQ.
Fig.IV.17 Sonda Dormia
L DLFL VXSUDYHJKHUHD DWHQW vQ SULPHOH GH RUH HVWH

FUXFLDO (att
sub
aspectul
parametrilor
generali:
TA,
puls,
WHPSHUDWXUFkWLVSHFLILFLDVSHFWXOOLFKLGXOXLGHODYDMPRQLWRUL]DUHD
diurezei (UE = VE 9/PRQLWRUL]DUHDHOLPLQULORUSULQWXEXOde dren.
)LLQGFRSHUDLDSUHVXSXQHGHVFKLGHUHDYH]LFLLHQXFOHHUHDGLJLWDOD
WXPRULLSURVWDWLFHEHQLJQHLQVWDODUHDWXEXOXLSHQWUXODYDMLVXWXUDUHD
peretelui vezical n 2 planuri, ULVFXODSDULLHLXQHLGHKLVFHQHODQLYHOXO
LQFL]LHL YH]LFDOH L D XQHL fistule vezico-cutanate, nu trebuie
Fig.IV.18 ureteroscop flexibil

minimalizat.
QGHSUWDUHDWUDFLXQLLjOD6DOYDULV GXSSULPHOH 20 ore

GLPHQVLXQL VDX LQWHUYHQLD SHQWUX FRQILUPDUHD DQDWRPR-SDWRORJLF D
8URORJLD PRGHUQ HVWH GH QHFRQFHSXW IU XQ arsenal
unei tumori infiltrative, poate dura 30-PLQXWH GDU LQWHUYHQLD VH
complex de instrumente, semirigide sau flexibile, care fac posibile
poate QWLQGH SH R GXUDW PDL PDUH GDF WXPRULOH VXQW PDL
o multitudine de gesturi urologice, de la banalul cateterism uretro-
voluminoase.
/D VIkULWXO LQWHUYHQLHL VH LQVWDOHD] R VRQG )ROH\ FX
triplu curent, FX EDORQD PLF -PO L GHVLJXU ODYDM YH]LFDO 9RP
DYHDDFHOHDLSUHRFXSULOHJDWHGHIXQFLRQDUHDVLVWHPOXLGHODYDMFD
LvQFD]XO785-3DWkWvQWLPSXOWUDQVSRUWXOXLVSUHVDORQLLQVWDOULLvQ
pat.
Monitorizarea lavajului vezical GH RELFHL vQ SLFWXU OHQW
VDXPHGLHDUHDFHHDLPRWLYDLHFDLOD785-P i anume prevenirea
FROPDWULLVRQGHLYH]LFDOHFXFKHDJXULvQFD]XODSDULLHLQHDWHSWDWHD
XQHL VkQJHUUL GLQ SHUHWHOH YH]LFDO GH OD ORFXO de UH]HFLH
YH]LFDO SkQD OD XUHWHURVFRSLD UHWURJUDG VDX ODSDURVFRSLH

8URORJXO HVWH FXQRVFXW FD RPXO FX VRQGD $FHVWH LQVWUXPHQWH
devenite banale n ziuDGHDVW]LSULQXWLOL]DUHVXEGLIHULWHYDULDQWH
UHXHVFVDOLQHVXIHULQDFkWGHGXUHURDVHVWHUHWHQLDDFXWGH
XULQ L V VDOYH]H YLDD DQXULD REVWUXFWLY UHWHQLD GH XULQ
LQIHFWDWvQFLOHXULQDUHVXSHULRDUH
Sondele VXQWQLWHWXEXULGLQplastic de diferite dimensiuni
L IRUPH FH UHDOL]HD] FRPXQLFDUHD XQXL VHJPHQW al aparatului
H[FUHWRUFXPHGLXOH[WHUQvQFLUFXLWvQFKLVVRQGXUHWUR-YH]LFDO
QHIURVWRP VDX FX DOW VHJPHQW OHJWXUD VLVWHP SLHORFDOLFHDOYH]LFD XULQDU SULQ VRQG DXWRVWDWLF XUHWHUDO WLS -- &DOLEUXO
,QUHJLVWUDUHD FXUHQW D SDUDPHQWULORU IXQFLRQDOL 7$ SXOV
VRQGHORUVHDSUHFLD]GXSVFDUD&KDULHUUH&KRXQLWDWHILLQG
WHPSHUDWXUGLXUH] folosind aceasta formul de calcul de la TUR-
mm.
3 DOWXUL GH VXSUDYHJKHUHD UHYHQLULL GXS DQHVWH]LH L XUPULUHD
Sondele uretro-vezicale se folosesc pentru evacuarea
ODYDMXOXL YH]LFDO FRQVWLWXLH SUHRFXSULOH FRQVWDQte ale primei zile
XULQLL GLQ YH]LF 6XQW IRUPDWH GLQ WXEXUL FX FDSHWH XQXO
pentru asistenta de salon. ntreruperea lavajului se face cnd ne
DMXQJkQG vQ YH]LF LDU FHOODOW UPkQkQG vQ H[WHULRU L OD FDUH VH
DVLJXUPFKHPRVWD]DHVWHVXEFRQWUROGHLvQUDUHFD]XULSRDWH
DWDHD]RSXQJFROHFWRDUH)RUPDVSHFLDODFDSWXOXLFDUHHVWH
VDSDUGLQVHQLQRVkQJHUDUHOHJDWGHXQYDOGHVkQJHGLQSDWXO
intURGXVvQYH]LFSUHFXPVLMHOO\-anestezicul utilizat permit, n cele
WXPRUDOGLQFDUHDVULWFKHDJXO).
mai multe cazuri, progresia uRDU L IDFLO D VRQGHL vQ YH]LF Q
Vom recomanda mobilizarea precoce FX DFHOHDL SUHFDXLL
prezent se folosesc mai frecvent 3 tipuri de sonde uretro-vezicale:
OHJDWH GH PDQLSXODUHD SXQJLL FROHFWRDUH L UHOXDUHD SURJUHVLY D
- Sonda Nelaton FX YkUI GUHSW L SOLQ DYkQG JXUL ODWHUDOH GH
DOLPHQWDLHLFDLvQFD]XOUH]HFLLORUWXPRULORUSURVWDWLFH
preferat la femei (fig.IV.1);
6XSULPDUHD VRQGHL YH]LFDOH VH IDFH GRDU OD LQGLFDLD

operatorului L HVWH OHJDW vQ SULQFLSDO GH SURIXQ]LPHD UH]HFLHL
HYHQWXDOH LQFLGHQWH FD GH H[HPSOX SHUIRUDLD DFFLGHQWDO D YH]LFLL
GDU vQ FHOH PDL PXOWH FD]XUL VH IDFH GXS -5 zile. ,GHQWLILFDUHD L

- Sonda Tiemann FX YkUI FXGDW L HILODW FH SHUPLWH DQJDMDUHD

prin curbura uretrei bulbare (fig.IV.2);
De]DYDQWDMXO DFHVWRU VRQGH HVWH F HOH QX SRVHG XQ VLVWHP GH
IL[DUHLQWHUQILLQGQHFHVDUIL[DUHDH[WHUQFXOHXFRSODVWLQVWDELO

VDXOLJDWXUDODSUHSXGXUHURDV
HVWHVWHULO
7RWXLGDFUHXLPVLQWURGXFHPFXJUHXWDWHRVRQGGH
$OLPHQWDLDYDUHVSHFWDUHJXOLOHLQWHUYHQLLORUVXEUDKLDQHVWH]LH
DFHVW WLS HVWH GH SUHIHUDW V R PHQLQHP SkQD FDOLEUP XUHWUD
7RWXURORJXOYDGHFLGHGDFHVWHFD]XOVPDLHYDFXH]HGLQEDORQDXO
GHFkWVILPDPELLRL LVvQFHUFPVRvQORFXLP
- Sonda Foley sau sonda cu EDORQD FDUH SH OkQJ FLUFXLWXO
QRUPDOGHHYDFXDUHDXULQLLPDLSUH]LQWXQFLUFXLWIRUPDWGLQWU-un
canal n grosimea peretelui sondei prin care se introduce ser printrRUDPLILFDLHH[WHUQFXVXSDS$VWIHOVHXPIOEDORQDXO aflat la
FDSWXOLQWHUQvQvQYHOLXOSHUHWHOXLILJ,9$FHVWEDORQDIL[HD]
VRQGDLQXSHUPLWHLHLUHDHL'LPHQVLXQLOHORUYDULD]GHOD&KODFRSLLSvQOD&K-ODSDFLHQLLRSHUDLHQGRVFRSLF
2 YDULDQW VSHFLDO GH VRQG )ROH\ HVWH FHD cu dublu
curent, SHQWUXVSODUHDFRQWLQXDYkQGUDPLILFDLLH[WHUQHXQD
GHGUHQDMXULQDUXQDSHQWUXXPIODUHDEDORQDXOXLLXQDSULQFDUH
sondei Foley 5-10-PO OLFKLG vQ IXQFLH GH FRQGLLLOH VSHFLILFH

LQWUDRSHUDWRULL 8Q SURFHQW UHODWLY PLF GH SDFLHQL WROHUHD] PDL JUHX
VRQGD YH]LFDO IDSW PDQLIHVWDW SULQ WHQHVPH YH]LFDOH GXUHUL
hipogastrice.
ExplickQG FX EOkQGHH SDFLHQWXOXL SUREOHPD L
DGPLQLVWUkQG PHGLFDLD 1R-Spa 2fX3/zi, Piafen 1fX3/zi, Arcoxia

PJ]LvOSXWHPDMXWDVGHSHDVFDFHVWLQFRQYHQLHQW
Q IRDUWH UDUH FD]XUL UHDSDULLD XULQLORU GH DVSHFW KHPDWLF
impune reinstalarea, vQ FRQGLLL GH DVHSVLH L DQWLVHSVLH PQXL
VWHULOHEDGLMRQDUHFX%HWDGLQ lavajului vezical pentru cteva ore, o
]LFKLDUODXQIOX[FDUHVvPSLHGLFH colmatarea sondei.
QFRQGLLLOHREQXLWHGHHYROXLHn ziua a 3-DVHVXSULP sonda
VHLQWURGXFHVHUVDXDSVWHULOvQYH]LFSHQWUXVSODUH
6H LQVWDOHD] DWXQFL FLQG GRULP UHDOL]DUHD XQXL ODYDM
Foley, evacund complet OLFKLGXO GLQ EDORQD FX DMXWRUXO XQHL VHULQJL
YH]LFDO GXS UH]HFLLOH GH SURVWDW VDX GH WXPRUL YH]LFDOH FX ULVF
fara ac. 'DF SHUVLVW R VHQ]DLH QHSOFXW GH GXUHUHXVWXULPH VH
de hematurie (fig.IV.4).
SRDWH DGPLQLVWUD R PHGLFDLH DQWLDOJLFDQWLLQIODPDWRDUH 9RP LQYLWD
([LVW VLWXDLL FkQG QX VH SRDWH VDX QX VH UHXHWH
pacientul V FRQVXPH OLFKLGH din abunden L VH YD PRQLWRUL]D
cateterizarea uretro-YH]LFDO - OD EROQDYL FX VWULFWXU XUHWUDO VDX
FDQWLWDWHD GH XULQ HOLPLQDW L RUD 'DF SDFLHQWXO vQ FLXGD
GXSLQWHUYHQLDvQIRUDXQXLFRQIUDWHJHVWFHVHSRDWHVROGDFX
FRQVXPXOXL GH OLFKLGH QX XULQHD] YD IL HYDOXDW HFKRJUDILF LDU
o caOH IDOV 'DFD XUHWUD HVWH LQDERUGDELO HYDFXDUHD XULQLL VH
PHGLFXO GH JDUG YD GHFLGH DVXSUD RSRUWXQLWLL UHLQVWDOULL VRQGHL
UHDOL]HD]SULQWU-un drenaj suprapubian. $FHVWDVHUHDOL]HD]FX
vezicale.
un dispozitiv special (Cystofix) care cuprinde un ac gros (trocar),
3DFLHQLORU FX GLDJQRVWLF GH QHRSODVP GH SURVWDW OD FDUH V-a
FH FRQLQH vQ LQWHULRU XQ REWXUDWRU 6H SXQFLRQHD] VXSUDSXELan,
luat decizia de a se praFWLFD VXE DFHHDL DQHVWH]LH 785-P de
perpendicular pe planul abdomenului, se scoate obturatorul apoi
GHEORFDUHLRUKLHFWRPLHOLVHYDXUPULDVSHFWXOSOJLORURSHUDWRULLL
VHLQWURGXFHSULQWURFDUvQYH]LFXQWXEFXJXULFHVHIL[HD]OD
SLHOH VDX R VRQG )ROH\ VXELUH ILJ,9 FH YD IL FXSODW la o
SXQJFROHFWRDUHvQFLUFXLWvQFKLV
!
pansamentul care va fi schimbat zilnic.
II.
TUR-V
5H]HFLD HQGRVFRSLF a tumorilor vezicale papilare de mici
$
vezica umplndu-se de cheaguri, decaillotarHDHLGHYLQHIRDUWHGLILFLO
Cei mai mulLDXWRULUHFRPDQGevitarea sondelor uretro-
LDUVkQJHUDUHDGLQORMDSURVWDWLFVHDFFHQWXHD] 0HGLFXOGHJDUG
vezicale la WLQHUL L FRSLL, pentru menajarea uretrei (risc de
WUHEXLH DQXQDW LPHGLDW FH DVSHFWXO OLFKLGXOXL GH ODYDM
VWULFWXU SUHIHUkQGX-se drenajul suprapubian. La EWUkQL, la care
VHPQDOHD] R VkQJHUDUH LPSRUWDQW (care poate impune, n rare

cazuri,
UHLQWHUYHQLD
pentru realizarea
hemostazei,
la
vedere,
endoscopic'DFHYROXLDHVWHVLPSOIUFRPSOLFDLLVHGHFLGH
VXSULPDUHD WUDFLXQLL 6DOYDULV ILH vQ FXUVXO VHULL ILH OD PD[LP
GHRUHGHODLQWHUYHQLH
Avnd n vedere lavajul vezical, DVLVWHQWD YD DYHD JULM V
noteze prHFLVvQIRDLDGHREVHUYDLHcantitatea de lichide perfuzate,
YROXPXO GH OLFKLG IRORVLW SHQWUX ODYDM 9/ L FDQWLWDWHD GH OLFKLG
HOLPLQDW vQ SXQJD FROHFWRDUH 9( 8ULQD HOLPLQDW 8( YD IL
FDOFXODW SULQ IRUPXOD UE = VE-VL L YD IL WUHFXW vQ IRDLD GH
REVHUYDLH
RULFXP XUPHD] R LQWHUYHQLH HQGRVFRSLF VH SRW IROosi sondele

uretro-vezicale. De asemenea, tot pentru menajarea uretrei, se
SUHIHU GUHQDMXO VXSUDSXELDQ vQ FD] GH UHWHQLL DFXWH GH XULQ GH
cauze non-urologice. n cazul UHWHQLHL FURQLFH FRPSOHWH GH XULQ,
FRPSOLFDLH ILUHDVF D REVWUXFLHL VXEYH]LFDOH VH LQVWDOHD] OD
nceput, de SUHIHUDWRVRQGXUHWUR-YH]LFDO
Sonde sau catetere ureterale VXQWVXELULOXQJLLIOH[LELOH
cel mai frecvent de calibru 5-&KFXPDQGUHQPHWDOLFGHvQWULUH
Ele pot fi folosite n:
- scop terapeutic cateterism ureteral n anurie
REVWUXFWLYGHH[HPSOXILJ,9
- scop diagnostic FX ROLY WURQFRQLF SHUIRUDW OD FDS
$OWXUL GH DVSHFWXO XULQLL YRU IL PRQLWRUL]DWH 7$ SXOV
Chevassu (fig.IV.7) pentru uretero-SLHORJUDILHUHWURJUDG.
WHPSHUDWXUSUHFXPLUHFXSHUDUHDGXSUDKLDQHVWH]LH&RQVXPXOGH
2GDW UHDOL]DW LQWURGXFHUHD VRQGHL vQ VLVWHPXO SLHOR-
OLFKLG IU ]DKU FHDL DS SODW YD IL vQFXUDMDW vQ PVXUD vQ FDUH
caliceal prLQGHSDLUHDREVWDFROXOXLGHFHOHPDLPXOWHRULOLWLD]LF
SDFLHQWXOvLUHLDWROHUDQDGLJHVWLY
SURILWPGHILUXOJKLGFDUHDSHUPLVDVFHQVLXQHDSHQWUXDLQWURGXFH
'XS VXSULPDUHD WUDFLXQLL VRQGHL vQ FRO supravegherea
R VRQG XUHWHUDO VSHFLDO FXQRVFXW FD VRQGD 'RXEOH - sau
DVSHFWXOXL OLFKLGXOXL GH ODYDM YD FRQWLQXD FX DFHHDVL DWHQLH pentru
3LJ-tailvQIXQFLHGHIRUPDH[WUHPLWLORU2GDWDLQWURGXVVRQda,
XUPWRDUHOH GH RUH FkQG PHGLFXO RSHUDWRU YD VWDELOL GDF ODYDMXO
ILUXOJKLGHVWHUHWUDVLDWXQFLVHIRUPHD]RSULPDEXFOvQED]LQHW
YH]LFDOSRDWHILvQWUHUXSWvQFRQGLLLOHvQFDUHIOX[XOXULQDUVLQJXU din ce
5HWUDJHUHD FRPSOHW D ILUXOXL YD IDFLOLWD vQFXUEDUHD VRQGHL L vQ
vQ FH PDL DEXQGHQW vQ FRQGLLLOH KLGUDWULL SHU RV SRDWH DVLJXUD
YH]LFUHDOL]kQGX-VHDVWIHODGRXDEXFOFHHDFHH[SOLFDQXPHOH).
eliminarea micilor cheaguri.
De oELFHL HOH VH PHQLQ FkWHYD VSWPkQL GDr uneori se pot
Din ziua 1 postoperator SDFLHQWXO YD IL vQFXUDMDW V VH

PRELOL]H]HPDLvQWkLODPDUJLQHDSDWXOXLLDSRLSULQVDORQ GDF
VWDUHD JHQHUDO R SHUPLWH FX VSHFLILFDUHD SUHFLV Ge a nu ridica
SXQJD FROHFWRDUH OD QLYHOXO YH]LFLL XULQDUH XULQD GLQ SXQJ QX

PHQLQH L OXQL de zile, iar anumite sonde zise ORQJ OLIH pot fi
PHQLQXWH FKLDU SkQD OD DQ FRPSR]LLD ORU vPSLHGLFkQG LQ
majoritatea cazurilor, vQ FRQGLLLOH XQXL IOX[ XULQDU QRUPDO
GHSXQHUHD VUXULORU FDUH IDF FD VRQGHOH -- RELQXLWH V QX ILH
!
PHQLQXWH PDL PXOW GH OXQL GH ]LOH Q PRG FXUHQW HOH VH
-LQVWDODUHD EROQDYXOXL vQ SDW VH IDFH vQ IXQFLH GH IHOXO
LQVWDOHD]VXEFRQWUROUDGLRORJLFSHQWUXRFRUHFWSR]LLRQDUH dar
anesteziei GHFXELWGRUVDOFXRSHUQVXELUHVXEFDSFXFDSXOvQWRUV
vQ VDUFLQ VXQWHP REOLJDL V IDFHP LQVWDODUHD VRQGHL GRDU VXE
ntr-o parte n cazul rahianesteziei; GHFXELW VHPLH]kQG FX GRX
control ecografic. Desigur, operatorul trebuie sOXFUH]HFXILQHHOD
perne sub cap sau cu ridicarea somierei patului la extremitatea
LQWURGXFHUHDJKLGXOXLLDSoi a sondei JJ iar confirmarea HFRJUDILF

OD VIkULWXO LQWHUYHQLHi este obligatorie.Cnd nu se poate monta o
VRQGXUHWHUDOLVLWXDLDLPSXQHXQGUHQDMDOFDYLWLORUUHQDOHVH
HIHFWXHD] VLPLODU FD OD YH]LFD XULQDU XQ GUHQDM H[WHUQ DO
ULQLFKLXOXLDGLFRQHIURVWRPLHSHUFXWDQ.
Vom utiliza o WUXVGHQHIURVWRPLH FDUHFRQLQHXQDFFX
PDQGUHQ FX FDUH VH SXQFLRQHD] VLVWHPXO SLHOR-caliceal sub
ghidaj
ecografic
si
sonda
propriu-]LV 'XSD VFRDWHUHD
maQGUHQXOXL L H[WHULRUL]DUHD XULQLL vQ VWD] VH LQMHFWHD]
FHIDOLF n cazul anesteziei generale);

-VRQGD XULQDU GUHQXULOH VH DGDSWHD] OD SXQJL VWHULOH L VH
DHD] OD XQ QLYHO LQIHULRU IU FXGXUL, cu posibilitatea de
supraveghere peUPDQHQW pentru a descoperi la timp ntreruperea
VFXUJHULLGHOLFKLGFDUHSRDWHILFDX]DWGHREVWUXDUHDGHSODVDUHDVDX
cudarea sondei sau drenurilor.
-pentru combaterea eventualelor frisoane bolnavul este nvelit
FXGRXSWXULVHDGDXJWHUPRIRDUHHYHQWXDOVHDGDXJDPHGLFDLD
VXEVWDQ GH FRQWUDVW DPHVWHFDW FX XQ FRORUDQW LQRIHVLY
SUHVFULV GH PHGLF Ca gluconic, Mialgin, antibiotice conform
vizualizndu-se astfel sistemul pielo-caliceal, se introduce un ghid
DQWLELRJUDPHL vQ FD]XO vQ FDUH IULVRQXO QX FHGHD] VH YRU UHFROWD
meWDOLF SULQ DF SkQ vQ ED]LQHW GXS FDUH VH H[WUDJH DFXO 3H
KHPRFXOWXULXURFXOWXUSHQWUXHYLGHQLHUHDFDX]HL
ghidul PHWDOLFVH LQWURGXFHXQWXE GH QHIURVWRPLHFDUHVHIL[HD]

la piele sau o sond )ROH\ &K - FX EDORQD PLF - 3 ml
I.
,1*5,-,5($63(&,),&3(17583$&,(1,,&8TUR-P
5H]HFLD HQGRVFRSLF D WXPRULORU SURVWDWLFH EHQLJQH VDX
PDOLJQHGXUHD]DSUR[LPDWLYRU /DVIkULWXOSURFHGXULLSDFLHQWXO
(fig.IV.9).
&kQG QX H[LVW DOWHUQDWLYD UDGLRORJLF VH FRQWLQX
SUVHWH EORFXO RSHUDWRU DYkQG PRQWDW R SHUIX]LH LY R VRQG FX
SURFHGXUD QXPDL VXE FRQWURO HFKRJUDILF GDU WUHEXLH V DFLRQP
WULSOX FXUHQW L XQ ODYDM YH]LFDO vQ PXOWH FD]XUL VRQGD SXWkQG IL
UDSLG V QX VH SLDUG GLODWDLD SLHOR-FDOLFHDO FH SHUPLWH
WUDFLRQDW L IL[DW GH FRDSV FX EHQ]L GH OHXFRSODVW j OD 6DOYDULV
FRQWLQXDUHD PDQHYUHORU 1HIURVWRPD HVWH WHPSRUDU vQ DIHFLXQLOH

REVWUXFWLYH
DFXWH
GDU
GHILQLWLY
vQ
DFHOHDL
QHRSOD]LL
JHQLWDOHQHRSODVPH FH LQYDGHD] WULJRQXO YH]LFDO VDX XUHWHUHOH

XUPkQG D IL VFKLPEDW periodic, sub ghidaj radiologic, n sala de
RSHUDLH
INSTRUMENTARUL ENDOSCOPIC
3ULPLLHQGRVFRSLWLDXIRVWXURORJLLSHQWUXFHLDXIRVWFHL
!
pentru a asiguUD R FRPSUHVLH KHPRVWDWLFD D FROXOXL $VLVWHQWD YD

VXSUDYHJKHDSHGXUDWDWUDQVSRUWXOXLGHODVDOODVDORQVRQGDODYDMXO
L FXSODUHD SXQJLL FROHFWRDUH LDU OD LQVWDODUHD SDFLHQWXOXL vQ SDW YD
XUPULFDPRQWDMXOUHDOL]DWvQVDOVQXVXIHUHGHFXSOULWractionari.
0RQLWRUL]DUHD VWULFW D SDFLHQWXOXL 7$ SXOV L D ODYDMXOXL
vezical n primele 4- RUH SRVWRSHUDWRU HVWH HVHQLDO vQ SUHYHQLUHD
IRUPULLFKHDJXULORU FDUHSRWREVWUXDVRQGDYH]LFDOGHRDUHFHRGDW

3HULRDGDSRVWRSHUDWRULHHVWHGLYL]DWvQLPHGLDWLWDUGLY
n postoperatorul imediat, pacientul va fi transportat fie n
salonul de supraveghere postoperatorie, fie n salonul de terapie
LQWHQVLY vQ IXQFLH GH VWDUHD FOLQLF L GH WLSXO LQWHUYHQLHL GH
FRPSOLFDLLOH LQWHUYHQLWH vQ WLPSXO DFWXOXL FKLUXUJLFDO GH EROLOH FURQLFH
asociate. Aici pacientul va fi monitorizat continuu i va beneficia de
vQJULMLULVSHFLDOHFHOSXLQSHQWUXGHRUHVDXPDLPXOWGXSFD]
ngrijirile acordate pacientului pe timpul transportului de la
VDOLLQVWDODUHDDFHVWXLDODSDW
-OD DQXQDUHD YHQLULL EROQDYXOXL vQ VHFLH PHGLFXO KRWUWH
VDORQXOLSDWXOvQFDUHXUPHD]DILDGXVvQIXQFLHGHGLDJQRVWLFGH
VWDUHD GH JUDYLWDWH VH[ L GDF HVWH QHFHVDU SUHJWLUHD GH
PDWHULDOHVDXDSDUDWXUvQPRGVSHFLDO
dinti care au privit in interiorul vezicii urinare cu ajutorul unui

cistoscop.
CISTOSCOPUL
EXPLORATOR
are
urmatoarele
componente:
- teaca de lucru, OD FDUH VH DWDHD] VXUVD GH DSD VWHULOVHU
fiziologic.
- telescopul un sistem de prisme pentru transmiterea imaginii, la
FDUH VH DWDHD] FDEOXO GH OXPLQ GH OD R VXUV H[WHUQ 1X SRL
YL]XDOL]D FRQLQXWXO YH]LFDO GDF QX DL OXPLQ L lichid.
7HOHVFRDSHOHSHUPLWRYHGHUHGHODODvQIXQFLHGHVLWXDLD
SDFLHQWXOXL QHOHJHP DFXP GH FH OD SDFLHQLL FX FLVWLW DFXW
XQGH GLVWHQVLD YH]LFDO HVWH SUDFWLF LPSRVLELO FLVWRVFRSLD HVWH
contraindicata!
CISTOSCOPUL OPERATOR ILJ,9 PDL FRQLQH R
-SUHJWLUHD PDWHULDlelor necesare, camerei, patului, se
UDPLILFDLHH[WHUQQXPLW car de cateterism format din 1
YHULILFVWDUHDGHIXQFLRQDUHDEDUERWRUXOXLGH2 2 umidificat, n care
sau 2 canale de lucru prin care se pot introduce sonde
VH SUHJWHVF DHURVROL SHQWUX SUHOXDUHD EROQDYXOXL GLQ VDOD GH
ureterale sau pense (ce pot fi folosite pentru biopsie,
RSHUDLH
extragerea sondelor JJ, etc.)
-DYkQGvQYHGHUHFvQJULMLULOHSRVWRSHUDWRULLVHDFRUGvQIXQFLH
URETROTOMUL este format din:
de aneVWH]LH GHQDWXUD LQWHUYHQLHLGHFRPSOLFDLLOHFDUHDXVXUYHQLW
- teaca de lucru (18-20 Ch) cu canal de lucru de 5 Ch pentru
vQ WLPSXO RSHUDLHL VDX DU SXWHD V DSDU GXS L VWDUHD JHQHUDO D
introducerea unui ghid;
bolnavului, la preluarea pacientului, DVLVWHQWD VH LQWHUHVHD] GH

WRDWHDFHVWHGDWHSHQWUXDSXWHDDFLRQDvQFRQFRUGDQ cu starea
EROQDYXOXL SHQWUX UHVWDELOLUHD IXQFLLORU RUJDQLVPXOXL prevenirea
FRPSOLFDLLORU L HIHFWXDUHD PDQHYUHORU FRUHVSXQ]WRDUH SHQWUX R
YLQGHFDUHFRUHFWLFRPSOHWvQWLPSRSWLP
-vQ WLPSXO WUDQVSRUWXOXL VH VXSUDYHJKHD] SXOVXO UHVSLUDLD
aparLLDFLDQR]HLVWDUHDGHFRQWLHQSHUIX]LDGUHQXULOH

- telescopul FXRSWLFGH
- elementul de lucru SDUWHDPHFDQLFFRPSXVGLQWU-un mner ce
WUDQVPLWHRPLFDUHvQDLQWH-vQDSRLXQHLODPHDIODWHODFDSWXOLQWHUQ
DO GLVSR]LWLYXOXL ILJ,9 6H IRORVHWH SHQWUX uretrotomia
LQWHUQ RSWLF D XQHL VWULFWXUL GH XUHWU GXSD FH DQWHULRU SULQ
zona stricturDW D IRVW WUHFXW XQ ILU JKLG ,QFL]LD ]RQHL VWULFWXUDWH
HVWH XQLF RUD VDX PXOWLSO RUD /D VIkULWXO
LQWHUYHQLHLVHLQVWDOHD]RVRQGXUHWUR-YH]LFDO)ROH\VDX
!$
&KFHVHPHQLQH-]LOHFDVGLODWH]RQDVWULFWXUDW
REZECTOSCOPUL DUHvQFRPSRQHQ
- teaca de lucru (24-&KODFDUHVHDWDHD]WXEXOGHLQWUDUHL

LHLUHDOLFKLGXOXLGXEOXFXUHQW
V-LJROHDVFYH]LFD
-se vor face XOWLPHOH YHULILFUL DOH VWULL GH FXUHQLH D
pacientului insistndu-VH SH UHJLXQHD RPELOLFDO L a organelor
genitale externe;
- telescopul GH RELFHL GH OD FDUH VH DWDHD] FDEOXO GH
OXPLQ
- elementul de lucru, FH WUDQVPLWH PLFDUHD vQDLQte-napoi unei
DQVHGHUH]HFLHFDUHODFDSWXOLQWHUQDUHREXFO6HXWLOL]HD]
SH SULQFLSLXO XQ FXUHQW HOHFWULF GH OD R VXUV H[WHUQ FH VH
DWDHD] la sistemul de lucru, trecnd prin bucla ansei va
GHWHUPLQD WLHUHD VDX FRDJXODUHD HVXWXOXL vQ IXQFLH GH
intensitatea curentului folosit (fig.IV.13). Operatorul realizea]
DFHVWH GH]LGHUDWH DFLRQkQG vQ WLPSXO LQWHUYHQLHL SHGDOD GH
VHFLXQHVDXGHFRDOJXODUHLQIXQFLHGHHWDS
Nu trebuie fFXW FRQIX]LD vQWUH FXUHQWXO HOHFWULF IRORVLW L
laser! (vezi capitolul dedicat acestui subiect).
$FHDVWD SURFHGXU VH QXPHWH vQ OLPED HQJOH]
7UDQVXUHWKUDO 5HVHFWLRQ RI WKH 3URVWDWH GH XQGH SUHVFXUWDUHD
IUHFYHQWXWLOL]DWvQFOLQLFGH785-P.
-vQIXQFLHGHVWDUHDVDJHQHUDOSDFLHQWXOYDILWUDQVSRUWDWOD
VDODGHRSHUDLHFXWDUJDVDXFXXQFUXFLRULYDILvQVRLWGHDVLVWHQWD
GH VDORQ FDUH vO YD SUHGD vPSUHXQ FX GRFXPHQWHOH PHGLFDOH IRDLD
GHREVHUYDLHUDGLRJUafii, CT), echipei operatorii;
-n blocul operator pacientul va fi preluat de asistentele de
DQHVWH]LHLGHODVDODGHRSHUDLHFDUHYRUIDFHSUHJWLULOHvQYHGHUHD
LQWHUYHQLHL PRQWDUHD SHUIX]LLORU YHQRDVH SUHJWLUHD FkPSXOXL
RSHUDWRUSUHJWLUHDSHQWUXDQHVWH]LHHWF
3UHJWLUHDvQYHGHUHD(6:/
- VH YD IDFH GLQ ]LXD SUHFHGHQW vQ SULPXO UkQG FX XQ UHJLP
DOLPHQWDUFDUHVH[FOXGDFHOHDOLPHQWHFDUH, fermentndSURYRDF
balonare GXOFLXULOH L IUXFWHOH GH RULFH IHO EXWXUL GXOFL VDX
FDUERJD]RDVHSkLQHDIDVROHDFDUWRILLYDU]DvQJKHDWDHWF
-FRQVXPXO GH DS SODW HVWH SHUPLV SDFLHQLORU FDUH QX
,GHDO DU IL V SXWHP OXFUD FX VROXLL L]RWRQH FDUH GDF
SUH]LQW GXUHUL FROLFDWLYH (VWH IRDUWHELQH GDF vQDLQWH GH SURFHGXU
ajung vQ VkQJH vQ WLPSXO LQWHUYHQLHL QX LQGXF GH]HFKLOLEUH KLGUR-
SDFLHQWXO DUH VWRPDFXO JRO vQWUXFkW GH OD PHGLFDLD DQHVWH]LF L
electrolitice. Dar, din motive economice, nu ne permitem folosirea
DQWDOJLF VDX GH OD SURFHGXUD vQ VLQH SRW DSDUH JUHXUL 2 FOLVP
ORUDSHOkQGODEDQDODDSVWHULO8WLOL]DUHDDSHLVWHULOHIDFHFDvQ
HYDFXDWRULHHIHFWXDWVHDUDODRUDHVWHGHDVHPHQHDUHFRPDQGDW
DQXPLWH VLWXDLL V H[LVWH ULVFXO DSDULLHL DD QXPLWXOXL sindrom
mai ales la cei care prezinta constipatie habitual. Este interzis fumatul
TUR GDWRUDW SWUXQGHULL DSHL vQ VLVWHPXO FLUFXODWRU vQ H[FHV FHHD
nainte de procedur!
FHGXFHODKHPROL]LLQVXILFLHQUHQDODFXW
5H]HFLD WUDQVXUHWUDO VH IRORVHWH DVW]L SH VFDUD ODUJ
SHQWUXDWUDWDWXPRULOHYH]LFDOHKLSHUSOD]LDEHQLJQGHSURVWDWGH
voluPPHGLXVDXGHEORFDUHDGHFROYH]LFDODSDUXWODSDFLHQLLFX
!
1*5,-,5,/(%2/1$9,/25'83,17(59(1,,
CHIRURGICALE PE APARATUL URINAR
QJULMLULOH SRVWRSHUDWRULL vQFHS LPHGLDW GXS LQWHUYHQLD
FKLUXUJLFDO L GXUHD] SkQ OD YLQGHFDUHD FRPSOHW D EROQDYXOXL

VXSUDID FkW PDL ODUJ vQ IXQFLH GH UHJLXQH VH YD IRORVL ORFDO R
FDQFHUGHSURVWDW
VROXLHDQWLVHSWLF%HWDGLQ
3HQWUX SDFLHQLL FDUH QX VH SRW GHSODVD WRDWH DFHVWH
SUHJWLUL VH YRU HIHFWXD OD SDW DWkW FOLVPD HYDFXDWRULH FkW L
toaleta pe regiuni).
Q VLWXDLLOH GH XUJHQ SUHJWLULOH SHQWUX RSHUDLH VH YRU
efectua ntr-XQ WLPS VFXUW GDU DYkQG JULM V VH UHVSHFWH WRDWH
HWDSHOH FX H[FHSLD FOLVPHL HYDFXDWRULL FDUH VH YD IDFH GRDU OD
recomandarea medicului.
3UHJWLULOHGLQGLPLQHDDLQWHUYHQLHL
-pacientul nu mai aUHYRLHVFRQVXPHOLFKLGH VIXPH]H
-vLYDHIHFWXDWRDOHWDRELQXLWGHGLPLQHD;
LITOTRITORUL MECANIC DUHvQFRPSRQHQ:
- teaca de lucru JURDV &K FX WXE GH LQWUDUH L LHLUH D

lichidului;
- telescopul, de obicei de 0, cuplat la FDEOXOGHOXPLQ
- elementul de lucru FH WUDQVPLWH PLFDUHD GH VWUkQJHUH GLQ
H[WHULRU FX DMXWRUXO XQXL PkQHU D XQRU JKHDUH FD XQ FOHWH OD
FDSWXO LQWHUQ FDUH DWXQFL FkQG PULPHD FDOFXOXOXL R SHUPLWH vO
FXSULQGHVWUkQJHLVSDUJHILJ,9
Desigur, calculii de inIHFLH FH DX UHSXWDLD GH D IL IULDELOL
GDULDFHLPDLGXULGDUSXLQPDLYROXPLQRLSRWILWULWXUDLDVWIHOQ
FD]XOFDOFXOLORUYH]LFDOLYROXPLQRLFDUHQXSRWILSULQLvQFOHWH
SXWHPIRORVLLQLLDO/,7+2&/$67-XOSHQWUXRIUDJPHQWDUHSULPDU
-L VH YRU PVXUD L QRWD FD GH RELFHL principalii parametri
L DSRL OLWRWULWRUXO PHFDQLF SHQWUX VIDUkPDUHD vQ EXFDL FH SRW IL
7$SXOVUHVSLUDLHGLXUH]LYRUILREVHUYDWHHYHQWXDOHOHPRGLILFUL
HYDFXDWH SH WHDFD LQVWUXPHQWXOXL ([LVW ULVFXO FD vQ WLPSXO
DSUXWHvQFXUVXOQRSLLIHEU WXVHYUVWXULGLDUHHHWF
HIHFWXULL PDQHYUHORU GHVFULsH V VH SURGXF L OH]LXQL DOH
-SDFLHQWXOvL YDvQGHSUWD FHDVXO ELMXWHULLOHSURWH]D GHQWDU
PXFRDVHL YH]LFDOH vQVRLWH GH VkQJHUUL FDUH vQJUHXQHD]
OHQWLOHOH GH FRQWDW DJUDIHOH L OH YD SUHGD IDPLOLHL VDX DVLVWHQWHL GH
LQWHUYHQLD 'DF QH YRP OLPLWD GRDU OD OLWRWULLD HQGRVFRSLF D
salon;
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-SDFLHQWXO vL YD VFKLPED OHQMHULD GH FRUS vPEUFkQG o

FPDGHVSLWDOFXUDWODUJ
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H[HPSOX KLSHUSOD]LD EHQLJQ GH SURVWDW WUHEXLH V QH DWHSWP

ODUHFLGLYDOLWLD]LFvQWUXFkWVWD]DYH]LFDOFDIDFWRUHWLRORJLFSULPDU
DOOLWLD]HLSHUVLVW
FRQWH[WXOUHWHQLHLGHXULQH[DGHQRPGHSURVWDWOLVHYDsuprima
Instrumentele descrise pna acum sunt utilizate n
VRQGD L VH YD SURFHGD OD HIHFWXDUHD XQHL WRDOHWH ULJXURDVH D
LQWHUYHQLLOH HQGRXURORJLFH DOH DSDUDWXOXL XULQDU LQIHULRU 8OWLPHOH
RUJDQHORUJHQLWDOHH[WHUQHFXDSLVSXQantibacterian;
decenii aOH VHFROXOXL WUHFXW DX DGXV LQYHQLL UHYROXLRQDUH FDUH
-PHGLFDLD SUHRSHUDWRULH UHFRPDQGDW GH PHGLFXO DQHVWH]LVW

YDILDGPLQLVWUDWvQWLPSXWLOH[VHGDWLYHDQWLKLSHUWHQVLYHDQWLELRWLFH
pentru a se instala efectul SkQODPRPHQWXOLQWHUYHQLHL
-vQDLQWHGHDILWUDQVSRUWDWODVDODGHRSHUDLHSDFLHQWXOWUHEXLH
SHUPLW HIHFWXDUHD SURFHGXULORU HQGRXURORJLFH L DVXSUD DSDUDWXOXL

urinar superior.
Iata principalele instrumente folosite:
NEFROSCOPUL, (fig.IV.15): instrumentul care permite
!
LQWHUYHQLDUHQDOSHUFXWDQDWHVWHFRPSXVGLQ
La finalul consultului preanestezic, medicul anestezist poate ncadra
- teaca nefroscopului, OD FDUH VH DGDSWHD] WXEXO GH LQWUDUH L
pacientul, n perspectiva interveniei chirurgicale, ntr-R JUXS GH ULVF
LHLUHDIOXLGXOXLGHOXFUX
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medicaie care poate modifica coagularea (PLAVIX, TROMBEX,
Tipuri de lasere folosite in urologie :

1.
Holmium (Ho): Yag (Ytrium aluminium garnet) laser;
2.
.73 SRWDVLX WLWDQ\O IRVIDW .7$ 1G <DJ L /%2
(lithium borat, LBO:Nd:Yag) laser;

3.
Thulium (Tm): Yag laser;
4.
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HQGRXURORJLF$FHVWHDVXQW
1.
n endourologia aparatului urinar inferior:

x
Se verific faptul c pacientul care era pe tratament cronic cu
(QXFOHHUHD VDX YDSRUL]DUHD WUDQVXUHWUDO D
ASPENTER, ASPIRINA CARDIO, etc) i-a ntrerupt-o cu cel putin 710 zile nainte de puncie!!!
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PHGLFXO YD HIHFWXD SXQFLD SURSULX-]LV VXE UHSHUDM ecografic cu un
transductor special, sau prin ghidaj digital, palpatoriu. Se vor recolta
cte 5-6-12 fragmente din fiecare lob prostatic, care vor fi puse n
UHFLSLHQWHFXIRUPROLvQVRLWHGHEXOHWLQXODQDWRPR-patologic care va
cuprinde datele pacientului vor fi transportate la laborator.
'XS HIHFWXDUHD ELRSVLHL VH YD DSOLFD XQ pansament local,
DGHQRPXOXLGHSURVWDW
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etc.
vezicale;
x
6HFLXQHDHQGRVFRSLFDVWULFWXULORUuretrale;
Incizia colului vezical;
!

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2. n endoscopia aparatului superior:
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6HFLXQHD HQGRVFRSLF D MRQFLXQLL SLHORXUHWHUDOH
stenozate (endopielotomie);
IUSUXULWUDVKFXWDQDW
Tratament: vQ IXQFLH GH VHYHULWDWH DQWLKLVWDPLQLFH 7DYHJ\O
i.vIPO PJVDXGHULYDLFRUWL]RQLFL6ROX-Decortin 100-250mg sau
/LWRWULLD HQGRVFRSLF D FDOFXOLORU XUHWUDOL vQ FXUVXO
XUHWHURVFRSLHL L D calculilor pielocaliceali n cursul nefrolitotomiei

percutanate sau a ureteroscopiei retrograde flexibile.
Hemisuccinat de hidrocortizon 100mg).
Cele mai multe studii au avut drept obiectiv chirurgia
5HDFLLJHQHUDOHVHYHUH
- Simptome generale: URHDDIHHL LWUXQFKLXOXL VHQ]DLHGH
DQ[LHWDWH DJLWDLH XUWLFDULH JHQHUDOL]DW FX SUXULW GXUeri de spate,
YUVWXUL SDOLGLWDWH WUDQVSLUDLL UHFL SLHUGHUHD FXQRWLQHL stare
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mg
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sau
Valon
solubil,
100-300mg;
oxigenoterapie
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FHUW DO DFHVWXLD vQ SULYLQD UH]XOWDWHORU SRVWRSHUDWRULL GH

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cale de abord venos. Vscozitatea produsului de contrast este
laseri:
GLPLQXDWSULQvQFO]LUHDVDODWHPSHUDWXUDFRUSXOXL.
1.
Neodium YAG laser emite
nDLQWH GH LQMHFWDUH SDFLHQWXO HVWH SUHYHQLW DVXSUD VHQ]DLei de gust
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timpul urografiei.
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5HFRPDQGULOHJDWH GHXWLOL]DUHDVXEVWDQHORUGHcontrast:
VkQJHUHD] HOH HOLPLQkQGX-se ulterior

vQ
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3ULQ
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;<
loc
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2.
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Laserul KTP (potasiu titanyl fosfat) emite pe o lungime
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momente nainte de utilizare, examinndu-VHFXDWHQLHVROXLDVQX
verde) provocnd un nivel mediu de
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nivelul
de
penetrare
al
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laserului
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IRORVLW OD VHFLXQHD Hsutului prostatic
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UH]HFLDODVHU
3.
Laserul
Holmium:
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YAG
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2000mm, pulsat, spre deosebire de
5HDFLLDOHUJLFHPRGHUDWH
primele 2 lasere care sunt emise

continuu.
Efectul hemostatic este mai redus, ca al
=)&+
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gdilituri n gt.
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$
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RMN.
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Dispozitivele
- examene endoscopice: cistoscopie;
moderne
de
- H[SORUDUHUDGLRL]RWRSLF
generare a laserului cu un volum
- SXQFLHELRSVLHUHQDO
relativ redus, sunt deplasabile n sala
- SXQFLHELRSVLHSURVWDWLF
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1.PrHJWLUHDSDFLHQWXOXLSHQWUXXURJUDILH
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speciale QXPLWHVXEVWDQHGHFRQWUDVW care ajungnd n rinichi se
HOLPLQRSDFiILLQGDVWIHOSHUDGLRJUDILLOHHIHFWXDWHVHFYHQLDOVLVWHPXO
pielo-caliceal, XUHWHUXO L PDL WkU]LX YH]LFD Q YHGHUHD XQHL EXQH
SUHJWLUL SHQWUX XURJUDILH D SDFLHQWXOXL DVLVWHQWD YD DYHD JULM FD
acesta VUHVSHFWHXUPWRDUHOHUHJXOL:
- restrngerea consumului de lichide cu 12 ore nainte de
explorare;
GH RSHUDLH GDU vQ WLPSXO IRORVLULL ORU

QHFHVLW SXUWDUHD GH RFKHODUL GH
SURWHFLH contra fasciculului luminos.
La
dispozitivul
de
producere
se
DGDSWHD] ILEUH FH WUDQVPLW OXPLQD

laser, care se introduc pe canalele de
lucru ale endoscoapelor, ajungnd n
='*><
FRQWDFWFXHVXWXO
4.
/DVHUXO WLS GLRG &HO PDL
cunoscut este laserul Indigo, utilizat mai ales n Statele Unite

SHQWUX YDSRUL]DUHD VDX FRJXODUHD LQWHUVWLLDO D DGHQRPXOXL GH
SURVWDW
- FRQVXPXO GH DOLPHQWH IU UH]LGXXUL FDUH QX SURYRDF

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- evitarea FRQVXPXOXL GH OLFKLGH GXOFL VPkQWkQ vQJKHDW
3HQWUX OLWRWULLD FDOFXOLORU XULQDUL FHO PDL ODUJ XWLOL]DW HVWH

laserul Holmium:Yag. Se folosesc fibre cu diametru redus. De
DVHPHQHD XQGD GH RF FUHDW OD VSDUJHUHD FDOFXOXOXL HVWH PDL
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compoturi, fructe, dulciuri),
ureter n sistemul pielocaliceal. Din cauza acestor avantaje laserul
- evitarea fumatului ;
Efectuarea urografiei se va face sub stricta supraveghere a medicului
SDUH VXSHULRU FHORUODOWH WLSXUL GH OLWRWULLH - UDWD GH VWRQH IUHH IU
radiolog pentru a fi siJXUL GH FDOLWDWHD LQYHVWLJDLHL! ATENIE la
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QHIURSDWLL JUDYH KLSHUWLURLGLH 7%& SXOPRQDU HYROXWLY DQHPLH

KHPROLWLF VWUL IHEULOH Kipersensibilitate la iod, cardiopatii grave,
pacienii diabetici aflai sub tratament cu metformin.
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materialelor
moderne,
siliconate,
instrumentelor
flexibile,
perfectarea sistemelor optice, VXUVHORU GH OXPLQL de redare a

imaginii.
I.
CATETERISMUL URETRO-VEZICAL
performan Karnofsky pe care l redm n tabelul de mai jos.

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care trebuie efectuate respectnd normele de asepsie

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abdominal, ECG,
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intervine:
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venoase, oxigenoterapie, introducerea unei sonde vezicale, etc),
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Avnd ca UHSHU WHPSRUDO HVHQLDO PRPHQWXO LQWHUYHQHL

vQvQJULMLULSUHRSHUDWRULLLvQJULMLULSRVWRSHUDWRULL
3UHJWLUHD SUHRSHUDWRULH FRQVW ntr-o serie de ngrijiri
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SDUDFOLQLF vQJULMLUL LJLHQLFH XUPULUHD IXQFLLORU YLWDOH L YHJHWDWLYH
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foarte mare!
Etapele cateterismului uretro-vezical:

&XQRVFXW L VXE GHQXPLUHa de sondaj vezical DFHDVW
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VSHFLDOvQIXQFLHGHWLSXOLQWHUYHQLHL
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ngrijiri generale:
PQXL VWHULOH L GXS GH]LQIHFLD PHDWXOXL XULQDU L D UHJLXQLL
Examen clinic general FRQVW n evaluarea pacientului
SHULQHDOH YD LQWURGXFH FX PXOW JULM VRQGD XUHWUDO VWHULO
prin observarea aspectului general (a faciesului, a mersului,
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PVXUDUHD vQOLPLL JUHXWLL VXSUDYHJKHUHD FRPSRUWDPHQWXOXL
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pacienii purttori de sond schimbarea acesteia se face
Dup efectuarea examenului clinic medicul curant poate face i
respectnd normele menionate.
o evaluare a statusului de performa a pacientului n perspectiva unei

intervenii chirurgicale, unul dintre cele mai folosite e scorul de

$
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XI. NGRIJIREA PACIENTULUI UROLOGIC

Dei din pcate de ctre unii minimalizat, ngrijirea pre- si
post-operatorie a pacientului este poate la fel de important ca i
interventia chirurgical propiu-zis Aceasta ncepe n momentul
LQWHUQULL L VH vQFKHLH vQ PRPHQWXO FkQG pacientului i s-a nmnat
ELOHWXOGHLHLUHGLQVSLWDOLLV-DXIFXWUHFRPDQGULOHQHFHVDUH7Ri
cei implicai n actul medical (medic, asistent, infirmier, etc.) au
roluri bine definite i trebuie s vi cunoasc foarte bine prerogativele.
Insuirea nc de pe bancile facultaii/colii a cunotinelor necesare
Fig.VI.1 - Cateterism uretral
unei bune ngrijiri a pacienilor urologici i nu numai, va aduce mai
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trziu n practica clinic importante beneficii pacientului .
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Modul n care preia asistenta pacientul, odat ajuns la salon,
GH SODVWLF ([LVW ULVFXO SURGXFHULL XQHL FL IDOVH FDUH YD FUHD
ajuta mult la integrarea lui n noua situaie. Cu tact LFDOP, ea trebuie
QHSOFHUL PDL WkU]LX 'XS FH VRQGD D DMXQV vQ YH]LF YRP DYHD
s prezinte pacientului regulamentul de ordine interioar i
JULMFDHYDFXDrea urinii V VHIDF vQSLFWXU lenta pentru a nu
explice modul n care va decurge internarea (recoltarea analizelor,
VH SURGXFH DD QXPLWD KHPRUDJLH H[-YDFXR
GDWRULW
efectuarea ecografiei, urografiei, EKG, consultul preanestezic, etc).
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'H IHOXO vQ FDUH VH YD GHVIXUD DFHVW SULP GLDORJ vQWUH DVLVWHQW L
SXQJ FROHFWRDUH SHQWUX D VH UHDOL]D GUHQDMXO XULQDU vQ FLUFXLW
pacient va depinde ntr-o buna PVXUFkWLJDUHDvQFUHGHULLSHFDUH
nchis.
pacientul tUHEXLHVRDLEvQHFKLSDFDUHvOYDvQJULML
n cazul n FDUH UHWHQLD HVWH SULQ FKHDJXUL VH YD LQVWDOD
GHODvQFHSXWRVRQG)ROH\FXWULSOXFXUHQWGHFDOLEUXPDUHSULQ
FDUH VXE XQ ODYDM YH]LFDO DEXQGHQW V SRDW IL HYDFXDWH
eventualele cheaguri.
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(conform principiului vaselor comunicante).

s i
$VW]LSHEXQGUHSWDWH, nu mai este normal i nici posibil s

se interneze pacieni cu o stare general bun doar pentru a fi
investigai. Toate investigaiile, de la cele mai simple (analize de
snge i urin, etc.) pn la cele mai complexe (CT sau RMN) trebuie
desfaurate la aceast categorie de pacieni n condiii de ambulator,
i, cnd strategia terapeutic s-a conturat, pacientul accept
intervenia i riscurile ei iar comorbiditile sunt bine controlate, se
GHFLGHLQWHUQDUHDLct mai rapid, gestul terapeutic.

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II.
Acetazolamida
n cazul sondelor Tiemann sau Nelaton care nu sunt
III.
Furosemid
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IV.
Tiazide
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V.
Triamteren
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%LVHSWRO 1RUIOR[DFLQ 2IOR[DFLQ HWF SHQWUX D SUHYHQL DSDULLD
13. Hipouricemiante
I.
Allopurinol
LQIHFLHL XULQDUH n condiiile n care ne pregtim pentru o
II.
Probenecid
intervenie care s rezolve problema (de exemplu TUR-P).
III.
Sulfinpirazona
14. Altele
I.
/DSDFLHQLLSXUWWRULGHVRQGYH]LFDOYRPUHFRPDQGD
- consumul abundent de lichide pentru a mpiedica pe ct posibil
6UXULGH$8
colmatarea sondei;
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DWkW SHQWUX SDFLHQW FkW L SHQWUX PHGLF VDX IFkQG VFKLPEDUHD
VRQGHLFKLDULPSRVLELO1XYRPUHFRPDQGDGHUXWLQ antibiotice la
SDFLHQLL SXUWWRUL GH sond. Le vom pstra pentru a trata
eventalele complicaii infecioase acute ce pot apare (de ex.
epididimita).
3XQFLD YH]LFDO VXSUDSXELDQ un tub de plastic
introdus n vezicprintr-un trocar se utilizeaz cnd cateterizarea
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FDOH IDOV FUHDW SULQ PDQHYUDUH LQWHPSHVWLY, etc.) iar pacientul
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antisepsie fiind obligatorii!
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UDGHUHDSUXOXLSXELDQLQ]RQDVLPIL]HLSXELHQH
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deasupra simfizei pubiene, perpendicular pe planual abdominal.
Umplndu-se,
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DMXQJkQG LPHGLDW VXE SHUHWHOH DEGRPLQDO DQWHULRU Q FRQGLLLOH GH

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;LOLQ 8OWHULRU FX XQ DF GH SXQFLH JURV L OXQJ SWUXQGH
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I.
Ergotamina
6. Anestezice generale
I.
Metoxifluran
7. Anticoagulante
I.
Dicumarol
II.
Fenindiona
8. Anticonvulsivante
I.
Oxazolidindione
9. Antidiabetice orale
Fig. VI.2 3XQFLDVXSUDSXELDQ
([LVWtruse speciale numite CYSTOFIX/CYSTOCATH prin

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explicate clar SDFLHQWXOXL ,QGLIHUHQW GH PRGXO vQ FDUH VH DVLJXU
!
I.
Clorpropamida
II.
Tolbutamida
10. Antihipertensive
I.
Alfametildopa
II.
Captopril
III.
Hidralzine
11. Citotoxice-citostatice
12. Diuretice
I.
Diuretice mercuriale

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3.
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4.
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DDQXPLWDSUREDVRQGHL vLYDUHOXDPLFLXQLOH
uricozurice;
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alcalinizarea urinei;
6.
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persoanele cu risc crescut la care examinarea nu poate fi
II.
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urinare cu un endoscop rigid sau flexibil.
HYLWDW
I.
Vizualizarea lumenului uretral, a mucoasei vezicale, a

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RULILFLLORU XUHWHUDOH L D DVSHFWXOXL PDFURVFRSLF DO urinii care vine
1.
SULQDFHVWHRULILFLLVXQWUHSHUHHVHQLDOHvQVWDELOLrea diagnosticului
Antibiotice Chimioterapice
a. Aminoglicozide
toate
b. Beta lactamine
L LPSOLFLW a conduitei terapeutice n multe DIHFLXQL XURORJLFH vQ

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66
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A.
Rifampicina
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A.
Demeclociclina
V.
96
966
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+8
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permite pasajul direct al instrumentului, alternativa recomandat
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direct (uretro-cistoscopie). Unghiul lentilei permite endoscopistului
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0 fXUQL]HD]RLPDJLQHSHGLUHFLDWHOHVFRSXOXLILLQGRSWLPHSHQWUX
explorarea uretrei, cele de 30 permit vizualizarea peretilor laterali
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HYDOXDUHDFRUHFWDGRPXOXLYH]LFDOVLD]RQHLDQWHUioare a colului
vezical.
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!

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unor stricturi uretrale, OLSVD XQHL FRODERUUL DGHFYDWH GLQ SDUWHD
doze
pacientului.
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mari,
discontinue,
la
repetarea
tratamentului
cu
,QYHVWLJDLDVHYDIDFe n sala de cistoscopie, medicul fiind
PHFDQLVPXOLPXQRORJLFFDUHVWODED]DDFHVWHLUHDFLLDGYHUVH
echipat steril (fig.VI.3). $QWLELRSURILOD[LD UHFRPDQGDW FRQVW vQ
Pentru diminuarea riscului, utilizarea acestora se face
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QXPDL SHQWUX FD]XUL ELQH VHOHFWDWH FkQG QX H[LVW R DOW
6XOIDPHWR[D]ROSHQWUXRGXUDWGHPD[LPGHRUH
Pacientul va fi pus pe masa de cistoscopiH vQ SR]LLH
JLQHFRORJLF'XSEDGLMRQDUHDFXVROXLHDQWLVHSWLF%HWDGLQD
RUJDQHORU JHQLWDOH L D UHJLXQLL SHULQHDOH VH LQWURGXFH SH XUHWU
jelly-DQHVWH]LFRVXEVWDQXOHLRDVFXUROOXEUHILDQW, antiseptic L
anestezic; pensarea penisului pentru 3-5 minute va facilita
contactul cu mucoasa, instalndu-VHDQHVWH]LDORFDO
DOWHUQDWLY 9D IL XUPULW FRUHFW GLXUH]D SHQWUX D VXUSULQGH

PRPHQWXO LQVWDOULL SROLXUHL FD VHPQ DO LQVWDOULL GLVIXQFLHL
UHQDOHvQVRLWGHGHWHUPLQDUHDSHULRGLFDGHQVLWLLXULQDUHL
monitorizarea clerence-XOXL FUHDWLQLQHL 'DF VH FRQVWDW
GHWHULRUDUHD IXQFLHL UHQDOH VH RSUHWH DGPLQLVWUDUHD L VH
ncepe tratamentul adecvat al IRA.
6H YD HYLWD XWLOL]DUHD vQ GR]H PDUL FXUH SUHOXQJLWH L
repetarea tratamentului cu aceste antibiotice.
Q FD]XO SDFLHQLORU GH VH[ PDVFXOLQ VH UHFRPDQG
6XEVWDQHOHGHFRQWUDVWLRGDWHGHWHUPLQDXQDGLQFHOH
DQHVWH]LH JHQHUDO VDX UDKLDQHVWH]LH SHQWUX D VH SXWHD UHDOL]a o
PDLIUHFYHQWHIRUPHGHQHIURSDWLHWR[LFPHGLFDPHQWRDVGXS
HYDOXDUH FLVWRVFRSLF GHWDOLDW 6H LQWURGXFH DSRL SH XUHWU
DPLQRJOLFR]LGH 3ULQFLSDOLL IDFWRUL GH ULVF SHQWUX DSDULLD
cisWRVFRSXO L VH SURJUHVHD] OD YHGHUH VSUH XUHWUD SURVWDWLF
acesteia sunt:
evalundu-se aspectul mucoasei uretrale, eventuale stricturi,

tumori, calculi migraL.
1. LQVXILFLHQDUHQDOSUHH[LVWHQW
2. QHIURSDWLDGLDEHWLFFXSURWHLXQXULHPDLPDUHGH
g/24 de ore;
3. mielomul multiplu;
4. transplantul renal;
5. YkUVWDvQDLQWDW
6. HTA;
7. DUWHULRVFOHUR]DSHULIHULF
8. LQVXILFLHQDFDUGLDF
9. GR]HOHPDULFXFRQFHQWUDLHFUHVFXWDVXEVWDQHORU
de contrast;
10. repHWDUHDH[DPLQULORUODLQWHUYDOHVFXUWHGHWLPS
0VXULOHWHUDSHXWLFHFDUHXUPUHVFVSUHYLQ
instalarea nefropatiei sunt:
Fig.VI.3. 3R]LLDEROQDYXOXLSHPDVDGHFLVWRVFRSLH

1.
OLPLWDUHD H[DPHQHORU FX VXEVWDQ GH FRQWUDVW OD
persoanele cu risc crescut;

;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
VHSRWUHJVLWRDWHDFHVWH PDQLIHVWULHVWHGHQHIURSDWLLWR[LFH
9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
$FHDVW PDQHYU H[HFXWDW FX EOkQGHH SHUPLWH
medicamentoase. Datele epiGHPLRORJLFH UHOHY IDSWXO F -
FLVWRVFRSXOXLVSURJUHVH]HvQYH]LF, XQGHYDILH[DPLQDW
GLQ QHIURSDWLL FXQRVF R FDX] WR[LF LDU GLQWUH DFHVWHD
- MUCOASA VEZICAL SH WRDW VXSUDIDD HL XUPULQGX-se
VXQWPHGLFDPHQWRDVHGLQLQVXILFLHQHOHUHQDOHDFXWH
eventuale tumori vezicale, aspectul lor (vegetant sau infiltrativ),
GLDOL]DWHVXQWGHFDX]WR[LF-PHGLFDPHQWRDV
ED]D GH LPSODQWDUH QXPUXO SR]LLD ORU UDSRUWDW OD SHUHL FRO
Q SUDFWLFD QHIURORJLF SRVLELOLWDWHD XQHL HWLRORJLL toxic-
RULILFLLOHXUHWHUDOH6HYRUFRQVHPQDLDOWHPRGLILFULDOHDVSHFWXOXL
PHGLFDPHQWRDVH VH GLVFXW vQ FRQWH[WXO DSDULLHL FHORU GRX
mucoasei: edHPSHWHLLSODFDUGHFDOFLILFULHWF
PDULVLQGURDPHQHIURORJLFHUHVSHFWLY,5$L,5&
- CALCULI VEZICALI sau fragmente litiazice, notndu-se
$QWLELRWLFHOH L VXEVWDQHOH GH FRQWUDVW GHWHUPLQ ,5$
QXPUXOIRUPDDVSHFWXOFXORDUHDLGLPHQVLXQLOH
prin mecanisme diferite, toxice directe, imunologice, ischemice
- eventualele cheaguri, fragmente tumorale, FRUSLVWULQL
LREVWUXFLHWXEXODU
- ORIFICIILE URETERALE YRU IL DWHQW XUPULWH QRWkQGX-se o
$,16 SRW GHWHUPLQD DWkW ,5$ FkW L ,5& DFHDVWD GLQ
HYHQWXDO SUH]HQ D IUDJPHQWHORU GH FDOFXOL WXPRUL XUHWHUDOH FH
XUP DSUkQG GXS XWLOL]DUHD PDL DOHV DVRFLDW D
SURHPLQ SULQ OXPHQXO RULILFLXOXL %RPEDUHD H[WUHPLWLL GLVWDOH D
analgezicelor sau la asocierea acestora cu diuretice la bolnavi
XUHWHUXOXLvQOXPHQXOYH]LFDOVHPQDOHD]SUH]HQDXQXLXUHWHURFHO
FX KHSDWRSDWLL FURQLFH QHIURSDWLL FURQLFH LQVXILFLHQ FDUGLDF
9RPXUPULFXDWHQLHLHOLPLQULOHGHXULQGHODQLYHOXORULILFLLORU
FRQJHVWLY 0HULW UHLQXW L IDSWXO F QHRSOD]LLOH UHQDOH DSDU
ureterale n ncercarea de a stabili sursa unei hematurii. Evacuarea
PXOW PDL IUHFYHQW OD SDFLHQLL FX QHIURSDWLL DQDOJH]LFH GHFkW vQ
XQHL PXOH SXUXOHQWH SULQ RULILFLXO XUHWHUDO VHPQDOL]HD] XQ SURFHV
SRSXODLDJHQHUDO
VXSXUDWLY UHQDO FRPXQLFDQW FX FDOHD H[FUHWRULH 3UH]HQD XQXL
Utilizarea foarte frecvent a antibioticelor impune n
oriILFLXXUHWHUDOEHDQWODUJVXJHUHD]H[LVWHQDXQXLUHIOX[YH]LFR-
YHGHUHD DSOLFULL XQRU PVXUL FXQRDWHUHD FODVLILFULL
XUHWHUDOSHSDUWHDUHVSHFWLY
antibioticelor GXSFDOHDGHHOLPLQDUHLGXSQHIURWR[LFLWDWH
- COLUL VEZICAL YDILH[DPLQDWFXDWHQLHODIHOFDLFHOHODOWH
'LQWUH DQWLELRWLFHOH FX HOLPLQDUH UHQDO IU UHDFLL
]RQH XUPULQGX-VH H[LVWHQD ORELORU SURVWDWLFL DVSHFWXO ORU L
WR[LFH UHLQHP SHQLFLOLQD * SHQLFOLQHOH GH VHPLVLQWH]
SURHPLQHQD ORU vQ OXPHQul vezical, ncercndu-se o evaluare a
DPSLFLOLQ R[DFLOLQ FDUEHQLFLOLQ FHIDORVSRULQHOH FX
GLPHQVLXQLORU SHQWUX R HYHQWXDO LQWHUYHQLH HQGRVFRSLF VDX
H[FHSLDFHIDORULGLQHLHULWURPLcina, cotrimoxazolul, lincomicina,
GHVFKLVODSURVWDW
clindamicina.
UretrocistoscopLD HVWH R SURFHGXU LQYD]LY L poate fi
'LQWUH DQWLELRWLFHOH FX HOLPLQDUH UHQDO UHDFLL WR[LFH
DVRFLDW FX LQIHFLL VkQJHUUL UHWHQLH GH XULQ VDX SHUIRUDLH
frecvente dau: toate aminogicozidele, cefaloridina, meticilina,
YH]LFDO 2 LQIRUPDUH FRUHFW D SDFLHQWXOXL FX SULYLUH OD
ULIDPSLFLQD FLFORVHULQD L VXOIDPLGHOH Q XOWLPLL GH DQL V-au
FRPSOLFDLLOHSRVLELOHHVWHREOLJDWRULH
GHVFULV LQVXILFLHQH UHQDOH DFXWH JUDYH GXS DGPLQLVWUDUHD vQ

9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
Avantajele principale ale cistoscopiei flexibile sunt :

- tolerabilitatea superioDU
- SRVLELOLWDWHDHIHFWXULLvQGHFXELWGRUVDO
- XXULQDDYDQVULLLQVWUXPHQWXOXLvQFRQGLLLOHXQXLFROYH]LFDOvQDOW
- capacitatea de flectare a vrfului endoscopului fapt care permite
YL]XDOL]DUHDvQWUHJLLYH]LFLXULQDUHLLQVSHFLDFROXOXLYH]ical.
Video-uretrocistoscopia
permite
imaginilor
att
din
HQGRVFRSLD ULJLG FkW L GLQ FHD IOH[LELO V ILH SURLHFWDWH SH XQ
$FLXQHWHUDSHXWLF: analog de hormon antidiuretic.

,QGLFDLL HQXUHVLVQLFWXULHGLDEHWLQVLSLGFROLFDUHQDO"
Mod de administrare: VHDGPLQLVWUHD]GHSUHIHUDWODDFHHDL
RU vQDLQWH GH PHVH FRPSULPDWXO QX VH LQJKLWH FL VH WRSHWH
sub limb.
Contraindicatii: $OHUJLH VSHFLILF cardiopatia LVFKHPLF
epilepsia IHPHL JUDYLGH KLSRQDWUHPLH DOWH DIHFLXQL FH
QHFHVLWWUDWDPHQWGLXUHWLFSROLGLSVLDKDELWXDOVDXSVLKRJHQ
LQVXILFLHQDUHQDOVHYHUERDODYRQ:LOOHEUDQG,LE
5HDFLL DGYHUVH IULWDLD mucoasei nazale, cefalee,
FRQMXQFWLYLW
monitor. Beneficiile acestei tehnici sunt reprezentate de evitarea

FRQWDFWXOXL FX IOXLGH ELRORJLFH vPEXQDWLUHD FRQGLLLORU GH
'XS DFHDVW SUH]HQWDUH D DUVHQDOXOXL WHUDSHXWLF FHO
meQLQHUH D FkPSXOXL RSHUDWRU VWHULO IDFLOLWDUHD GRFXPHQWULL
PDLIUHFYHQWXWLOL]DWGHFWUHXURORJDUWUHEXLDGXJDWIDSWXOF
SURFHGXULL L D SURJUDPHORU GH vQYPkQW SUHFXP L DPHOiorarea
SHQWUX PHGLFDPHQWHOH FX HOLPLQDUH UHQDO PHGLFXO WUHEXLH V
egonomiei chirurgului.
DLEvQYHGHUHDVSHFWH
III.
ELECTRORE=(&,$75$1685(75$/
5H]HFLDWXPRULLYH]LFDOH sau TUR-9UHSUH]LQWRLQWHUYHQLH

FKLUXUJLFDOHQGRVFRSLFHVWHR continuare a cistoscopiei (pe care
R HIHFWXP vQ UDKLDQHVWH]LH L FDUH FRQILUP H[LVWHQD XQHL
Nefrotoxicitatea pentru a evita instalarea sau
SUHFLSLWDUHDXQHLGLVIXQFLLUHQDOH
1HFHVLWDWHD DGDSWULL SRVRORJLHL vQ IXQFLH GH
YDORDUHDILOWUDWXOXLJORPHUXODUJUDGXOLQVXILFHQHLUHQDOH
Arsenalul
farmacoterapeutic
urologic
cuprinde
IRUPDLXQL WXPRUDOH (D HVWH UHFRPDQGDW SHQWUX VWDGLLOH 7 a, T1
VSHFLDOJUXSHGHPHGLFDPHQWHDFURULPSDFWDVXSUDIXQFLHL
XQGH VH FRQVLGHU F HVWH WUDWDPHQW FX YL] radical. Se
UHQDOHHVWHLPSRUWDQWVILHFXQRVFXW(VWHYRUEDGHVSUH
HIHFWXHD]LvQVWadii mai avansate, T2vQVSHUDQDFSHQHWUDLD

vQVWUDWXOPXVFXODUQXHVWHSUHDSURIXQGLSXWHPUH]HFDSkQvQ
HVXWXO PXVFXODU OLEHU Q 7 L 7 VH SUDFWLF QXPDL vQ VFRS
GLDJQRVWLF VDX SDOHDWLY KHPRVWD] VDX PULUHD FDSDFLWLL
vezicale, cnd nu se pRDWHHIHFWXDFLWHFWRPLDWRWDO
5H]HFLD vQFHSH GLQVSUH ]RQD OLEHU D WXPRULL VSUH ED]D HL,
DGLFVSUHSHUHWHOHYH]LFDOILJ9,6HWDLHIUDJPHQWHWXPRUDOH
FX EXFOD DQVHL FDUH DSRL YRU IL H[WUDVH FX R VHULQJ VSHFLDO
*X\RQ FX FDSDFLWDWH PDUH L FDUH VH DWDHD] OD WHDFD

antibiotice;
antiinflamatorii nesteroidiene (AINS);
VXEVWDQHGHFRQWUDVW
EfecWXO QHIURWR[LF GHWHUPLQ OH]LXQL LQWHUVWLLDOH VDX

JORPHUXODUH H[SULPDWHFOLQLFSULQLQVXILFLHQUHQDODFXWVDX
FURQLFSHULQLFKLQRUPDOLDQWHULRUXWLOL]ULLPHGLFDPHQWHORU'H
PHQLRQDW F DFHODL DJHQW WR[LF PHGLFDPHQWRV SRDWH
GHWHUPLQD OH]LXQL L PDQLIHVWUL FOLQLFH PXOWLSOH L UHFLSURF
DFHODL WDEORX FOLQLF SRDWH IL GHWHUPLQDW GH R PXOWLWXGLQH GH
VXEVWDQHWR[LFHPHGLFDPHQWRDVH7LWXODWXUDFRPXQVXEFDUH
$
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
2. DOXORUBICIN
$FLXQHWHUDSHXWLFchimioterapic antineoplazic.
,QGLFDLL WXPRUL YH]LFDOH GXS UH]HFLD HQGRVFRSLF a
acestora.
Mod de administrare: LQVWLODLLLQWUDYH]LFDOH cu 50 mg n 50 ml
VHURLQVWLODLHVSWPkQVSWPkQLGXS785-V.
5HDFLL DGYHUVH locale: polakiurie, hematurie (fenomene de
FLVWLW FKLPLF JHQHUDOH DPHHOL JUHD IHEU KLSRWHQVLXQH
Asocieri medicamentoase: 'R[RUXELFLQ KLGURSURSLOFHOXOR]
XQ DGH]LY OD PXFRDVD YH]LFDO ! FUHWH FRQFHQWUDLD
FKLPLRWHUDSLFODQLYHOXOPXFRDVHLYH]LFDOH'R[RUXELFLQ
7KLRWHSDVDX0LWRPLFLQ&- efect sinergic.
UH]HFWRVFRSXOXL &KLDU GDF ED]D WXPRULL HVWH vQJXVW OD FHOH

papLODUH QX QH OFRPLP V R WLHP GH OD vQFHSXW ILLQF WXPRUD
HOLEHUDW QX YD SXWHD IL H[WUDV 1X VH IDFH KHPRVWD] GXS
ILHFDUHIUDJPHQWWLDWFLQXPDLFkQGVHvQWkOQHWHXQYDVPDLDFWLY
SH PVXU FH QH DSURSLHP GH ED] /D SHUHWHOH YH]LFDO
hemostaza sHIDFHULJXURVODYHGHUHSHWRDWVXSUDIDDUH]HFDW
'XS UH]HFLH VH LQVWDOHD] R VRQG )ROH\ SHQWUX zile, pentru
limpezirea urinii.
3.THIOTEPA
$FLXQHWHUDSHXWLFagent alkilant
,QGLFDLLGXS UH]HFLDHQGRVFRSLF a tumorilor vezicale.
Mod de administrare: LQVWLODLLLQWUDYH]LFDOHFXPJvQPO
VROXLH VDOLQ VDX PJ vQ PO VROXLH VDOLQ VROXLD VH
UHFRPDQG D IL UHLQXW LQWUDYH]LFDO - RUH VH UHFRPDQG
LQVWLODLHVSWPkQ - VSWPkQL DSRL LQVWLODLH SH OXQ
timp de 1 an.
5HDFLL DGYHUVH WR[LFLWDWH KHPDWRORJLF - VXSUHVLH PHGXODU
fenomene locale polakiurie, hematurie.
,QWHUDFLXQL PHGLFDPHQWRDVH efect sinergic n asociere cu
Doxorubicin.
4.MITOMICINA C
$FLXQH WHUDSHXWLF chimioterapie DQWLWXPRUDO
,QGLFDLLn tratamentul adjuvant al tumorilor vezicale.
Mod de administrare: LQVWLODLLLQWUDYH]LFDOHFXPJvQPO
DSLQVWLODLH x VSWPkQ VSWPkQL GXS 785-V; se
UHFRPDQG FD VXEVWDQD V ILH UHLQXW vQ YH]LF FkW PDL PXOW
timp posibil.
5HDFLL DGYHUVH FLVWLW FKLPLF KHPDWXULH IHEU GXUHUL
HSLJDVWULFHUHDFLLFXWDQDWH VXEIRUPGHHF]HPGHFRQWDFW
UDVKSDOPDUGHVFXDPDLL
Asocieri medicamentoase: 'R[RUXELFLQ 0LWRPLFLQ C
HIHFW VLQHUJLF 0LWRPLFLQ & hipertermie - XQ SRWHQLDO
adjuvant important.
XVI. TRATAMENTUL NOCTURIEI SI ENUREZISULUI
1.Minirin Melt (desmopresina)
3UH]HQWDUH IDUPDFHXWLF trochisti de contin 60 respectiv 120
PLFURJUDPHVXEVWDQDFWLY

Fig.VI.4. 5H]HFLDWXPRULLYH]LFDOH
6H SRW vQWkPSOD XQHOH LQFLGHQWH vQ WLPSXO UH]HFLHL &nd

UH]HFPSUHDFXUDMRVSXWHPperfora peretele vezical:
- FkQGDFHDVWSHUIRUDLH VHSHWUHFHvQ]RQDIL[DYH]LFLL
DGLF WULJRQ VDX SHUHL ODWHUDOL QX HVWH QHYRLH GH DOWH JHVWXUL
WHUDSHXWLFHFLSXULVLPSOXVHPHQLQHVRQGDXUHWUR-YH]LFDOPDL
multe zile.
- FkQG SHUIRUDLDHVWHvQVSHFDORWHDYDILvQFDYLWDWHD
SHULWRQHDO ILLQG QHFHVDU LQWHUYHQLD FKLUXUJLFDO vQ YHGHUHD

9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
VXWXUULLYH]LFLLXULQDUHFLVWRUDILH LDGUHQULLFDYLWLLSHULWRQHDOH.
Prezentare farmaceutica: comprimate cu 250 mg abiraterona

acetat.
Actiune terapeutica: inhibitor puternic al citocromului steroidal
3&<3LQKLEkQGDVWIHOHQ]LPDFDUHGHWHUPLQVLQWH]D
WHVWRVWHURQXOXLDWkWvQJODQGHOHVXSUDUHQDOFkWLvQWHVWLFXO
,QGLFDLL WUDWDPHQWXO FDQFHUXOXL GH SURVWDW PHWDVWDWLF
rezistent la castrare n asociere cu analogi de LH-RH.
Mod de administrareGR]DUHFRPDQGDWHGHPJFS
FD GR] XQLF ]LOQLF 7UHEXLH DGPLQLVWUDW FX GR]H PLFL GH
prednisol sau prednisolol ( 10 mg/zi).
&RQWUDLQGLFDLL KLSHUVHQVLELOLWDWH OD VXEVWDQD DFWLY
iQVXILFLHQDKHSDWLFVHYHUFODVD&&KLOG-Pugh)
5HDFLL DGYHUVH DQHPLH GLVIXQFLH VH[XDO KLSHUWHQVLXQH
DUWHULDOKLSRSRWDVHPLHUHWHQLHGHOLFKLGHHGHPHSHULIHULFH
2DOWVLWXDLHcare poate determina DSDULLDXQHLSHUIRUDLL

VHvQWkPSOFkQGWXPRUDVHDIOSHSHUHWHOHODWHUDO LODUH]HFLH
VDUH REWXUDWRUXO 'DF DFHVW OXFUX HVWH FXQRVFXW vQDLQWH GH
RSHUDLHVDXUHFXQRVFXWvQFXUVXOFLVRVFRSLHLSRDWHILSUHYHQLWSULQ
modificarea formei de anestezie, excitarea obturatorului putnd
ILSUHYHQLWSULQDQHVWH]LHJHQHUDOFXLQWXEDLHRUR-traheaO
5H]HFLDDGHQRPXOXLGHSURVWDW sau TUR-P.
Se SUDFWLFvQJHQHUDOSHQWUXDGHQRDPHGHSkQOD-60
FPF VH HFKLYDOHD] FPF FX J HVXW SURVWDWLF (QGRVFRSLWLL
H[SHULPHQWDL SRWUH]HFD VLDGHQRDPHPDLPDUL5H]HFLDFRQVW
GLQ WLHUHD GH HVXW SURVWDWLF FX EXFOD DQVHL GLQVSUH LQWHULRUXO
prostatei SkQODFDSVXODVDIUDJPHQWHOHILLQGXOWHULRUndeprtate.
ILJ9,3UDFWLFXUHWUDSURVWDWLFVHGHVILLQHD]WUDQIRUPkQGX-se
ntr-o cavitate. )UDJPHQWHOH GH HVXW UH]HFDW VH vQGHSUWHD] FX
DFHHDLVHULQJ*X\RQ'DFUPkQIUDJPHQWHGHHVXWvQYH]LF
ele pot dHWHUPLQDFRPSOLFDLLUHWHQLHGHXULQODVFRDWHUHDVRQGHL
LQIHFLLSHUVLVWHQWHIRUPDUHGHFDOFXOL
Fig.VI.5 5H]HFLD HVXWXOXLSURVWDWLF

;9,,167,/$,,,175$9(=,&$/(
1.BCG:
3UH]HQWDUH IDUPDFHXWLF suspensie de bacilli Calmette
*XHULQ YLL 0\FREDFWHULXP ERYLV OLRILOL]DW 7 mg
imunostimulent BCG liofilizat; solvent (lichid de suspensionare
Sautan diluat 3 ml).
$FLXQHWHUDSHXWLFimunomodulator.
,QGLFDLL LPXQRVWLPXOHQW GXS LQWHUYHQLL FKLUXUJLFDOH SHQWUX
WXPRUL PDOLJQH GH YH]LFL XULQDUH GH VkQ GLJHVWLYH EURQLFH
laringiene, melanom malign, tratamentul leucemiilor.
Mod de administrare: recomandat la 7- ]LOH GXS UH]HFLH
HQGRVFRSLF FX VXVSHQVLD UHFRQVWLWXLW GLQ FRQLQXWXO D ILROH
(2 ml) care se dLOXHD] FX PO VHU IL]LRORJLF VWHULO
LPXQRVWLPXOHQWXO WUHEXLH PHQLQXW vQ YH]LF WLPS GH K
SURJUDPXOGHHIHFWXDUHDLQVWLODLLORUVSWPkQDOvQSULPHOH
VSWPkQL DSRL OXQDU SkQ OD OXQL GXS FDUH VH IDFH R
LQVWLODLHSHDQ
&RQWUDLQGLFDLLdeficit imun congenital sau dobndit, serologie
+,9 SR]LWLY WXEHUFXOR] VDX KHSDWLW DFWLY VDX vQ
DQWHFHGHQWH LQIHFLL DOH WUDFWXOXL XULQDU SkQ OD QHJDWLYDUHD
XURFXOWXULLLRSULUHDDQWLELRWHUDSLHL
5HDFLLDGYHUVH loco-regionale: polakiurie, disurie, hematurie,
SURVWDWLWJUDQXORPDWRDVHSLGLGLPLW
,QWHUDFLXQLPHGLFDPHQWRDVHtratament cu corticosteroizi sau
LPXQRVXSUHVRDUH LQIOXHQHD] UVSXQVXO OD LPXQRVWLPXOHQW
BCG - ULVFLQIHFLL%&*JHQHUDOL]DWHWUDWDPHQWFRQFRPLWHQWVDX
n antecendente cu un imunomodelator poate avea efecte
negative asupra imunostimulului BCG.

;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
Indicatii: WUDWDUHD SDFLHQLORU FX FDQFHU GH SURVWDWD vQ VWDGLX

avansat.
Mod de administrare: 'R]DLQLLDOGHPJDGPLQLVWUDWFD
GRX LQMHFLL XOWHULRU OXQDU FkWH R LQMHFLH VXEFXWDQDW Este
LQWHU]LVinjectarea LQWUDYHQRDV VDXLQWUDPXVFXODU
&RQWUDLQGLFDLL KLSHUVHQVLELOLWDWH OD VXEVWDQD DFWLY VDX la
oricare GLQWUHH[FLSLHQL
5HDFLL DGYHUVH DQHPLH FUHWHUH vQ JUHXWDWH LQVRPQLH
DPHHDO FHIDOHH GLDUHH JUHD FUHWHUHD WUDQVDPLQD]HORU
hepatice.
IV. Antiandrogeni
1. CASODEX (Bicalutamida)
3UH]HQWDUH IDUPDFHXWLF comprimate filmate de 50, 150 mg
$FLXQH WHUDSHXWLF $QWDJRQLWL KRUPRQDOL FDUH EORFKHD]
receptorii pentru androgeni ai celulelor prostatice.
,QGLFDLLFDQFHUGHSURVWDW metastazat n asociere cu analogi
LH-5+VDXRUKLHFWRPLDELODWHUDO
Mod de de administrare: oral, 1 tb de 50 mg pe zi.
5HDFLL DGYHUVH EXIHXUL SUXULW JLQHFRPDVWLH WXOEXUUL
GLJHVWLYH JUHD YUVWXUL DIHFWDUH KHSDWLF WUDQ]LWRULH
VFGHUHDOLELGRXOXLDVWHQLH
&RQWUDLQGLFDLL femei L FRSLL KLSHUVHQVLELOLWDWH OD
bicalutamida.
$VRFLHUHXWLO: analogi LH-RH.
2. EULEXIN )OXWDPLG
3UH]HQWDUHIDUPDFHXWLFcps 250 mg.
$FLXQH WHUDSHXWLF DQWLDQGURJHQ SHULIHULF EORFKHD] prin
FRPSHWLLHUHFHSWRULLSHQWUXdihidrotestosteron).
Mod de administrare: oral, 1 cp x 3/zi.
&RQWUDLQGLFDLLKLSHUVHQVLELOLWDWHODIOXWDPLG VDXODH[FLSLHQL
SUXGHQ DIHFLXQL KHSDWLFH vQ DVRFLHUL FX DQWLFRDJXODQWH
5HDFLL DGYHUVH JLQHFRPDVWLH JUHD YUVWXUL PRGLILFUL
WUDQ]LWRULL D IXQFLHL KHSDWLFH VFGHUHD OLELGRXOXL DQRUH[LH
edeme, echimoze, prurit, sdr. lupus-like, cefalee, vertij, anemie
KHPROLWLF LFWHU FROHVWDWLF VGU GH VXSUHQVLH DQGURJHQLF la
SDFLHQLL FDUH QX PDL UVSXQG OD EORFDGD DQGURJHQLF
PD[LPDO WUDWDPHQW LQWHUPLWHQW FX )OXWDPLGD VWDELOL]HD]
HYROXLDSHQWUXXQWLPS
Asocieri medicamentoase: analogi LH-RH.
V. Inhibitori ai sintezei de androgeni
1. ABIRATERONE (Zytiga)

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$YDQWDMXOUH]HFLHLIDGHLQWHUYHQLDGHVFKLVHVWHF
SRL IDFH KHPRVWD]D la YHGHUH coagulnd direct artera sau
YHQD L DLFL KHPRVWD]D QX VH IDFH GXS ILHFDUH WLHUH ILLQGF
DFHODL YDV GH VkQJH vO UHJVHWL GH PDL PXOWH RUL PHUJkQG vQ
SURIXQ]LPH VSUH FDSVXO $MXQL OD FDSVXO WUHEXLH V IDFHP R
FRDJXODUH HILFLHQW &HD PDL PDUH JULM WUHEXLH V R DFRUGP
VkQJHUULL DUWHULDOH ILLQGF HD QX SRDWH IL FRQWURODW SULQ
FRPSUHVLXQH FX EDORQDXO VRQGHL )ROH\ FD FHD YHQRDV 'H
DVHPHQHD KHPRVWD]D OD QLYHOXO FROXOXL YH]LFDO WUHEXLH V ILH PDL
DWHQWIDGHDOWH]RQHILLQGFODDFHVW QLYHOQXH[LVWRVXILFLHQW
FRPSUHVLXQH D EDORQDXOXL VRQGHL )ROH\ /D ILQDOXO UH]HFLHL VH
LQVWDOHD] R VRQG )ROH\ HYHQWXDO FX GXEOX FXUHQW FDUH VH
PHQLQH-3 zile.
6H SRWvQWkPSODXQHOHLQFLGHQWHLvQ WLPSXODFHVWXLWLSGH
UH]HFLH2ULFDUHHQGRVFopist poate deschide un sinus venos cnd
taie prea profund, cu sngerare masiv. n acest caz se
HIHFWXHD] R FRDJXODUH LQVLVWHQW L FkQG QX HVWH VXILFLHQW VH
XPIOEDORQDXOVRQGHLPDLPXOWLDFHDVWDVHPHQLQHWUDFLRQDW
&RQWLQXDUHDUH]HFLHLFXVLQXVGHVFKLVSRDWH GXFH ODSWUXQGHUHD
FUHVFXWGHDSvQFLUFXLWXOVDQJXLQFXULVFXOLQVWDOULLLQWR[LFULLFX
DSLLQVWDODUHDXQXLsindrom TUR.
2 DOW FDSFDQ R FRQVWLWXLH GRULQD GH D UH]HFD FkW PDL
PXOW vQ ]RQD YHUXPPRQWDQXP OLPLWD GLVWDO D XUHWUei prostatice),
dar care este foarte aproape de sfincterul striat, voluntar al uretrei.
/H]DUHDDFHVWXLDGXFHODRSHQLELOFRPSOLFDLHSHQWUXSDFLHQWGDU
L SHQWUX PHGLF L DQXPH LQFRQWLQHQD XULQDU. De aceea este
PDL ELQH V evaluezi bine situatia cnd rezeci un adenom. Dect
un sindrom TUR, mai bine un RE-TUR. Sau dect un incontinent
XULQDU PDL ELQH UH]HFL GH GRX RUL $GLF HVWH GH SUHIHUDW R
$
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UHLQWHUYHQLHGHFkWVULWLRFRPSOLFDLH
Deblocarea de col vezical sau TUR-$'. FRQVW n
UH]HFLD DGHQRFDUFLQRPXOXL GH SURVWDW 'HVLJXU, tratamentul de
HOHFLH SHQWUX QHRSODVPXO SURVWDWLF HVWH SURVWDWHFWRPLD UDGLFDO
&RQGLLDHVWHVVXUSULQ]LDIHFLXQHDvQVWDGLLOHLQLLDOHVLWXDLHFDUH
GLQSFDWHVHvQWkPSOPXOWSUHDUDU
0DMRULWDWHD SDFLHQLORU FX DGHQRFDUFLQRP GH SURVWDW VH
SUH]LQW OD PHGLF FX UHWHQLH FRPSOHW GH XULQ FkQG VWDGLXO
LQWHUYHQLHL UDGLFDOH HVWH GHSLW ILLQG QHFHVDU LQWHUYHQLD
SDOLDWLYGHEORFDUHHQGRVFRSLFGHFROYH]LFDOKRUPRQRWHUDSLH
5H]HFLD HVWH DVHPQWRDUH FX FHD a adenomului de
SURVWDW GDU HVWH PDL SXWLQ VkQJHUkQG VL IU SUHWHQLH GH D
DMXQJHODFDSVXO6HLQVWDOHD]RVRQG)ROH\HYHQWXDOFXGXEOX
FXUHQWFDUHVHPHQLQH]LOH
,QFL]LD WUDQVXUHWUDO GH SURVWDW (ITUP) sau incizia
colului vezical LPSOLF VHFLRQDUHD SULQ SURVWDWD REVWUXFWLY FX XQ
FXUHQWHOHFWULFGHvQDOWIUHFYHQIRORVLQGRDQV special.
$FHDVWWHKQLFHVWHDGHFYDWGRDUSURVWDWHORUPLFLFXXQ
col vezical nalt L IU ORE PHGLDQ 2 LQFL]LH HVWH HIHFWXDW GLQ
]RQD VLWXDW VXE RULILFLXO XUHWHUDO XQL VDX ELODWHUDO L H[WLQV SULQ
FROXO YH]LFDO SkQ OD FP SUR[LPDO GH YHUXPRQWDQXP (VWH
SRVLELO R VkJHUDUH SRVWRSHUDWRULH YDULDELO FD LQWHQVLWDWH PRWLY
SHQWUX FDUH LQWHUYHQLD HVWH XUPDW GH LQVHULD XQXL FDWHWHU
uretrovezical dotat cu sLVWHPGHLULJDLHYH]LFDOSHQWUXRSHULRDG
de 24-48 de ore.
5H]XOWDWHOH VXQW H[FHOHQWH FX R LQFLGHQ IRDUWH PLF D
FRPSOLFDLLORU HMDFXODUHD UHWURJUDG ILLQG vQUHJLVWUDW OD PDL SXLQ
GHGLQSDFLHQLLQFRQWLQHQXULQDUvQLPSRWHQvQ15%.

;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
ILHFDUH OXQ PJ VDX OD ILHFDUH VSWPkQL PJ

,QGLFDLL FDQFHU GH SURVWDW PHWDVWD]DW FDQFHU GH SURVWDW
ORFDO DYDQVDW FD R DOWHUQDWLY OD RUKLHFWRPLD ELODWHUDO
Tratamentul adjuvaQW DO SURVWDWHFWRPLHL UDGLFDOH HIHFWXDW vQ
stadiul local avansat.
5HDFLL DGYHUVH EXIHXUL VFGHUHD OLELGRXOXL VFGHUHD
WROHUDQHLODJOXFR]UDUJLQHFRPDVWLH
$VRFLDLLXWLOHantiandrogeni (Casodex).
2.ELIGARD /HXSURUHOLQ
3UH]HQWDUH IDUPDFHXWLF - liofilizat L VROYHQW SHQWUX VROXLH
LQMHFWDELOPJPJPJ
,QGLFDLL SHQWUX WUDWDPHQWXO FDQFHUXOXL GH SURVWDW
hormonodependent, n stadiu avansat.
Mod de administrare: (OLJDUGVHDGPLQLVWUHD] sub forma unei
sinJXUH LQMHFLL VXEFXWDQDWH 6ROXLD LQMHFWDW IRUPHD] XQ
GHSR]LW VROLG FX HOLEHUDUH SUHOXQJLW FDUH YD HOLEHUD FRQWLQXX
DFHWDWGHOHXSURUHOLQ
&RQWUDLQGLFDLL +LSHUVHQVLELOLWDWH OD DFHWDW GH OHXSURUHOLQ OD
DOLDJRQLWLDL*Q5+VDXODRULFDUHGLQWUHH[FLSLHQL/DSDFLHQLL
FDUH DX IRVW RUKLHFWRPL]DL vQ SUHDODELO FD L OD DOL DJRQLWL DL
GnRH, Eligard nu scade valorile plasmatice de testosteron mai
PXOW GHFkW vQ FD]XULOH GH FDVWUDUH FKLUXUJLFDO (OLJDUG HVWH
FRQWUDLQGLFDWODIHPHLLFRSLL
5HDFLL DGYHUVH EXIHXUL VWDUH GH UX RERVHDO L WUDQ]LWRU
LULWDLH ORFDO OD ORFXO LQMHFWULL /D DSUR[LPDWLY GLQWUH
SDFLHQLDSDUEXIHXULLPSRWHQVFGHUHDOLELGRXOXLDPEHOHFD
R FRQVHFLQ D VFGHULL FRQFHQWUDLHL SODVPDWLFH D
testosteronului HGHPH SHULIHULFH HPEROLH SXOPRQDU
SDOSLWDLL PLDOJLL KLSRWRQLH PXVFXODU IULVRDQH GLVSQHH YHUWLM
HUXS LL FXWDQDWH DPQH]LH WXOEXUUL GH YHGHUH L VHQVLELOLWDWHD
pielii.
,,,$QWDJRQLti LH-RH
1. Degarelix
Prezentare farmaceutica: )ODFRQFHFRQLQHPJGHJDUHOL[
VXEIRUPde acetat'XSUHFRQVWLWXLUHILHFDUHPOGHVROXLH
FRQLQHPJGHJDUHOL[
$FLXQH WHUDSHXWLF antagonist al hormonului eliberator de
JRQDGRWURILQ *Q5+ LQGLFDW SHQWUX WUDWDPHQWXO SDFLHQLORU
DGXOL GH VH[ PDVFXOLQ FX FDQFHU GH SURVWDW KRUPRQRdependent n stadiu avansat. Degarelix reduce cantitatea de
testosteron din organism si ncetineste dezvoltarea celulelor
canceroase.
!
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
Mod de administrare: 'R]D X]XDO LQFOXVLY SHQWUX batrni)

este de 5 mg de 2-3 ori pe zi
&RQWUDLQGLFDLL JODXFRP GLVXULH GDWRUDW XQXL VLQGURP
REVWUXFWLY KLSHUWURILH EHQLJQ GH SURVWDW VDX DOW FDX]
PLDVWHQLHVHYHUGLILFXOWDLGHIRUPDUHDMHWXOXLXULQDUGDWRUDWH
DGHQRPXOXL GH SURVWDW, boli intestinale (inclusiv REVWUXFLL
intestinale si colite), tiroide hiperactive, sarcina, perioada de
ODFWDLHLSHULRDGDGHSUHFRQFHSLHFRSLLVXEYkUVWDGHDQL
5HDFLL DGYHUVH: XVFFLXQHD JXULL FRQVWLSDLH YHGHUH
vQFHRDWVHQ]DLHGHUXGXUHULVDXDUVXULJDVWULFHvQURLUHD
IHHLvQVSHFLDOODFRSLLVLGLILFXOWLGHPLFLXQH
4. Mirabegron ( Betmiga)
3UH]HQWDUH IDUPDFHXWLF FRPSULPDWH FX HOLEHUDUH SUHOXQJLW
FHFRQLQUHVSHFWLYPJPLUDbegron.
$FLXQH WHUDSHXWLF Atunci cnd urina se acumuleaza n
YH]LFD XULQDU SUHGRPLQ VWLPXODUHD QHUYRDV VLPSDWLF FX
activarea receptorilor beta-DGUHQHUJLFL GLQ PXVFXODWXUD QHWHG
0LUDEHJURQ DFLRQHD] FD XQ DJRQLVW SRWHQW L VHOHFWLY DO
receptorilor beta 3-adrenergici determinnd relaxarea
musculaturii netede la nivelul vezicii urinare.
,QGLFDLL WUDWDPHQWXOVLPSWRPDWLFDOLPSHULR]LWLLPLFLRQDOHDO
IUHFYHQHL PLFLRQDOH FUHVFXWH LVDX DO LQFRWLQHQHL SULQ
LPSHULR]LWDWHPLFLRQDO
Mod de administrare: 'R]D UHFRPDQGDW HVWH GH PJ R
GDWSH]LFXVDXIUDOLPHQWH
&RQWUDLQGLFDLL KLSHUVHQVLELOLWDWHODVXEVWDQDDFWLY
5HDFLL DGYHUVH LQIHFLL GH WUDFW XULQDU WDKLFDUGLH GLVSHSVLH
urticarie.
XV. MEDI&$,$11(23/$608/'(35267$7
I. Analogi LH-RH
1. ZOLADEX *RVHUHOLQ
3UH]HQWDUH IDUPDFHXWLF implant ntr-R VHULQJ SUHXPSOXW
ntr-un ambalaj protector (3,6 mg; 10,8 mg);
$FLXQH WHUDSHXWLF prin administrarea de doze repetate
LQKLE VHFUHLD KLSRIL]DU GH /+ GHWHUPLQkQG VFGHUHD
FRQFHQWUDLHLSODVPDWLFHDWHVWRVWHURQXOXLODEUEDL'XS
GH ]LOH GH OD DGPLQLVWUDUHD SULPHL GR]H FRQFHQWUDLLOH
plasmatice ale testosteronului ating valori similare cu cele
LQGXVHGHFDVWUDUHDFKLUXUJLFDO
Administrare: LQMHFWDUH VXEFXWDQDW n peretele abdominal la
!
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IV.
1()52/,7,75,,$3(5&87$1$71/3
1HIUROLWRWRPLDSHUFXWDQDWHVWHRLQWHUYHQLHFKLUXUJLFDOPLQLP
LQYD]LYSULQFDUHVHSDWUXQGHFXQHIURVFRSXOSHUFXWDQDWSkQOD
QLYHOXO VLVWHPXOXL SLORFDOLFHDO XQGH VH UHSHUHD] L GLVWXJH SULQ
diferite metode (ultUDVRQLF EDOOLVWLF ODVHU FDOFXOL VLWXDL OD DFHVW
nivel.
,QGLFDLLOH1/3
x
Calcul bazinetal voluminos (peste 2-3cm) VDX OLWLD]

PXOWLSOORFDOL]DWvQED]LQHW
Calcul coraliform (NLP singur sau NLP + ESWL);
&DOFXODQFODYDWvQMRQFLXQHDSLHOR-XUHWHUDOFXULQLFKLPXW
urografic;
/LWLD] UHQDO XQLF VDX PXOWLSO VHFXQGDU VWHQR]HL

FRQJHQLWDOHVDXFkWLJDWHDMRQFLXQLLSLHOR-uretrale.
&RQWUDLQGLFDLLOH1/3
a) Absolute: WXOEXUULGHFRDJXODUHFHSUHGLVSXQODVkQJHUUL
JUDYHFRQWUROXOSHUDPHWULORUFRDJXOULLHVWHREOLJDWRULXFD
LSHQWUX(6:/856VDXWUDWDPHQWFKLUXUJLFDO
SDFLHQWHOHFXVDUFLQPDLDOHVvQSULPHOHOXQLSHQWUXF
H[LVWXQULVFFUHVFXWGHPDOIRUPDLLvn contextul expunerii
ODUDGLLLOH;SDFLHQLLQHFRRSHUDQLvQFRP
b) Relative: GLDEHWXO ]DKDUDW GHFRPSHQVDW DIHFLXQL FDUGLRUHVSLUDWRULL GHFRPSHQVDWH XOFHU GXRGHQDO vQ ID]D DFWLY
,QIHFLLOH XULQDUH QHVSHFLILFH QHWUDWDWH VDX QHFXQRVFXWH
anterior inteUQULL QHFHVLW XQ WUDWDPHQW LQWHQVLY FX
DQWLELRWLFH FRQIRUP DQWLELRJUDPHL vQDLQWH GH SURFHGXU
([LVWHQD XQXL SURFHV EDFLODU DFWLY VH VXSXQH DFHORUDL
UHJXOL DIHFLXQLOH FDUGLR-vasculare aflate sub tratament cu
anticoagulante (Trombostop), pot beneficia de tratament

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SULQ 1/3 GXS RSULUHD DQWLFRDJXODQWHORU FX ]LOH L

YHULILFDUHDULJXURDVDQRUPDOL]ULLSDUDPHWULORUFRDJXOULL
$7(17,(DQRPDOLLOHGHIRUPLSR]LLHDULQLFKLORUVHSRW
vQVRL GH DQRPDOLL GH YDVFXODUL]DLH GH H[ ULQLFKLXO vQ
potcoDY
,DWprincipalele etape ale procedurii:

DH]DUHDSDFLHQWXOXL vQSR]LLHJLQHFRORJLF
uretrocistoscopia care va vizualiza orificiul ureteral de

SDUWHD FDOFXOXOXL GDU VH YRU XUPUL L DOWH SRVLELOH OH]LXQL
asociate - ex: tumori vezicale);
instalarea unei sonde ureterale simple (5-&K SkQ vQ

ED]LQHWLLQMHFWDUHDVXEVWDQHLGHFRQWUDVWDPHVWHFDWFX
DOEDVWUX GH PHWLOHQ SHQWUX YL]XDOL]DUHD L GHVWLQGHUHD
sistemului pielo-caliceal;
UHSR]LLRQDUHD SDFLHQWXOXL SH PDVD GH RSHUDLH 'LQ

SR]LLDLQLLDOSDFLHQWXOHVWHDH]DWvQSR]LLHGHSURFXELW
FX SDUWHD SH FDUH VH DIO FDOFXOXO VSUH RSHUDWRU 6H
foloseste si pozitia de decubit dorsal in anumite situatii.
'H]LQIHFLDSLHOLLFXEHWDGLQLDH]DUHDFkPSXULORUVWHULOH
peste pacient sunt urPWRULLSDL
SXQFLD FDOLFHDO (VWH SXQFLRQDW GH RELFHL XQ FDOLFH

LQIHULRUGDUGDFVLWXDLDRLPSXQHLGDFHVWHSRVLELOH[
DERUGXO MRQFLXQLL SLHOR-XUHWHUDOH FDOFXOL LQFODYDL vQ
MRQFLXQHD SLHOR-XUHWHUDO VH SRDWH DERUGD L FDOLFHOH
mijlociu. 3XQFLD VH IDFH VXE FRQWURO IOXRURVFRSLF LVDX
HFRJUDILF /D SWUXQGHUHD vQ FDOLFH VH VFXUJH OLFKLGXO GLQ
sistemul pielo-FDOLFHDO VROXLD GH FRQWUDVW DOEDVWUX GH
PHWLOHQ &RQVLGHU F HFRJUDILD RIHU R RULHQWDUH VSDLDO
PDLEXQSULQHYLGHQLHUHDFDOLFHOXLSRVWHULRUSHUPLkQGR
!
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
Mod de administrare: 'R]DUHFRPDQGDWHGHPJRGDWSH

]L OD QHYRLH SRDWH IL PDULW OD PJ R GDWD SH ]L QX HVWH
QHFHVDU DMXVWDUHD GR]HL OD SDFLHQLL FX LQVXILFLHQ UHQDO
XRDUSkQODPRGHUDWFOHDUDQFHFUHDWLQLQD!POPLQ
&RQWUDLQGLFDLL 5HWHQLH GH XULQ PHJDFRORQ PLDVWHQLH
JODXFRP LQVXILFLHQ KHSDWLF VHYHU LQVXILFLHQ UHQDO
VHYHUEROQDYLVXEKHPRGLDOL]
5HDFLL DGYHUVH XVFFLXQHD JXULL GLVSHSVLH FRQVWLSDLH
WXOEXUULRFXODUH
2. Tolterodina
Prezentare farmaceutica: comprimate filmate de 1 respectiv 2
mg tolterodina
$FWLXQH WHUDSHXWLF
antagonist specific competitiv al
UHFHSWRULORUPXVFDULQLFLFHDFWLRQHD]VHOHFWLYDYkQGLQYLYRR
DILQLWDWH FUHVFXW SHQWUX UHFHSWRULL GH OD QLYHOXO YH]LFLL XULQDUH
IDGHFHLGHODQLYHOXOJODQGHORUVDOLYDUH
,QGLFDLL tratamentul vezicii urinare hiperactive cu simptome de
polakiurie si PLFLXQL LPSHULRDVHLQVRLWHGHLQFRQWLQHQ
Mod de administrare: 'R]D UHFRPDQGDW HVWH GH PJ GH
RUL SH ]L FX H[FHSLD SDFLHQLORU FX GLVIXQFLL KHSatice, la care
GR]DUHFRPDQGDWHVWHGHPJGHRULSH]L
&RQWUDLQGLFDLL 7ROWHURGLQDHVWHFRQWUDLQGLFDWODSDFLHQLLFX
UHWHQLHXULQDU; forme necontrolate de glaucom cu unghi nchis;
miastenia gravis; antecedente de hipersensibilitate la
WROWHURGLQ VDX H[FLSLHQL IRUPH JUDYH GH FROLW XOFHUDWLY;
megacolon toxic.
5HDFii adverse: XVFFLXQHD JXULL GLVSHSVLH VFGHUHD
ODFULPDLHLGLVSHSVLHFRQVWLSDLHGXUHULDEGRPLQDOHIODWXOHQ
YUVWXUL
3. Oxibutinina
3UH]HQWDUH IDUPDFHXWLF FRPSULPDWH FH FRQLQ PJ
R[LEXWLQLQFORUKLGUDW
$FLXQH WHUDSHXWLF
EORFKHD] DQXPLL UHFHSWRUL GLQ
RUJDQLVP QXPLL UHFHSWRULL PXVFDULQLFL 0 VL 0 /D QLYHOXO
YH]LFLL XULQDUH HIHFWXO HVWH GH UHOD[DUH D PXFKLORU FDUH
FRQWUROHD]PLFLXQHD$FHDVWDGHWHUPLQFUHWHUHDFDQWLWLL
GHXULQFDUHSRDWHILUHLQXWGHYH]LFDXULQDUVLPRGLILFDULDOH
PRGXOXLGHFRQWUDFWDUHDPXFKLORUYH]LFLLXULQDUHSHPDVXUFH
aceasta se umple.
,QGLFDLL LPSHULR]LWDWHXULQDUODfemeiFXVDXIUSLHUGHULGH
XULQ, n cazurile de YH]LF LQVWDELO FX H[FHSLD LQFRQWLQHQHL
urinare de efort - YH]LFDQHXURORJLF VSDVWLF
!
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
DULWPLLQHFRQWURODWHKLSRWHQVLXQHDUWHULDOPP+JVDX

FXKLSHUWHQVLXQHDUWHULDOQHFRQWURODWSDFLHQLLFDUHXWLOL]HD]
RULFHIRUPGHQLWUDWRUJDQLF
Reactii adverse: cele mai frecvente sunt cefaleea si dispepsia.
2. Avanafil
Prezentare farmaceutica: coprimate cu 50 mg substanta
activa
Actiune terapeutica:
inhibitor selectiv, reversibil al
fosfodiesterazei tip 5 (PDE5) cu specificitate pentru guanozin
monofosfatul ciclic (cGMP).
Indicatii: WUDWPHQWXOGLVIXQFLHLHUHFWLOHODEDUEDW
Mod de administrare: GR]D UHFRPDQGDW H GH PJFX
GH PLQXWH vQDLQWH GH DFWLYLWDWHD VH[XDO vQ IXQFLH GH
HILFDFLWDWHLWROHUDELOLWDWHGR]DSRDWHILFUHVFXWODPJVDX
VFD]XWODPJ
&RQWUDLQGLFDLL SDFLHQL FDUH XWLOL]HD] RULFH IRUP GH QLWUDW
RUJDQLFSDFLHQLFXDQJLQSHFWRUDOLQVWDELOSDFLHQLFDUHDX
avut infarct miocardic sau accident vascular cerebral n ultimele
6 lXQLSDFLHQLFXLQVXILFLHQUHQDOVDXKHSDWLFVHYHU
Reactii adverse: FHIDOHH KLSHUHPLH IDFLDO FRQJHVWLH QD]DO
SDOSLWDLLLQWROHUDQGLJHVWLY
3. Dapoxetina
3UH]HQWDUHIDUPDFHXWLF comprimate filmate de 30 si 60 mg.
$FLXQHWHUDSHXWLF inhiELWRULVHOHFWLYLDLUHFDSWULLVHURWRQLQHL
Indicatii: VH XWLOL]HD]D vQ WUDWDPHQWXO HMDFXOULL SUHFRFH OD
EDUEDLLFXYkUVWFXSULQVvQWUHLGHDQL
&RQWUDLQGLFDLL LQVXILFLHQDFDUGLDFDULWPLLFDUGLDFHSDFLHQLL
cu manie sau depresii severe, pDFLHQL VXE WUDWDPHQW FX
inhibitori ai monoaminooxidazei ( IMAO), linezolid, litiu,
tramadol.
5HDFLL DGYHUVH FRQYXOVLL KLSRWHQVLXQH DUWHULDO OLSRWLPLH
vertij, cefalee.
XIV. 0(',&$,$19(=,&$+,3(5$&7,9$
9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
SXQFLHPDLVLJXU

LQWURGXFHUHDILUXOXLJKLGSULQDFXOGHSXQFLH. Firul ghid

HVWH R VkUP VSHFLDO FX XQ FDSW PRDOH QHDJUHVLY L
FHOODOW FDSW ULJLG 6H LQWURGXFH SULQ OXPHQXO DFXOXL LDU
SDUWHD PRDOH VH YD vQFROFL vQ ED]LQHW LVDX FDOLFH VH
LQFL]HD] WHJXPHQWXO SH OkQJ DF DSUR[ FP GDU L vQ
SURIXQ]LPHGDFHVWHSRVLELOSkQODDSRQHYUR]
dilatarea traiectului de nefrostomie cu ajutorul unor

dilatatoare coaxiale (primul dilatator este introdus pe firul
ghid!). Ultimul dilatator este practic teaca nefroscopului
(26-28Ch).
nefroscopia, FDUH YL]XDOL]HD] vQ FRQGLLL EXQH FDOFXOXO

MRQFLXQHD SLHOR-XUHWHUDO VRQGD XUHWHUDO &KLDU GDF QH
SHUPLWH R YL]LELOLWDWH PDL EXQ KLSHUSUHVLXQHD SUHOXQJLW
SRDWH GXFH OD DEVRUELH FUHVFXW GH DS vQ FLUFXODLD
VDQJXLQFXHIHFWHDVHPQWRDUHFDODHQGRVFRSLDMRDV
liWRWULLD SURSULX-]LV SRDWH IL H[HFXWDW XOWUDVRQLF

HOHFWURKLGUDXOLF VDX EDOLVWLF OLWRWULLD LQWUD-FRUSRUHDO 'H
UXWLQVHXWLOL]HD]VRQRWURGXOFDUHDUHPXOWLSOHDYDQWDMH
IUDJPHQWHD] ELQH DUH VLVWHP GH DVSLUDLH FRQWLQX D
IUDJPHQWHORULULVFUHGXVGHOH]DUHDSHUHWHOXLFLLXULQDUH
(fig.VI.6).
'LVWUXJHUHD
FDOFXOXOXL
HVWH
XUPDW
GH
DVSLUDUHD
PLFURIUDJPHQWHORUVDXGHH[WUDFLDORUFXRSHQVULJLGFXJKHDUH
1. Vesicare ( Solifenacin)
GDF GLPHQVLXQLOH SHUPLW H[WUDJHUHD SH WHDFD QHIURVFRSXOXL
Prezentare IDUPDFHXWLF Comprimate filmate 5 mg, 10 mg;

cutie 3 blist. 10 comprimate
Solifenacinul este un antagonist
competitiv, specific, al receptorilor colinergici.
Indicatii: Tratamentul simptomatic al LQFRQWLQHQHL XULQDUH,
PLFLXQLIUHFYHQWHODSDFLHQLLFXYH]LFDKLSHUDFWLY
/LWRWULLD VH RSUHWH FkQG Falculul a fost distrus/extras complet,
!!
GDF DSDUH XQ LQFLGHQW QHSUHY]XW VkQJHUDUH VDX GDF QX PDL
pot fi extrase celelalte fragmente restante prin acest traiect.

9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
Fig.VI.6 /LWRWULLDLQWUDFRUSRUHDO cu ajutorul sonotrodului
2ULFH 1/3 VH WHUPLQ SULQ instalarea unei sonde de

nefrostomie prin teaca nefroscopului. Rolul nefrostomiei este de
D DVLJXUD HYDFXDUHD PLFLORU IUDJPHQWH UHVWDQWH L D FKHDJXULORU
GXS LQWHUYHQLH 6H SRW IRORVL vQ DFHVW VFRS L VRQGH DXWRVWDWLFH
cu balonet (care este umflat n bazinet). Nefrostomia are rol de
KHPRVWD] FRPSULPkQG WUDLHFWXO GH QHIURVWRPLH DYDQWDM SHQWUX
VRQGHOH FX EDORQHW FDUH GLQ PRWLY GH KHPRVWD] SRDWH IL
WUDFLRQDWXRUSHQWUXDH[HUFLWDRFRPSUHVLXQHLPDLEXQ
NLP supine :
n YDULDQWD FODVLF SHQWUX SUDFWLFDUHD 1/3 SDFLHQWXO HVWH
plasat n decubit ventral.
Q XOWLPLL DQL D FkWLJDW WHUHQ YDULDQWD GH DERUGDUH
SHUFXWDQDW D ULQLFKLXOXL OD SDFLHQWXO SODVDW vQ GHFXELW GRUVDO
(tehnica Valdivia), ce s-a dovedit a fi la fel de siguULHILFLHQWFD
YDULDQWDFODVLF
$YDQWDMHOH SR]LLHL GH GHFXELW GRUVDO VXQW WLPSXO RSHUDWRU
PDL VFXUW SRVLELOLWDWHD HIHFWXULL VLPXOWDQH D XUHWHURVFRSLHL
UHWURJUDGH VDX D XQHL LQWHUYHQLL ODSDURVFRSLFH L FRQIRUWXO VSRULW
SHQWUXSDFLHQWRSHUDWRULanestezist.

;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
FRQLQkQGHWDPVLODWJFXWLLFXEXF
$FLXQHWHUDSHXWLF$QWLKHPRUDJLFSULQPHQLQHUHDLQWHJULWLL
FDSLODUHORU UHGXFH WLPSXO GH VkQJHUDUH IU V DIHFWH]H
coagularea.
,QGLFDLL Profilaxia si tratamentul hemoragiilor prin ruptura de
vase mici vQSkQ]DvQFXUVXOLQWHUYHQLLORUFKLUXUJLFDOHVDX vQ
GLIHULWH VLWXDLL FOLQLFH - FLUR]D L KHSDWLWD FURQLF KHPRUDJLL
ginecologice, purpura, echimoze si hepatoame spontane,
epistaxis,
hemoragii
gingivo-dentare,
hemoragii
medicamentoase (prin anticoagulante sau antiinfiamatorii
nesteroidiene).
Mod
de
administrare:
,QMHFLL LQWUDPXVFXODUH VDX
intravenoase, 3 fiole (0,75 g) cu 1- RUH vQDLQWHD LQWHUYHQLLORU
FKLUXUJLFDOHHYHQWXDOvQF-ILROHvQWLPSXOVDXGXSRSHUDLH
vQ XUJHQH ILROH DSRL FkWH o fiola la 4-6 ore; doza de
vQWUHLQHUHRELVQXLWHVWHRILRODGHRUL]L
5HDFLL DGYHUVH 5DUHRUL KLSRWHQVLXQH WUHFWRDUH FHIDOHH
HUXSLLFXWDQDWH
&RQWUDLQGLFDLL 3UXGHQ VDX VH HYLW OD EROQDYLL FX DIHFLXQL
WURPERHPEROLFHILEULODLHDWULDOLDQJLQSHFWRUDO
XIII. 0(',&$,$1',6)81&7,$(5(&7,/I EJACULARE
PRECOCE
1. Cialis ( Tadalafil)
Prezentare farmaceutica: GLVSRQLELOVXEIRUPGHFRPSULPDWH
filmate de 2,5 PJPJPJLPJ
inhibitor selectiv, reversibil al
fosfodiesterazei tip 5 (PDE5) cu specificitate pentru guanozin
monofosfatul ciclic (cGMP).
Indicatii: 7UDWDPHQWXO GLVIXQFLHL HUHFWLOH OD EUEDLL DGXOL
Pentru ca tadalafil V ILH HILFDFH HVWH QHFHVDU SUH]HQD
VWLPXOULLVH[XDOH
Mod de administrare: IQ JHQHUDO GR]D UHFRPDQGDW HVWH GH
PJDGPLQLVWUDWvQDLQWHGHDFWLYLWDWHDVH[XDODQWLFLSDWL
LQGLIHUHQW GH LQJHVWLD GH DOLPHQWH /D SDFLHQLL OD FDUH WDGDODILO
10 mg nu produce un efect adecvat, se poate ncerca
administrarea a 20 mg. Medicamentul se poate administra cu
FHOSXLQPLQXWHvQDLQWHGHDFWLYLWDWHDVH[XDO
Contraindicatii: $OHUJLH OD WDGDODILO SDFLHQLL FX LQIDUFW
miocardic in ultimile 90 de zile, SDFLHQLL FXDQJLQLQVWDELOVDX
FX DQJLQ FDUH DSDUH vQ WLPSXO DFWXOXL VH[XDO paciHQLL cu
LQVXILFLHQ FDUGLDF &ODVD 1HZ <RUN +HDUW $VVRFLDWLRQ
1<+$ VDX PDL PDUH DSUXW vQ XOWLPHOH OXQL SDFLHQLL cu
!
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
L FURQLF WHODQJLHFWD]LD IDPLOLDO HSLVWD[LV VLQGURDPHOH

caSLODUH WR[LFH vQ LQWR[LFDWLL FX DUVHQ L EHQ]RO - hemoragii
FDSLODUH DOH DSDUDWXOXL UHVSLUDWRU L GLJHVWLY FLUR]H KHSDWLWH
hematemeze, hemoptizie, hemoragii retiniene, uterine.
'R]D SHQWUX DGXOL este de 1,5 mg de 1-3 ori/zi.
&RQWUDLQGLFDLL: Hemoragii masive prin ruptura de vase mari
(este ineficace).
,QWHUDFLXQLPHGLFDPHQWRDVH: Se poate asocia in perfuzie cu
analeptice, simpatomimetice, curarizante, barbiturice. Este
incompatibil cu vitamina C.
2. FITOMENADION
3UH]HQWDUHIDUPDFHXWLF)LROHDPOVROXLHDSRDV FRORLGDO
LQMHFWDELO FRQLQkQG ILWRPHQDGLRQ PJ FXWLH FX EXF
$FLXQH WHUDSHXWLF 9LWDPLQD . QDWXUDO DFLRQHD]
antihemoragic prin perfectarea sintezei hepatice a protrombinei
L D DOWRU IDFWRUL DL FRDJXOULL 9,, ,; L ; HIHFWXO HVWH UHODWLY
rapid - VHLQVWDOHD]vQ-4 ore - LQWHQVLSUHOXQJLW
,QGLFDLL ,QWR[LFDLH DFXW cu anticoagulante cumarinice;
SURILODFWLFVDXFXUDWLYvQDOWHVkQJHUULSULQKLSRSURWURPELQHPLH
sau hipovitamino] . vQ ERDOD KHPRUDJLF OD QRX-QVFXW vQ
FXUVXO WUDWDPHQWXOXL FX VDOLFLODL vQ LFWHUXO REVWUXFWLY vQ EROLOH
KHSDWLFH HILFDFLWDWHD HVWH VODE VDX LQWHVWLQDOH vQ FD]XO
folosirii ndelungate de antibiotice administrate oral, etc.
Mod de administrare: /D DGXOL RELQXLW LQWUDPXVFXODU -40
PJRGDWSH]LvQIXQFLHGHJUDYLWDWHvQXUJHQHLQWUDYHQRV
foarte lent, 2-PJ]LvQLQWR[LFDLDDFXWFXFXPDULQLFHVHSRW
LQMHFWD SkQ OD PJ]L OD QRX-QVFXL L VXJDUL FXUDWLY
intramuscular 1-2 mg/zi; profilactic, intramuscular 0,5-2 mg, oral
1-PJvQERDODKHPRUDJLF'R]DUHDSRDWHILFRQWURODWSULQ
timpul Quick sau prin trombotest.
5HDFLLDGYHUVH,QMHFWDUHDLQWUDYHQRDV UDSLG poate provoca
FRQJHVWLD IHHL VXGRUDLH VHQ]DLH GH FRQVWULFLH WRUDFLF
GLVSQHH FLDQR] WDKLFDUGLH FRODSV FKLDU DFFLGHQWH OHWDOH
IRDUWH UDU LQWROHUDQ FX IHQRPHQH GH RF OD QRX-QVFXL
ILWRPHQDGLRQD SRDWH IL FDX] GH KLSHUELOLUXELQHPLH UDUHRUL
&RQWUDLQGLFDLL ,QWROHUDQ OD ILWRPHQDGLRQ DWHQLH OD
VLPSWRPHOH GH RF SUXGHQ OD QRX-QVFXL L OD VXJDUL
6ROXLD LQMHFWDELO GH ILWRPHQDGLRQ QX WUHEXLH DPHVWHFDW FX
DOWHVROXLLSHQWUXLQMHFWDUHVDXSHUIX]LH
3. ETAMSILAT
3UH]HQWDUH IDUPDFHXWLF )LROH D PO VROXLH LQMHFWDELO
!
9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
3UDFWLFDUHD 1/3 vQ YDULDQWD 9DOGLYLD QHFHVLW vQV

HFKLSDPHQWUDGLRORJLFLPDVGHRSHUDLHSHUIRUPDQWHLDUSR]LLD
UHVSHFWLY RIHU XQ FkPS OLPLWDW SHQWUX SXQFLH H[SXQH SDFLHQWXO
XQXL ULVF GH OH]LXQH D RUJDQHORU LQWUDSHULWRQHDOH L OLPLWHD]
PDQHYUDELOLWDWHDLQWUDUHQDO
&RPSOLFDLLLQWUD- LSRVWLQWHUYHQLH
,QFLGHQWH
LQWUDRSHUDWRULL
SHUIRUDLD
ED]LQHWXOXL
(incident rar, datorat introducerii neadecvate a acului de

SXQFLHDILUXOXLJKLGVDXDGLODWDWRUXOXL3OJLOHMRQFLXQLL
pielo-ureterale (VH UH]ROY prin montarea unui stent
ureteral pentru 3-VSWPkQLQHIURVWRPLDPHQLQkQGX-se
3-4 zile).
Pierderea
traiectului
de
nefrostomie
SHUFXWDQ
intraoperator.
Pneumotorax/hidrotorax.
Acest
incident
apare
la
aproape un sfert din paciHQL GDF SXQFLD ULQLFKLXOXL V-a

efectuat deasupra coastei a XII-a. Leziuni ale organelor
adiacente rinichiului: FRORQILFDWVSOLQGXRGHQSHGLFXO
renal.
+HPRUDJLD LQWUDRSHUDWRULH L SRVWRSHUDWRULH sub1%

din cazuri), GDF KHPRUDJLD HVWH PDVLY poate avea risc
vital.
Hematuria poate apare LGXS 1-]LOHGHHYROXLH VLPSO
IULQFLGHQWH
V.
1()526720,$3(5&87$1$7
'HILQLLH 1HIURVWRPLD SHUFXWDQDW 163 UHSUH]LQW GHULYDLD

XULQDU H[WHUQ UHDOL]DW OD QLYHOXO ULQLFKLXOXL SH FDOH SHUFXWDQDW

9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
ORPEDU 3RDWH DYHD FDUDFWHU WHPSRUDU VDX GHILQLWLY L vQ
$FLXQHWHUDSHXWLFLQKLEDUHPDUFDW a factorului X ; DFLXQHD

GHLQKLEDUHDWURPELQHLHVWHVODEVDXQXO; efect inhibitor mai
VODEDVXSUDDFWLYULLLDJUHJULLSODFKHWHORU
,QGLFDLL profilaxia trombozelor venoase L D HPEROLLORU GH
FDX] PHGLFDO VDX FKLUXUJLFDO WUDWDPHQWXO WURPER]HL
YHQRDVH SURIXQGH DFXWH L D HPEROLHL SXOPRQDUH SUHYHQLUHD
FRDJXOULL n circuitul extracorporeal n timpul hemodializei n
LQVXILFLHQD UHQDO DFXW VDX FURQLF DQJLQD LQVWDELO L
infarctul miocardic non Q.
Mod de administrare: GR] SURILODFWLF VH DGPLQLVWUHD]
VXEFXWDQDW GR] VHULQJ SUHvQFUFDW GLQ RULFH SUHSDUDW
timp de 7-10 zile); GR]DFXUDWLY GR]ODRUH
&RQWUDLQGLFDLLhipersensibilitate, ulcer peptic acut, hemoragie
FHUHEUDO FRDJXORSDWLL JUDYH OH]LXQL L LQWHUYHQLL FKLUXUJLFDOH
SH61&RFKLXUHFKLDQWHFHGHQWHGHWURPERFLWRSHQLHPHGLDW
imunoloJLFLQGXVGHKHSDULQ
5HDFLL DGYHUVH UDU KHPRUDJLH WURPERFLWRSHQLH UHDFLL
DOHUJLFH UDUHRUL KLSHUNDOLHPLH IRDUWH UDU QHFUR] FXWDQDW OD
ORFXO LQMHFLHL L UHDFLL DQDILODFWLFH SUHFDXLL - n anestezia
HSLGXUDO UDKLGLDQ WURPERFLWRSHQLH ,+ I.R., hipertensiune
DUWHULDOQHFRQWURODWUHWLQRSDWLHKLSHUWHQVLYVDXGLDEHWLF. n
LQVXILFLHQD UHQDO supraveghere tratament cu heparine
IUDFLRQDWHSULQPVXUDUHDDFWLYLWLLDQWLIDFWRUXOXL;WHQGLQDOD
acumulare).
majoritatea cazurilor se H[HFXWvQFRQGLLLGHXUJHQ.

,QGLFDLL.
163WHPSRUDU VHLQGLFvQXUPWRDUHOHVLWXDLLSDWRORJLFH
-
n LQVXILFLHQD UHQDO DFXW REVWUXFWLY atunci cnd

cateterismul ureteral nu este posibil;
n FROLFD UHQDO KLSHUDOJLF UHIUDFWDU OD WUDWDPHQWXO

medical la care cateterismul ureteral este imposibil;
XUHWHURKLGURQHIUR]D
LQIHFWDW
atunci
cnd
cateterismul ureteral nu este posibil;

-
n leziunile ureterale iatrogene precoce sau tardive, cel

PDLIUHFYHQWGXSLQWHUYHQLLJLQHFRORJLFH
LQWHUYHQLLOH UHFRQVWUXFWLYH
DOH MRQFLXQLL SLHOR-
XUHWHUDOH XUHWHUXOXL VDX MRQFLXQLL XUHWHUR-vezicale pentru

SURWHFLD ]RQHL RSHUDWH FDUH UPkQH XVFDW L SHUPLWH
cicatrizarea mai UDSLG
-
de HYDOXDUHDIXQFLHLUHQDOHVHSDUDW
ca prim timp al nefrolitotomiei percutanate.
XII. HEMOSTATICE
NSP GHILQLWLY VH LQGLF vQ LQVXILFLHQD UHQDO FURQLF

REVWUXFWLY VHFXQGDU SDWRORJLHL WXPRUDOH SHOYLQH vezicoprostatice,
utero-ovariene,
recto-sigmoidiene)
atunci
cnd
FUHDWLQLQD GHSHWH PJ VDX H[LVW GH]HFKLOLEUH HOHFWUROLWLFH

LPSRUWDQWHKLSHUSRWDVHPLHDFLGR]PHWDEROLF
&RQWUDLQGLFDLL0DQHYUDQXSRDWHILSUDFWLFDWvQXUPWRDUHOH
VLWXDLL
-
SDFLHQLFXWXOEXUULQHFRUHFWDELOHDOHFRDJXOULL
paciHQLFXLQVXILFLHQUHVSLUDWRULHVHYHU
SDFLHQLQHFRRSHUDQL
Tehnica operatorie.

1. ADRENOSTAZIN
3UH]HQWDUHIDUPDFHXWLF POVROXLHDSRDV FRQLQHPJ
carbazocrom.
$FLXQHWHUDSHXWLF: Carbazocrom este un produs de oxidare
al adrenalinei. Este un hemostatic, produce diminuarea
permeabilitatii si cresterea rezistentei capilarelor. Administrat la
om reduce timpul de sangerare de la 200 secunde la 120-110
VHFXQGH 1RUPDOL]HD] WLPSXO GH VkQJHUDUH SUHOXQJLW vQ PRG
patologic. Adrenostazinul nu intervine n procesul de coagulare;
diferite teste de coagulare (timpul de coagulare, timpul de
SURWURPELQD HWF DX IRVW JVLWH QHPRGLILFDWH GXS
administrarea adrenostazinului.
,QGLFDLL prevenirea L WUDWDPHQWXO KHPRUDJLLORU FKLUXUJLFDOH
SURILODFWLF vQ LQWHUYHQLL FKLUXUJLFDOH FDUH H[SXQ OD KHPRUDJLL
FDSLODUH RUO XURORJLH FKLUXUJLH RVRDV L WRUDFR-SXOPRQDU SUHYHQLUHDLWUDWDPHQWXOKHPRUDJLLORUPHGLFDOHSXUSXUDDFXW
!$
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
GHvQMXPWLUHHVWHGHRUH
$FLXQH WHUDSHXWLF la SDFLHQLL FX IXQFLH UHQDO QRUPDO
FRQFHQWUDLLOH FHOH PDL PDUL UHDOL]kQGX-VH vQ VkQJH ILFDW L
rinichi.
,QGLFDLL urografii, computer tomografie cu suEVWDQ de
FRQWUDVW DQJLRJUDILL FX VXEVWDQH GLJLWDO IOHERJUDILL
KLVWHURVDOSLQJRJUDILL ILVWXORJUDILL DUWHULRJUDILL L vQ VSHFLDO
angiocardiografii.
Mod de administrare: - GR]D QHFHVDU pentru urografii este
de: 1,3 ml/kgc Ultravist 240; 1 ml/kgc Ultravist 300; 0,8
ml/kgc Ultravist 370.
&RQWUDLQGLFDLL hipertiroidism.
5HDFLL DGYHUVH JUHD YUVWXUL HULWHP VHQ]DLH JHQHUDO
GH FOGXU 8OWUDYLVWXO HVWH vQ JHQHUDO ELQH WROHUDW FKLDU L OD
SDFLHQLL FDUH DX SUH]HQWDW vQ DQWHFHGHQWH UHDFLL alergice la
VXEVWDQHGHFRQWUDVW
4. Visipaque ( Iodoxanol)
3UH]HQWDUHIDUPDFHXWLF IODFRDQHFXVROXLHLQMHFWDELOSHQWUX
administrare LQWUDYHQRDV VL LQWUDDUWHULDO GH L
PO FX FRQFHQWUDLL GH PJ ,PO PJ ,POVL PJ
I/ml.
,QGLFDLL compus organic, iodat, utilizat pentru urografii i.v.,
DQJLRFDUGLRJUDILLDRUWRJUDILLDUWHULRJUDILHFHUHEUDO
Mod de administrare: 'R]D DGPLQLVWUDW HVWH LQ IXQFLH GH
WLSXO GH H[DPLQDUH YkUVW JUHXWDWH GHELWXO FDUGLDF L VWDUHD
JHQHUDO D SDFLHQWXOXL FkW L GH WHKQLFD XWLOL]DW DVWIHO SHQWUX
urografie 270/320 mgI/ml 40-80 ml, flebografie 270 mgI/ml 50150 ml/mb. inf., CT corp 270/320 mgI/ml 75-150 ml . Doza de
270 mg I/ml este recomandata in cele mai multe cazuri.
&RQWUDLQGLFDLL 7LUHRWR[LFR] PDQLIHVW LQVXILFLHQ FDUGLDF
GHFRPSHQVDW
5HDFLL DGYHUVH VHQ]DLH GH FDOGXU GH UHFH VDX GXUHUH OD
ORFXO LQMHFWULL WXOEXUUL GH YHGHUH FHIDOHH JUHDD YUVWXUL L
WXOEXUUL GH JXVW 3RW DSUHD GH DVHPHQHD UHDFLL FXWDQDWH
prurit, parosmie, angioedem si simptome respiratorii.
XI. ANTICOAGULANTE
1. HEPARINE FXPDVPROHFXODUPLF
3UH]HQWDUH IDUPDFHXWLF VHULQJL SUHvQFUFDWH FX R GR] de
DQWLFRDJXODQW(12;,3$5,1 POPJ)5$;,3$5,1
0,3 ml 36 mg sau 2850 UI; CLIVARIN 0,25 ml 13,8 mg,
sau 1750 UI; INNOHEP 0,3 ml 20,83 mg 3500UI.
!
9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
(VWH DEVROXW QHFHVDU H[LVWHQD XQHL VOL GH RSHUDLL

HQGRXURORJLFH SUHY]XW FX PDV RSHUDWRULH UDGLRORJLF DSDUDW
UDGLRORJLF PRELO FX EUD vQ & HFRJUDI RSHUDWRU L instrumentar
specific.
3DFLHQWXO vQ DQHVWH]LH UHJLRQDO UDKLGLDQ SHULGXUDO VDX
JHQHUDO HVWH SR]LLRQDW vQ GHFXELW YHQWUDO SH PDVD GH RSHUDLH
H[FHSLHIDFJUDYLGHOHFDUHVHYRUSR]LLRQDvQGHFXELWODWHUDO
Timpii operatori. n cazul unei nefrostomii temporare se
SUHIHU PRQWDUHD XQHL QHIURVWRPLL D PLQLPD GH 8 Ch respectnd
XUPWRULLSDL
- SXQFLDHFRJKLGDWDVLVWHPXOXLSLHORFDOLFHDOFXXQDFILQ
* PP L H[WUDJHUHD GH XULQ GLQ VLVWHP FRQILUP SXQFLD
FRUHFW
- VH LQWURGXFH VXE FRQWURO UDGLRORJLF R VROXLH VHU IL]LRORJLFcolorant-VXEVWDQGHFRQWUDVWvQVLVWHPXOSLHORFDOFHDO
- FX XQ DF * PP L VXE FRQWURO IOXRURVFRSLF VH
SXQFLRQHD]JUXSXOFDOLFHDOLQIHULRUSRVWHULRU
- GXSVFRDWHUHDPDQGUHQXOXLDFXOXLVHH[WHULRUL]HD]XULQDFX
FRORUDQWGHFLDYHPRSXQFLHFRUHFWLVHLQVHUSHDFXQILUJKLG
SkQvQVLVWHPXOSLHORFDOLFHDOVDXXUHWHU
- VXE FRQWURO IOXRURVFRSLF L SH ILUXO JKLG VH SUDFWLF GLODWDLD
traiectului cu dilatatoare flexibile de teflon 5-7-9-11 Ch;
- VH LQVHU VRQGD GH QHIURVWRPLH &K vQ VLVWHPXO
pielocaliceal, se extrage firul ghid;
- H[WHULRUL]DUHD GH XULQ-contrast-FRORUDQW SH VRQG L
HYLGHQLHUHD IOXRURVFRSLF D EXFOHL VRQGHL vQ VLVWHP FRQILUP
SR]LLRQDUHDFRUHFWDQHIURVWRPLHL
- IL[DUHDVRQGHLFXILUHGHDODSLHOH

9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
QFD]XOSR]LLRQULLXQHLQHIURVWRPLLGHILQLWLYHVHXWLOL]HD]FD
VRQG XQ FDWHWHU )ROH\ &K 7HKQLFD RSHUDWRULH HVWH DFHLDL
ILLQG vQV QHFHVDU GLODWDLD VXSOLPHQWDU D WUDLHFWXOXL GH
nefrostomie cu dilaWDWRU D[LDO EXWRQDW $ONHQ SH FDUH VH LQVHU
succesiv
tecile dilatatoare 9-12-15-18-21- &K L vQ ILQDO
semiteaca Hutschenreiter (26 Ch) pe care se introduce sonda

Foley.
&RPSOLFDLL. Pot fi multiple dar din fericire sunt rare, invers
SURSRULRQDOH FX H[SHULHQD vQ FKLUXUJLD SHUFXWDQDW 0HULW D IL
PHQLRQDWHFHOHPDLIUHFYHQWH
-
hemoragia intra- VLH[WUDUHQDO
SHUIRUDLDED]LQHWXOXL
le]LXQLOH RUJDQHORU GH YHFLQWDWH: peritoneul parietal

posterior, colonul, ficatul, splina, etc.;
GHSR]LLRQDUHDQHIURVWRmiei.
ngrijirea nefrostomiei6XSUDYHJKHUHDLPHGLDWDSDFLHQWXOXL
FX QHIURVWRPLH LPSOLF PVXUL JHQHUDOH FOLQLFH FXUE WHUPLF
SXOV WHQVLXQH DUWHULDO HWF L VSHFLILFH GH ODERUDWRU
KHPROHXFRJUDP FUHDWLQLQ LRQRJUDP VDQJXLQ HWF2GDWD
drenajul urinar constituit ne asteptam la o tendinta de normalizare
a functiei renale.
6HLPSXQLFkWHYDPVXULGHPRQLWRUL]DUHORFDO
- FRQWUROXO SOJLL RSHUDWRULL D DQFRUDMXOXL VRQGHL L D
pansamentului, existind posibilitatea infiltrarii pansamentului cu
urina in cazul depozitionarii/infundarii sondei.
- FRQWUROXODVSHFWXOXLXULQLLGHRELFHLVHOLPSH]HWHvQRUHGXSPDQHYU
- FRQWUROXOGLXUH]HLSHVRQGH[LVWLQGULVFXOXQHLHYHQWXDOH
FROPDWDULFXFKHDJXULVDXGRSXULGHSXURL

;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
;68%67$1('(&2175$67
1.OMNIPAQUE (Iohexolum):
3UH]HQWDUHIDUPDFHXWLFOmnipaque 180 flac 10 ml sau 15
PO VRO LQM FRQLQH PJ,PO; Omnipaque 240 fl. a 15, 50,
POVROLQMFDUHFRQLQHPJ,PO; Omnipaque 300
IO D PO VRO ,QM FRQLQkQG PJ,PO;
Omnipaque 350 fl. a 20, 50, 100, 200 ml VRO ,QM FRQLQkQG
350 mgI/ml.
$FLXQHWHUDSHXWLFLLQGLFDLLcompus organic, iodat, utilizat
pentru urografii i.v., angiocardiografii, aortografii, arteriografie
FHUHEUDO
Mod de administrare: pentru urografii se poate folosi
Omnipaque 350 IO PO LY VDX FRQIRUP UHFRPDQGULL
radiologului.
5HDFLL DGYHUVH FRQJHVWLD SLHOLL VHQ]DLH GH FDOG JUHD
UHDFLLDQDILODFWLFHSkQODVWDUHGHRF
2. IOPAMIRO: (Iopamidol)
3UH]HQWDUHIDUPDFHXWLF: ILROHDPOVROLQMFRQLQkQG
,RSDPLGROFRUHVSXQ]WRUDPJ,POILROHIODFRDQH
DPOPOPOVDXPOVROLQMFRLQkQG
FRUHVSXQ]kQGDPJ,POILROHIODFRDQH 10 ml, 30
POPOVDXPOVROLQMFRQLQknd 75,5 % corespunznd la
370 mgI/ml.
$FLXQH WHUDSHXWLF L LQGLFDLL produs organic de contrast
WULLRGDW L KLGURVROXELO XWLOL]DW vQ FDUGLRORJLH LQWHUYHQLRQDO
XURORJLHLODPLHORJUDILH
0RG GH DFLXQH SHQWUX XURJUDILL VH SRW IRORVL ILROH L
-100 ml, maxim 200 ml pentru adult administrat i.v.
5HDFLL DGYHUVH FHIDOHH JUHD YUVWXUL GLVSQHH
KLSRWHQVLXQH RUWRVWDWLF VHQ]DLH GH FDOG UHDFLL DOHUJLFH
&RQWUDLQGLFDLL SUXGHQ VDX HYLWDUHD XWLOL]ULL OD SDFLHQLL FX
UHDFLL QHGRUite la iod n antecendente, la alergici, astmatici; la
SDFLHQLL FX LQVXILFLHQ KHSDWR-UHQDO JUDY SUXGHQ vQ
LQVXILFLHQ KHSDWLF VHYHU LQVXILFLHQ UHQDO PRGHUDW
VHYHU LQVXILFLHQ FDUGLDF EROL VLVWHPLFH GLDEHW PLHORP
multiplu; dezechilibrele hidroelectolitice trebuie corectate;
LQWHUIHUFXWHVWXOFXLRGUDGLRDFWLY-3 luni.
3. ULTRAVIST:
3UH]HQWDUH IDUPDFHXWLF IODFRDQH PO VRO LQM DSRDV
FRQLQkQG ,RSUDPLG JPO 8OWUDYLVW ; Iopramid 0,623
g/ml (Ultravist 300); Iopramid 0,769 g/ml (Ultravist 370); timpul
!
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
dismenoree.
Mod de administrare: oral 1 cpx3-]L LQM ILRO x 2-3 / zi la
nevoie
&RQWUDLQGLFDLL hipersensibilitate la Ketorolac, ulcer gastroGXRGHQDO DFWLY WXOEXUUL DOH KHPDWRSRH]HL GH HWLRORJLH
QHFXQRVFXW ,5 VHYHU FRSLL VXE DQL WULPHVWUXO DO ,,,-lea
GH VDUFLQ WUDYDOLX DOptare; SUHFDXLL DVWP EURQLF
antecendente de ulcere gastroduodenale, Boala Crohn,
KLSHUWHQVLXQH DUWHULDO GLVFUD]LL VDQJXLQH GLDEHW ]DKDUDW
5HDFLL DGYHUVH JUHD YUVWXUL GLDUHH HSLJDVWUDOJLL
VkQJHUULGLJHVWLYHHUXSLLFXWDQDWHGHUPDWLWH[IROLDWLY
FHIDOHHYHUWLMVRPQROHQQHIULWLQWHUVWLLDOWURPERFLWRSHQLH
anemie, hiperglicemie.
,QWHUDFLXQL PHGLFDPHQWRDVH asocierea cu alte AINS sau
glucocorticoizi ULVF GH VkQJHUDUH GLJHVWLY DVRFLHUHD FX
DQWLFRDJXODQWH L DQWLDJUHJDQWH FUHWH ULVFXO GH VkQJHUDUH
DVRFLHUHD FX ,(&$ ULVF GH LQVXILFLHQ UHQDO DFXW FUHWH
FRQFHQWUDLDSODVPDWLFDGLJR[LQHLLULVFXOHIHFWHORUWR[LF
Sonda de QHIURVWRPLHWHPSRUDUVHVXSULPvQPRPHQWXOvQFDUH
3.DICLOFENAC:
3UH]HQWDUHIDUPDFHXWLFdrajeuri 50 mg; sup 100 mg.
$FLXQH WHUDSHXWLF antiinflamator, antalgic L DQWLSLUHWLF GLQ
clasa AINS nesteroidiene.
,QGLFDLL SROLDUWULWD UHXPDWRLG VSRQGLODUWULWD DQFKLORSRHWLF
DIHFLXQL UHXPDWLFH H[WUDDUWLFXODUH FROLFL QHIUHWLFH VWUL
LQIODPDWRULL GXUHURDVH SRVWRSHUDWRU SRVWWUDXPDWLFH LQIODPDLL
dureroase vQVIHUDSHOYLQ
Mod de administrare: oral 1 drajeux3/zi la nevoie, ulterior 1-2
GUDMHXUL]LGXSPDVLQWUDUHFWDOVXS]LVHDUD
5HDFLL DGYHUVH JUHD GLDUHH HSLJDVWUDOJLL VkQJHUUL
GLJHVWLYH PLQRUH HUXSLL FXWDQDWH FHIDOHH DPHHOL IRDUWe rar
UHDFLL DQDILODFWLFH WXOEXUUL DOH KHPDWRSRLH]HL DGPLQLVWUDUH
vQGHOXQJDW QHIULW LQWHUVWLLDO DGPLQLVWUDUHD LQWUDUHFWDO
SUXULWVHQ]DLHGHDUVXUWHQHVPH
&RQWUDLQGLFDLL XOFHU JDVWURGXRGHQDO DFWLY VkQJHUUL
gastrointestinale,
leucopenie,
trombocitopenii,
porfirie,
LQWROHUDQODDQWLLQIODPDWRULLLQKLELWRDUHGH&2SUXGHQvQFD]
de antecedente ulceroase la astmatici, la cardiaci, la renali, n
,+ 1X VH DGPLQLVWUHD] vQ XOWLPXO WULPHVWUX GH VDUFLQ L OD
termen.
,QWHUDFLXQL PHGLFDPHQWoase: asocierea cu glucocorticoizii
FUHWH ULVFXO GH VkQJHUDUH GLJHVWLY L D XOFHUXOXL FUHWH
FRQFHQWUDLD SODVPDWLF D OLWLXOXL L D GLJR[LQHL VFDGH HIHFWXO
IXURVHPLGXOXLLDPHGLFDLHLDQWLKLSHUWHQVLYH
OD QLYHOXO XUHWHUXOXL SH XURJUDILHXUHWHURSLHORJUDILH UHWURJUDG
!
tractul urinar este permeabil. n cazul nefrostomiei definitive sonda

)ROH\ VH VFKLPE SHULRGLF OD OXQL VDX PDL GHYUHPH GDF VH
FROPDWHD]
VI.
URETEROSCOPIA
8UHWHURVFRSLD UHSUH]LQW R LQWHUYHQLH HQGRVFRSLF FH

SUHVXSXQHLQVSHFWDUHDXUHWHUXOXLFXDMXWRUXOXUHWHURVFRSXOXLGDUL
tratamentul
afecLXQLORU DVWIHO GLDJQRVWLFDWH calculi,
tumori,
stenoze) situate la acest nivel.

,QGLFDLLOHXUHWHURVFRSLHL
$ ,QGLFDLL GLDJQRVWLFH evaluarea unui "defect de
XPSOHUH LPDJLQH ODFXQDU vQFRQMXUDW GH VXEVWDQ GH FRQWUDVW
evaluarea unei hematurii macroscopice unilaterale; identificarea
XQHLWXPRULXURWHOLDOHvQFD]GHFLWRORJLHXULQDUVHOHFWLYSR]LWLY
FX XURJUDILH QRUPDO ELRSVLD IRUPDLXQLL WXPRUDOH OD YHGHUH
VXSUDYHJKHUHD HQGRVFRSLF GXS XQ WUDWDPHQW FRQVHUYDWRU
HOHFWURUH]HFLH D XQHL WXPRUL XUHWHUDOH VDX GXS RSHUDLL
conservatoare clasice.
B. ,QGLFDLLWHUDSHXWLFH
Patologia litLD]LF
vQGHSUWDUHD FDOFXOLORU XUHWHUDOL vQ VSHFLDO FHL XUHWHUDOL

pelvini sau iliaci);
vQGHSUWDUHD IUDJPHQWHORU GH FDOFXOL UH]XOWDWH vQ XUPD

(6:/
FDUH
IRUPHD]
vPSLHWUXLUHD
XUHWHUDO
("steinestrasse");
3DWRORJLDGLYHUVDOWDGHFkWFHDOLWLD]LF
HOHFWURUH]HFLD WUDQVXUHWUDO D XQHL WXPRUL GH XURWHOLX
$
9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
VXSHUILFLDOVLWXDWSHXUHWHU

instalarea unei sonde ureterale "la vedere" n caz de

REVWUXFLH VDX ILVWXO XUHWHUDO GLODWDUHD VDX LQFL]LD
stenozelor ureterale;
tratamentul
endoscopic
al
stenozelRU GH MRQFLXQH
pieloureterale congenitale;

extragerea unei sonde ureterale autostatice (tip "JJ")

DVFHQVLRQDW SH XUHWHU VDX D XQXL IUDJPHQW GH VRQG
XUHWHUDOFHV-a rupt n ureter).
&RQWUDLQGLFDLLOH85(7(526&23,(,856
Sunt similare cu cele ale nefrolitotomiei percutane, pe
care le reamintim succint:
&RQWUDLQGLFDLL DEVROXWH WXOEXUUL GH FUD] VDQJXLQ SDFLHQW
FRPDWRVQHFRRSHUDQWVDUFLQ
&RQWUDLQGLFDLL UHODWLYH 7%& DFWLY LQIHFLL nespecifice netratate,
tratament
prelungit
cu
anticoagulante,
diabet
zaharat
GHFRPSHQVDW DIHFLXQL FDUGLR-respiratorii decompensate, ulcer

GXRGHQDO vQ ID]D DFWLY +7$ QHFRQWURODW UHLPSODQWDUH XUHWHURYH]LFDOvQDQWHFHGHQWHOREPHGLDPSURVWDWLFYROXPLQRVFDUHIDFH
LPSRVLELOVDXGLILFLODERUGXORULILFLXOXL ureteral.
Etapele ce trebuie parcurse n cadrul ureteroscopiei
retrograde sunt:
- cistoscopia de evaluare a veziFLLLDRULILFLLORUXUHWHUDOH
-introducerea
XUHWHURVFRSXOXL vQ YH]LF DSRL
ureter
DVFHQGHQW UHWURJUDG 'DF RULILFLXO HVWH VXILFLHQW GH ODUJ VDX

pacientului i s-DPRQWDWDQWHULRU RVRQG --DFHDVWHWDSHVWH
UHODWLY IDFLO 'DF RULILFLXO XUHWHUDO HVWH VWUkPW VH SURFHGHD] OD
GLODWDUHD OXL vQ IXQFLH GH LQVWUXPHQWDUXO DYXW OD GLVSR]LLH L
GHVLJXUH[SHULHQDXURORJXOXL

cistinice; alcanizarea urinii n cursul tratamentului cu uricozurice

LFitostatice; WUDWDPHQWXOVLPSWRPHORUvQSRUILULDFXWDQDW
Mod de administrare: RUDOGR]DVHDMXVWHD] vQIXQFLHGHS+ul urinar (determinat nainte de fiecare administrare), doza
PHGLHPVXULUDVHGH8UDO\W U granule orale.
&RQWUDLQGLFDLL
hipersensibilitate,
I.H.,
hipotensiune
RUWRVWDWLFUHWHQLHKLGURVDOLQ
5HDFLLDGYHUVHIRDUWHUDULQWROHUDQ JDVWULF
Asocieri medicamentoase: Allopurinol n litiaza
XULF
IX. ANTIINFLAMATORII
1. VIMOVO
3UH]HQWDUH IDUPDFHXWLF: comprimate cu eliberare PRGLILFDW
FHFRQLQQDSUR[HQPJVLHVRPHSUD]ROPJ
$FLXQH WHUDSHXWLF
naproxenul este un antiiflamator
QHVWHURLGLDQ FH UHGXFH GXUHUHD VL LQIODPDLD vQ WLPS FH
HVRPHSUD]ROXO UHGXFH VHFUHLD DFLG JDVWULF DVWIHO DMXW OD
reducerea riscului de aSDULLH D XOFHUXOXL OD SDFLHQLL OD FDUH VH
administreaza AINS.
Indicatii FROLFD QHIUHWLF DUWUR]D SROLDUWULWD UHXPDWRLG
VSRQGLOLWDDQFKLOR]DQW
Mod de administrare: Un comprimat la 12 ore
Contraindicatii: alergie la naproxen sau esomeprazol,
WUDWDPHQW FX DWD]DQDYLU VL QHOILQDYLU IHPHL JUDYLGH SDFLHQL
FXQRVFXLFXXOFHUJDVWULF
5HDFLL DGYHUVH FHIDOHH IDWLJDELOLWDWH VHQ]DLH GH VHWH
WUDQVSLUDLLH[FHVLYHLQVRPQLDSDOSLWDLLYHUWLMJUHD
InteraFLXQL PHGLFDPHQWRDVH 'DWRULW OHJULL SXWHUQLFH GH
SURWHLQHOH SODVPDWLFH D QDSUR[HQXOXL SDFLHQLL FDUH SULPHVF
simultan KLGDQWRLQH WUHEXLH DWHQW PRQLWRUL]DL SHQWUX R
HYHQWXDO DMXVWDUH D GR]HL &D L DOWH $,16 QDSUR[HQ VRGLF
SRDWH FUHWH ULVFXO DIHFWULi renale asociat cu utilizarea IECA.
(VWH QHFHVDU SUXGHQ vQ FD]XO SDFLHQLORU DIODL vQ WUDWDPHQW
FXFLFORVSRULQ WDFUROLPXVGLXUHWLFHGHDQVGLXUHWLFHWLD]LGLFH
LGLJR[LQ
2. KETOROLAC (Ketanov):
3UH]HQWDUH IDUPDFHXWLF cp 10 mg; fiole 1 ml, 30 mg/ml.
$FLXQH WHUDSHXWLF antiinflamator, antialgic L DQWLSLUHWLF GLQ
clasa AINS nesteroidiene.
,QGLFDLL
FROLF
QHIUHWLF
GXUHUHD
SRVWWUDXPDWLF
SRVWFKLUXUJLFDO GXUHUHD DFXW GLQ EROLOH LQIODPDWRULL FURQLFH

;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
atrio-YHQWULFXODUJU,,VDX,,,RIDWXOHVWHFRQWUDLQGLFDWWLPSGHR
RU GXS DGPLQVWUDUH LY SUHFDXLL vQ VDUFLQ L DOSWDUH vQ
asociere cu levodopa.
5HDFLL DGYHUVH FHIDOHH YHUWLM SDOSLWDLL JUHD KLSRWHQVLXQH
RUWRVWDWLFGXSDGPLQLVWUDUHDLY
Asocieri medicamentoase: antiinflamatorii nesteroidiene n
FROLFDQHIUHWLF
VII. INHIBITORII DE XANTIN-2;,'$=
ALLOPURINOL:
3UH]HQWDUHIDUPDFHXWLF cps 10 mg
$FLXQHWHUDSHXWLFLQKLE xantinoxidaza diminund formarea
acidului uric.
,QGLFDLL- WUDWDPHQWXO OLWLD]HLXULFHJXWDFURQLF OD bolnavii cu
leucemie, limfoame, alte boli canceroase, sub tratament cu
citostatice sau terapie.
Mod de administrare: oral 1 cp x ]L GXS mese; la boli
canceroase cu valori foarte mari ale acidului uric se pot
administra 4-6 cp/zi.
&RQWUDLQGLFDLL - LQWROHUDQ OD DOORSXULQRO FUL]D GH JXW
KHPRFURPDWR] LGLRSDWLF vQ VDUFLQ L SH GXUDWD DOSWULL
5HDFLL DGYHUVH HUXSLL FXWDQDWH IHEU DOHUJLF DWUDOJLL
HR]LQRILOLH RFD]LRQDO HSLJDVWUDOJLL IHEU YUVWXUL GLDUHH
dureri abdominale, cefalee, DPHHOL VRPQROHQ OHXFRSHQLH
fenomene hepatotoxice.
,QWHUDFLXQL
PHGLFDPHQWRDVH
LQKLE
metabolizarea
mercapto-SXULQHL
D]DWLRSULQHL
LQKLE
PHWDEROL]DUHD
anticoagulantelor orale; se reduce doza de AC sub controlul
SURWURPELQHL 1X VH DVRFLD] FX XULFR]XULFH SHQWUX F FUHVF
HOLPLQDUHDGHDOORSXULQRO1XVHDVRFLD]FXDPSLFLOLQD risc de
UHDFLL FXWDQDWH $VRFLHUHD FX FORUSURSDPLGH SRDWH IDYRUL]D
UHDFLLKLSRJOLFHPLFHSUHOXQJLWHPDLDOHVODSDFLHQLLFX,5
Asocieri medicamentoase: cu alcalinizante urinare n
tratamentul litiazei urice.
VIII. ALCANIZANTE URINARE
URALYT U:
3UH]HQWDUHIDUPDFHXWLFflacoane JFRQLQkQGJUDQXOH
RUDOH GH KLGURJHQRFLWUDW GH SRWDVLX L VRGLX OLQJXUL
dozatoare + calendar de control + hrtie indicator).
$FLXQH WHUDSHXWLF : alcanizarea urinii, favoriznd dizolvarea
FDOFXOLORUGHDFLGXULFLSUHYHQLUHDUHIDFHULLORU
,QGLFDLL OLWLD]D XULF; tratament adjuvant al litiazei urinare

9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
-vizualizarea calculului;
-extragerea sau prelucrarea calculilor. n cazul n care calculul
YL]DW DUH GLPHQVLXQL PLFL VXE PP HO SRDWH IL vQGHSUWDW FX
pensa de calcul sau cu sonda Dormia R VRQG VSHFLDO IRORVLW
SHQWUX H[WUDJHUHD GH FDOFXOL VDX IUDJPHQWH (D DUH vQ FDSW XQ
FRXOH IRUPDW GLQ -6 spire, care cnd se strng cuprind calculul
SHFDUHYUHPV-OH[WUDJHP8QHRULVRQGD'RUPLDHVWHWUHFXWSULQ
canalul secundar de lucru al ureteroscopului, pentru a fixa calculul,
HIHFWXkQG OLWRWULLD LQWUDFRURSRUHDO vQWUH ILUHOH PHWDOLFH DOH
FRXOHXOXL 'RUPLD &alculii cu dimensiuni mai mari vor fi
GH]LQWHJUDL KLGUDXOLF SQHXPDWLF XOWUDVRQLF VDX ODVHU L DSRL
H[WUDL VXE IRUP GH IUDJPHQWH FX SHnsa de calculi. Riscul de
PLJUDUH DVFHQGHQW D FDOFXOXOXL HVWH SUHYHQLW LQVWDOkQG R VRQG
XUHWHUDO VSHFLDO FX EDORQ FDUH VH XPIO GHDVXSUD REVWDFROXOXL
litiazic (fig.VI.7).
-protezarea ureterului cu sonda "JJ". 'DF SUHOXFUDUHD VDXL
evacuarea fragmenWHORUDIRVWPDLGLILFLOVDXDXUPDVIUDJPHQWH
pe ureter, instalarea unei sonde ureterale autostatice pentru 48 ore
HVWH EHQHILF LQVWDOkQGX-VH vQ DFHODL WLPS L R VRQG YH]LFDO
pentru a preveni refluxul vezico-ureteral.
Fig.VI.7 Introducerea ureteroscopului n ureter

9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
&RPSOLFDLLOHXUHWHURVFRSLHLUHWURJUDGH
Incidente intraoperatorii
-$FFHV SH XUHWHU LPSRVLELO GDWRUDW XQRU DIHFLXQL YH]L

FRQWUDLQGLFDLLOH8565
-5XSWXUD XUHWHUXOXL LQWUDPXUDO FRPSOLFDLH FDUH SRDWH IL GHSLW
SULQ WUHFHUHD XUHWHURVFRSXOXL OD YHGHUH SH JKLG (HFXO DFHVWHL
YDULDQWHLPSXQHQHIURVWRPLDSHUFXWDQ
-0LJUDUHD FDOFXOXOXL vQDSRL SH XUHWHU GDWRULW PDQHYUHORU VDX
fluxului de lichid). DDF QX SRDWH IL JVLW L UH]ROYDW SULQ
XUHWHURVFRSLH WUHEXLH V DYHP vQ YHGHUH FHOHODOWH RSLXQL
terapeutice.
-/H]LXQL DOH PXFRDVHL XUHWHUDOH SHUIRUDUHD XUHWHUXOXL L FKLDU
LHLUHDFDOFXOXOXLGLQXUHWHUSULQEUHDFUHDW
-5XSHUHD L GH]LQVHULD XUHWHUXOXL QXPLW L VWULSSLQJ XUHWHUDO
GXS LQWHUYHQLD FODVLF SHQWUX YDULFHOH PHPEUHORU LQIHULRDUH
DSDUH PDL DOHV GDF VH IRUHD] H[WUDJHUHD XQHL VRQGH 'RUPLD
vQFUFDWFXXQFDOFXOYROXPLQRV
-&RPSOLFDLL VHSWLFH GDF XULQD GH GHDVXSUD REVWDFROXOXi era
LQIHFWDWLSURWHFLDDQWLELRWLFQXV-DIFXW
-Dureri lombare, hematurie, sunt probleme ce apar mai ales
postoperator. Postoperator tardiv s-DX GHVFULV FRPSOLFDLL GH FDUH
WUHEXLHVLQHPVHDPDreflux vezico-ureteral; stenoze ureterale.
,QGLFDLLOHLFRQWUDLQGLFDLLOH856
LQkQG FRQW GH IDSWXO F SULPD RSLXQH vQ OLWLD]D XUHWHUDO

ORPEDU D UPDV (6:/ GHVL QX H[LVWD XQ FRQVHQV LQ DFHDVWD
SUREOHPDLQGLFDLLOH856VHOLPLWHD]GRDUOD
-FDOFXOLLGXULDQFODYDLREVWUXFWLYLvQXUHWHUXOORPEDU la care ESWL
DHXDW
-vPSLHWUXLUHD XUHWHUDO ORPEDU VWHLQVWUDVVH DSUXW GXS
!
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
,QGLFDLL: tratamemtul simptomelor moderate pna la severe ale

+%3UHGXFHUHDULVFXOXLGHUHWHQLHDFXWGHXULQLDQHFHVLWLL
LQWHUYHQLHLFKLUXUJLFDOHODSDFLHQLLFX+%3
Mod de administrare: RUDORFDSVXOSH]L
&RQWUDLQGLFDLL IHPHL FRSLL DGROHVFHQL SDFLHQL FX
KLSHUVHQVLELOLWDWH OD GXWDVWHULG WDPVXORVLQ VDX RULFDUH GLQ
H[FLSLHQL SDFLHQL FX DQWHFHGHQWH GH KLSRWHQVLXQH RUWRVWDWLF
VDX FHL FX LQVXILFLHQD KHSDWLF VHYHU SDFLHQL OD FDUH VH
SUHFRQL]HD]RLQWHUYHQLHFKLUXUJLFDOSWFDWDUDFW
5HDFLL DGYHUVH HMDFXODUH UHWURJUDG DIHFWH] caracteristicele
VSHUPHLODEUEDLLVQWRLVFGHUHDOLELGRXOXLDPHHOLPULUHD
LVHQVLELOLWDWHODQLYHOXOVkQLORU
VI. ANTISPASTICE
1. PAPAVERINA:
3UH]HQWDUH IDUPDFHXWLF cp 100 mg; fiole - 1 ml = 40 mg
SDSDYHULQ; PO PJSDSDYHULQ
$FLXQH WHUDSHXWLF: vasodilatator L DQWLVSDVWLF SULQ DFLXQH
SULQDFLXQHGLUHFWSHPXVFXODWXUDQHWHG
,QGLFDLL FROLFL ELOLDUH LQWHVWLQDOH FROLFL QHIUHWLFH WXOEXUUL
FLUFXODWRULL LQWHVWLQDOH GH QDWXU VSDVWLF VGU 0HQLHUH VGU
DQJLQRVVSDVPSLORULFFRQVWLSDLHVSDVWLF
Mod de administrare: oral 1 cp x 3-5 / zi la nevoie; i.m., i.v. 1-2
fiole(ml) x 2-3/zi la nevoie.
5HDFLL DGYHUVH n administrare i.v. aritmii L EORF
atrioventricular, colaps, deprimare respiratorie; la doze mari:
VRPQFRQVWLSDLLDPHHOLFHIDOHHVXGRUDLH
&RQWUDLQGLFDLLforma inj. cu bloc atrioventricular, hipertensiune
intracranianSUXGHQvQJODXFRPLDGHQRPGHSURVWDW
,QWHUDFLXQL PHGLFDPHQWRDVH QX VH DVRFLD] cu -DJRQLWL
ULVF FUHVFXW GH DULWPLL SDSDYHULQD FUHWH HIHFWXO KLSRWHQVLY DO
medicamentelor antihipertensive.
2.NO-SPA: VXEVWDQD DFWLY clorhidrat de GRWUDYHULQ
3UH]HQWDUH IDUPDFHXWLF No-spa cp 1-40 mg; fiole 1 ml (20
mg/ml); No-spa forte cps 80 mg; fiole 4 ml (20 mg/ml)
$FLXQH WHUDSHXWLF L LQGLFDLL antispastic: colici nefretice,
biliare; tratament adjuvant n ulcer gastric sau duodenal, gaVWULW
FROLW VSDVPH DOH VILQFWHUHORU FDUGLD L SLORULF VGU GH LQWHVWLQ
LULWDELOFRQVWLSDLLVSDVWLFHGLVPHQRUHH
Mod de administrare: 120-240 mg / zi, 2- SUL]H FROLF
QHIUHWLFVDXELOLDU-80 mg i.m. sau i.v. lent.
&RQWUDLQGLFDLL I.H., I.R. LQVXILFLHQ FDUGLDF VHYHU EORF

;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
FRPSOH[XOVLPSWRPHORULULWDWLYHLREVWUXFWLYHvQLQVWDODUHDFUXLD
LQVWDELOLWDWHD YH]LFLL XULQDUH L WHQVLXQHD PXVFXODWXULL QHWHGH D
WUDFWXOXLXULQDULQIHULRUMRDFXQUROLPSRUWDQW
,QGLFDLL WHUDSHXWLFH Tratamentul simptRPHORU IXQFLRQDOH DOH
hiperplaziei prostatice benigne (HBP).
&RQWUDLQGLFDLL Hipersensibilitate la tamsulosin HCl sau la
oricare alt component al produsului. Antecedente de
KLSRWHQVLXQHRUWRVWDWLF,QVXILFLHQKHSDWLFVHYHU
5HDFLL DGYHUVH ameteli HMDFXODUH UHWURJUDG L FX IUHFYHQ
PDLVF]XW-FHIDOHHDVWHQLHKLSRWHQVLXQHRUWRVWDWLFL
SDOSLWDLL
Mod de administrare: 6H DGPLQLVWUHD] FkWH R FDSVXO pe zi
GXSPLFXOGHMXQ
,QWHUDFLXQLFXDOWHPHGLFDPHQWH administrarea FRQFRPLWHQW
FX DOL DOID-EORFDQL SRDWH FRQGXFH OD DSDULLD HIHFWHORU
hipotensive.
AVODART 'XWDVWHULG
3UH]HQWDUHIDUPDFHXWLF: cps 0,5 mg
$FLXQH WHUDSHXWLF: - LQKLE 5 1 L 2 reductaza. ,QGLFDLL
tratamentul simptomelor moderate, severe de hiperplazie
EHQLJQGHSURVWDWUHGXFHULVFXOUHWHQLHLDFXWHGHXULQ
Mod de administrare: 1 cp/zi.
&RQWUDLQGLFDLL IHPHL FRSLL DGROHVFHQL ,+ VHYHU OD
SDFLHQLL FX KLSHUVHQVLELOLWDWH OD LQKLELWRUL GH -UHGXFWD]
5HDFLL DGYHUVH LPSRWHQ VFGHUHD OLELGRXOXL WXOEXUUL GH
ejaculare, ginecomastie.
,QWHUDFLXQL PHGLFDPHQWRDVH Itraconazol, Ketoconazol,
,QGLQDYLU 9HUDSDPLO VFDG PHWDEROL]DUHD HQ]LPDWLF D
LQKLELWRULORU GH -reductaza ceea ce duce OD FUHWHUHD
FRQFHQWUDLHLVHULFH
Asocieri medicamentoase: inhibitorii de 5 -reductaza se pot
DVRFLD FX -EORFDQWH SHQWUX DPHOLRUDUHD PDL UDSLG D VFRUXOXL
simptomatic.
'(

$/)$
5('8&7$=
DUODART
Prezentare IDUPDFHXWLFCapsule FRQLQkQG
dutasterida si 0,4 mg tamsulosin.
!
-extragerea sondelor care, n timpul manevrelor endourologice, sau rupt n zona ureterului superior;
-introducerea la vedere a unui fir ghid, vQSHUVSHFWLYDUH]ROYULL
endoscopice a stenozelor ureterale strnse.
1RLOHXUHWHURVFRDSHIOH[LELOHSRWDMXQJHFXXVXULQSHXUHWHUXO
ORPEDULUH]ROYDVLWXDLDDVWIHO vQFkWXUHWHURVFRSLDDQWHURJUDGLa restrns mult aria de aplicare.
$FHDVW SURFHGXU IRORVHWH XQ WUDLHFW SHUFXWDQ OD IHO
FD L QHIUROLWRWRPLD SHUFXWDQDW 1/3 Q FRQVHFLQ se
SVWUHD] DFHOHDL FRQWUDLQGLFDLL FD OD 1/3 FX PHQLXQHD F
DERUGXOVHIDFHSULQFDOLFHOHPLMORFLXLDUFDOFXOXOWUHEXLHVILHPDL
,9,1+,%,725,'($/)$5('8&7$=
9 ,1+,%,725,
ALFABLOCANT
(6:/LFDUHQXV-DHOLPLQDWVSRQWDQVDXWRWSULQ(6:/

sus de L5.
8UHWHURVFRSLDDQWHURJUDGare urmatoarele etape:
-FLVWRVFRSLD L XOWHULRU GXS YL]XDOL]DUHD RULILFXOXL XUHWHUDO
respectiv, introducerea sondei ureterale;
-opacefierea sistemului pielo-FDOLFHDO SULQ LQMHFWDUH UHWURJUDG GH
VXEVWDQ GH FRQWUDVW GLOXDW FX VHU IL]LRORJLF 'DF FDOFXOXO HVWH
FRPSOHWREVWUXFWLYLQXSHUPLWHVXEVWDQHLGHFRQWUDVWVSWUXQG
LVRSDFiILH]HFDYLWLOHUHQDOHVHSUDFWLFSXQFLDHFRJKLGDWD
XQHLFDYLWLUHQDOHGLODWDWHVHLQWURGXFHVXEVWDQGHFRQWUDVWL
XOWHULRU VH SXQFLRQHD] IOXRURVFRSLF XQ FDOLFH PLMORFLX VDX
superior;
-SXQFLD FDOLFHDO HVWH UHFRPDQGDW D VH HIHFWXD OD MXPWDWHD
LQIHULRDU D VSDLXOXL Lntercostal (pentru a evita lezarea pachetului
vasculo-QHUYRVLQWHUFRVWDOSHOLQLDD[LODUSRVWHULRDU
-GLODWDLDWUDLHFWXOXLODIHOFDOD1/3
-LQWURGXFHUHD QHIURVFRSXOXL L HIHFWXDUHD QHIURVFRSLHL FDUH
0,5mg
LGHQWLILF HYHQWXDOD OLWLD] DVRFLDW ED]LQHWDO L MRQFLXQHD SLHOR-

9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
XUHWHUDO
-LQWURGXFHUHD XUHWHURVFRSXOXL SULQ WHDFD QHIURVFRSXOXL L DFFHVXO
acestuia pe ureter (fig.VI.8);
Fig.VI.8 Introducereanefroscopului prin teaca nefroscopului
-YL]XDOL]DUHDLHYHQWXDOH[WUDJHUHDFDOFXOXOXLVXEFPFXDMXWRUXO

SHQVHORU 3HQWUX FDOFXOL PDL PDUL VH LPSXQH GLVWUXFLD
LQWUDFRUSRUHDODFDOFXOXOXLLXOWHULRUH[WUDJHUHDGHIUDJPHQWH
-YHULILFDUHDSHUPHDELOLWLLXUHWHUDOHSULQLQMHFWDUHDDQWHURJUDGGH
VXEVWDQ GH FRQWUDVW 'DF H[LVW VDX VH EQXLHVF OH]LXQL
XUHWHUDOH GDWRUDWH FDOFXOXOXL VDX PDL DOHV PDQHYUULL VH
UHFRPDQG LQVWDODUHD XQHL VRQGH -- DQWHURJUDG SHQWUX D
preveni stHQR]DUHDXUHWHUXOXLLVDXH[WUDYD]DUHDGHXULQ
&RPSOLFDLLOH 856$ $ERUGXO SHUFXWDQ ILH F HVWH SHQWUX
QHIURVFRSLH VDX XUHWHURVFRSLH VH SRDWH vQVRL GH DFHOHDL
incidente pe care le-DPPHQionat n capitolul dedicat NLP.
VII.
LAPAROSCOPIA
Unul din domeniile n care tehnicile minim invazive (mai

FRUHFW WHKQLFL FX DFFHV PLQLP GHRDUHFH LQWHUYHQLD SURSULX-]LV
poate fi de amploare) au avansat spectaculos n ultimii ani este cel
al chirurgiei laparoscopice, acest domeniu al urologiei fiind unul din

;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
$FLXQH WHUDSHXWLF analgezic prin metamizol; antispastic

muscXORWURS L DWURSLQLF SULQ SLWRIHQRQ L IHQLSLSUDPLG
,QGLFDLLFROLF QHIUHWLFFROLF ELOLDUGLVNLQH]LHELOLDUFROLWH
FLVWDOJLLGLVPHQRUHHPLJUHQHLDOWHIRUPHGHFHIDOHH
Mod de administrare: - oral 2 cp de 1-3 ori / zi; intrarectal 1-3
sup/zi; i.m, i.v. 1-3 fiole/zi.
&RQWUDLQGLFDLLalergici la metamizol LDOLSLURVROL antecedente
GH DJUDQXORFLWR] OD DPLQRIHQD]RQ L FRPSXL vQUXGLL GHILFLW
de G-6-3'+KHSDWLFDFXWJODXFRPFXXQJKLvQFKLVDGHQRP
GHSURVWDWFXWHQGLQDUHWHQLHGHXULQFRODSVLQVXILFLHQ
FDUGLDFJUDYDQJLQSHFWRUDO
5HDFLL DGYHUVH UHDFLL DOHUJLFH OD PHWDPL]RO HUXSLL FXWDQDWH
IRDUWHUDURFDQDILODFWLFDQHPLHDJUDQXORFLWR]GR]HPDULSRW
SURYRFD IHQRPHQH DWURSLQLFH XVFFLXQHD JXULL WXOEXUUL Ge
vedere, tahicardie, disurie.
,QWHUDFLXQL PHGLFDPHQWRDVH SUXGHQ n asocierea cu
DPDQWDGLQD FKLQLGLQ DQWLGHSUHVLYH WULFLFOLFH FUHVF HIHFWHOH
atropinice).
III. ALFABLOCANTE
1. UROREC: (Silodosin)
3UH]HQWDUHIDUPDFHXWLFcapsule de 8 mg.
$FLXQHWHUDSHXWLF
blocarea
receptorilor
alfa1A
adrenoreceptori din prostata, vezica urinara si uretra.
,QGLFDLL tratamentul simptomelor de hiperplazie prostatica
benigna.
Mod de administrare: Doza recomandata este de o capsula de
8 mg o data pe zi. Pentru barbatii cu probleme renale moderate,
doza initiala trebuie sa fie de 4 mg o data pe zi. Dupa o
VSWPkQDFHDVWDSRDWHILPULWDODPJRGDWDSH]L
&RQWUDLQGLFDLL hipersensibilitate (alergie) la silodosin sau la
oricare dintre celelalte componente ale medicamentului.
Sindromul de iris flasc intraoperator (SIFI) apare la unii pacienti
tratati cu antagonisti de alfa-adrenoreceptori si poate cauza
complicatii in timpul operatiei de cataracta.
5HDFLL DGYHUVH: ejaculare retrograda, hipotensiune ortostatica,
cefalee.
2.OMNIC 0,4: (Tamsulosinum HCl)
3UH]HQWDUHIDUPDFHXWLFcapsule 0,4mg.
$FLXQL WHDSHXWLFH 2PQLF FUHWH YDORDUHD GHELWXOXL XULQDU
PD[LP SULQ UHGXFHUHD WHQVLXQLL PXVFXODWXULL QHWHGH GLQ SURVWDW
L XUHWU GHWHUPLQkQG GLPLQXDUHD REVWUXFLHL $PHOLRUHD]

;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
,QGLFDLL ,QIHFLLDOHFLORUUHVSLUDWRULLEURQLWDFURQLFVLQX]LWD
LQIHFLLOHFLORUXULQDUHSLHORQHIULWDFURQLFLQIHFLLDOHWUDLHFWXOXL
GLJHVWLY SURYRFDW GH 6DOPRQHOOD 6KLJHOOD L ( FROL ,QIHFLL
JHQLWDOH LQFOXVLY XUHWULWD JRQRFRFLF DOWH LQIHFLL EDcteriene
VLVWHPLFHLQIHFLLFXWDQDWHVHSWLFHPLL
Mod de administrare: 'R]D LQLLDO -3 cp. Biseptol 480, de 2
RULSH]L'R]DGHLQWUHLQHUHFRPSULPDWGHRULSH]L
&RQWUDLQGLFDLL +LSHUVHQVLELOLWDWHIDGHVXOIDPLGHVDXIDGH
trimetoprim, sarFLQDLSHULRDGDGHDOSWDUHSUHFDXLLvQFD] GH
LQVXILFLHQ KHSDWLF VDX UHQDO SUHFXP L OD SUHGLVSR]LLH
PDUFDQWODDOHUJLLODDVWPXOEURQLF
FHOHPDLGLQDPLFHvQDFHVWVHQV$FHDVWWHQGLQDIRVWVXVLQXW
5HDFLL DOUHJLFH DJUDQXORFLWR] DQHPLL OHXFRSHQLL LQIHFLL

cutanate alergice, Erythema multiforme, uUWLFDULLSUXULWGHUPDWLW
H[IROLDWLY WXOEXUDUL GLJHVWLYHLQIODPDLL DOH SDUHQFKLPXOXL
hepatic, cefalee, tulburari temporare ale sistemului nervos
central.
II. ANTALGICE
HVWH PULW VH SRDWH UHDOL]D R GLVHFWLH PXOW PDL SUHFLV D
vQXOWLPLLDQLLGHLQWURGXFHUHDWHKQRORJLHLURERWLFHFHDSHUPLVXQ
SURJUHVFRQVLGHUDELOvQWUDWDPHQWXOSDFLHQLORU
Principalele avantaje ale laparoscopiei sunt legate de
inciziilH PLFL FH FRQWULEXLH OD R UHGXFHUH LPSRUWDQW D QHFHVDUXOXL
GHDQDOJH]LFHSRVWRSHUDWRULODUHFXSHUDUHDUDSLGFXUHGXFHUHD
VHPQLILFDWLY D VSLWDOL]ULL SRVWRSHUDWRULL 'H DVHPHQHD GDWRULW
faptului ca imaginea ce se observa de catre chirurg pe monitor
structurilor anatomice avnd ca rezultat pierderi minime de snge.
5LVFXULOH LQWUDRSHUDWRULL DOH LQWHUYHQLLORU ODSDURVFRSLFH VXQW vQV
DWkW FHOH GLQ FKLUXUJLD GHVFKLV FkW L XQHOH VSHFLILFH DFHstei
metode.
1. TRAMADOL:
3UH]HQWDUH IDUPDFHXWLF - cps 50 mg; fiole 50 mg / 1 ml; sup
100 mg
$FLXQHWHUDSHXWLFDQDOJH]LFFXDFLXQHLQWHQV
,QGLFDLL - dureri intense sau moderate, acute sau cronice;
pentru analgezii cu prilejul unor manevre diagnostice sau
terapeutice.
Mod de administrare: i.v., i.m., sc. 1-2 fiole; 1 sup la nevoie,
maxim 400 mg/24 h.
&RQWUDLQGLFDLL - LQWR[LFDLH DFXW cu alcool, hipnotice,
DQDOJH]LFH SVLKRWURSH SUXGHQ vQ FD] GH ,5 ,+ GR]H PDL
mici).
5HDFLL DGYHUVH VHGDUH RERVHDO VXGRUDLL DPHHOL
XVFFLXQHDJXULLJUHDYRPKLSRWHQVLXQHRUWRVWDWLF
InWHUDFLXQL PHGLFDPHQWRDVH QX VH DVRFLD] cu alte
GHSULPDQWH FHQWUDOH SRWHQDUH; QX VH DVRFLD] FX ,0$2 ULVF
toxic mare).
2. PIAFEN:
3UH]HQWDUH IDUPDFHXWLF: cps: 500 mg metamizol sodic, 5 mg
SLWRIHQRQFORUKLGUDWLPJIHQSLSUDPLGEURPRPHWLODW; sup.
J PHWDPL]RO VRGLF PJ SLWRIHQRQ FORUKLGUDW L PJ
IHQSLSUDPLG EURPRPHWLODW ILROH PO 2,5 g metamizol sodic,
PJ SLWRIHQRQ FORUKLGUDW L PJ IHQSLSUDPLG
bromometilat.

3UDFWLF RULFH LQWHUYHQLH FKLUXUJLFDO FODVLF SRDWH IL

HIHFWXDW vQ YDULDQW ODSDURVFRSLF SULQ UHDOL]DUHD XQXL DERUG
transperitoneal, properitoneal sau retroperitoneal. Principalele
LQWHUYHQLL ODSDURVFRSLFH XURORJLFH VXQW QHIUHFWRPLD UDGLFDO VDX
SDULDO QHIUHFWRPLD GRQDWRUXOXL GH JUHI DEODLD JODQGHL
VXSUDUHQDOH SLHORSODVWLD DEODLD FKLVWXULORU UHQDOH SLHOROLWRWRPLD
ureterolitotomia, reimplantarea uretero-YH]LFDO SURVWDWHFWRPLD
UDGLFDO FLVWHFWRPLD UDGLFDO OLPIDGHQHFWRPLD SHOYLQ FXUD
YDULFRFHOXOXL vQ WUDWDPHQWXO FULSWRRUKLGLHL FKLUXUJLD LQFRQWLQHQHL
XULQDUHDEODLDGLYHUWLFXOXOXLYH]LFDOHWF
INSTRUMENTAR NECESAR:
3ULQFLSDOD GLIHUHQ vQWUH LQWHUYHQLLOH FKLUXUJLFDOH FODVLFH VL
cele laparoscopice este modul de abordare al regiunii anatomice
DVXSUD FUHLD LQWHUYHQLP DFHDVWD ILLQG DFFHVDW SULQ LQWHUPHGLXO
FkWRUYD PLFL LQFL]LL LQWHUYHQLD FKLUXUJLFDO ILLQG YL]XDOL]DW SH XQ
PRQLWRU XQGH LPDJLQLOH DMXQJ GDWRULW XQXL sistem video ce este

9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
IRUPDW GLQ VXUVD GH OXPLQ FDEOX RSWLF FDPHU YLGHR L XQ
laparoscop (instrument optic format dintr-o succesiune de lentile
dispuse in interiorul unui tub metalic ce transmite imaginea din
LQWHULRUXO SDFLHQWXOXL OD H[WHULRU GH XQGH HVWH SUHOXDW SULQ
LQWHUPHGLXO FDPHUHL YLGHR ,QWHUYHQLLOH VH GHVIDRDU vQ DD
QXPLWD FDPHU GH OXFUX ODSDURVFRSLF SQHXPRSHULWRQHX
pneumoretroperitoneu sau pneumoproperitoneu) acestea fiind
create VL PHQLQXWH FX DMXWRUXO XQXL sistem de insuflare cu CO2
IRUPDWGLQDFXOGHLQVXIODUHLQVXIODWRUXOL JD]XO LQVXIODW&2DUH
DYDQWDMXO XQHL VROXELOLWL YDVFXODUH IRDUWH EXQH L D XQHL HOLPLQUL
pulmonare rapide ce scad semnificativ riscul de ebolie gazoasa
fiind din acest motiv cel mai frecvent gaz folosit. Cel mai cunoscut
ac insuflator este acul Veress al carui mecanism permite att
VWUDSXQJHUHD SHUHWHOXL DEGRPLQDO FkW L SURWHMDUHD RUJDQHORU
DEGRPLQDOH WURFDUXO DFXOXL DFRSHULQG YDUIXO DVFXLW DO WHFLL RGDW
SHQHWUDW SHUHWHOH DEGRPLQDO ,QVXIODWRUXO HVWH GH IDSW R SRPS
FRQWURODW DXWRPDW FH UHDOL]HD] L PHQLQH SUHVLXQHD &2 vQ
FDPHUDGHOXFUX$FHDVWSUHVLXQHVHVLWXHD]vQJHQHUDOvQWUHPP+JFXRSUHVLXQHPD[LPGHPP+J
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
E. &()23(5$=21
SULBACTAM (Sulperazon)
3UH]HQWDUH IDUPDFHXWLF IO J J FHIRSHUD]RQ + 1 g
sulbactam).
$FLXQH WHUDSHXWLF spectru Stafilococus aureus (secretori L
QHVHFUHWRUL GH -ODFWDPD] 6WDILORFRFXV HSLGHUPLGLV
Streptococus
pyogenes,
Streptococus
pneumoniae,
Streptococus agalactiae, enterococi, peptococi, Bacteroides
spp., E. coli, Haemophilus influenzae, Neisseria gonorheae,
Neisseria meningitides, Klebsiella spp, Proteus mirabilis,
YXOJDULV 3VHXGRPRQDV DHUXJLQRVD 3URYLGHQLD (QWHUREDFWHU
&LWREDFWHU 6HUDLD 6DOPRQHOD 6KLJHOOD $FLQHWREDFWHU
Bordetela pertusis,
Yersinia enterocolitica.
,QGLFDLL LQIHFLL DOH WUDFWXOXL XULQDU vQDOWH L MRDVH LQIHFii
JHQLWDOH XUHWULW FX JRQRFRF LQIHFLL UHVSLUDWRULL LQIHFLL DOH
SLHOLL RVWHRPLHOLW LQIHFLL DOH 61& FROHFLVWLWH DEFHVH
abdominale.
Mod de administrare: DGXOL -4 g/zi n 2 prize.
&RQWUDLQGLFDLL: hipersensibilitate la peniciline, sulbactam,
FHIRSHUD]RQVDXDOWHFHIDORVSRULQHVHUHFRPDQGSUXGHQvQ
VDUFLQ
5HDFLL DGYHUVH GLDUHH JUHD YUVWXUL FROLW pseudoPHPEUDQRDV HUXSLL FXWDQDWH VGU 6WHYHQV -RKQVRQ
leucopenie, neutropenie, hipoprotrombinemie, eozinofilie,
cefalee, KLSRWHQVLXQHDUWHULDOIHEUIULVRDQH
,QWHUDFLXQL PHGLFDPHQWRDVH QX VH DPHVWHF cu AG n
DFHODL UHFLSLHQW QX VH YD UHFRQVWLWXL FX VRO 5LQJHU VDX VROXLL
GH/LGRFDLQ
F. SULFAMETOXAZOLTRIMETOPRIM (Biseptol)
FIG. VI.9. - ,QWHUYHQLHODSDURVFRSLF
3UH]HQWDUH IDUPDFHXWLF Comprimate 120, 480. Compozitia

chimica: Trimetoprim 20 mg, 80 mg; Sulfametoxazol 100 mg,
400 mg.
$FLXQH WHUDSHXWLF bacteriostatic, este o asociere de
WULPHWRSULP L VXOIDPHWR[D]RO DPEHOH FRPSRQHQWH DFLRQkQG
VLQHUJLFLSUH]HQWkQGRLQKLEDUHDFUHWHULLEDFWHULLORU inhibarea
VLQWH]HLFRPSXLORUSXULQLFLGLQFHOXOHOH EDFWHULLORUSULQLQIOXHQD
DVXSUD GLIHULWHORU ID]H GLQ IRUPDUHD L WUDQVIRUPDUHD DFLGXOXL
IROLF LQKLE VLQWH]D DFLGXOXL GH]R[LULERQXFOHLF DO EDFWHULLORU
DFLRQHD] DVXSUD DJHQLORU JUDP SR]LWLYL L JUDm negativi,
PLFUREDFWHULLYLUXLLIXQJL

$
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
&RQWDLQGLFDLL SUHFDXLH L DMXVWDUHD GR]HORU OD SDFLHQLL FX

LQVXILFLHQUHQDOvQIXQFLHGHFOHDUFH-XOGHFUHDWLQLQ
5HDFLL DGYHUVH GLDUHH YUVWXUL JUHD HUXSLL WUHFWRDUH SH
piele, leucopenie, neutropenie, trombocitopenie.
C. 7,&$5&,/,1
ACID CLAVULANIC (Timentin)
3UH]HQWDUHIDUPDFHXWLFflacon 1,6 g LJ
0RG GH DFLXQH L LQGLFDLL LQIHFLL JUDYH DOH DSDUDWXOXL
XURJHQLWDO UHVSLUDWRU VIHUD 25/ VHSWLFHPLL LQIHFLL
SRVWFKLUXUJLFDOHSHULWRQLWHLQIHFLLRVWHRDUWLFXODUHLQIHFLLVHYHUH
ODSDFLHQLLLPXQRGHSULPDL
Mod de administrare: uzual 1 f (3,2 g) OD RUHvQLQVXILFLHQ
UHQDO - FOHDUDQFH FUHDWLQLQ ! POPLQ J x 3 / zi;
FOHDUDQFH FUHDWLQLQ -30 ml/min, 1,6 g x 3/zi; clearance
FUHDWLQLQ
ml/min, 1,6 g la 12 ore.
&RQWUDLQGLFDLL KLSHUVHQVLELOLWDWH OD SHQLFLOLQ SUXGHQ la
SDFLHQLLFXGLVIXQFLLKHSDWLFHVDUFLQDOSWDUHVDXWXOEXUULGH
coagulare.
5HDFLLDGYHUVHVXQWUDUHLFRPXQHSHQLFLOLQHORULQMHFWDELOH
D. $03,&,/,1SULBACTAM (Ampiplus)
3UH]HQWDUH IDUPDFHXWLF IODFRDQH FH FRQLQ DPSLFLOLQ J
sulbactam 0,5 g.
AFLXQH WHUDSHXWLF sulbactamul este un inhibitor de beta
ODFWDPD] GHWHUPLQkQG vQ DVRFLHUH FX DPSLFLOLQD R OUJLUH D
spectrului acesteia (stafilococul rezistent la peniciline, E. Coli,
.OHEVLHOOD SURWHXV YXOJDULV L PLUDELOLV WXOSLQL GH JRQRFRF L
hemofLOXVSURGXFWRDUHGHEHWDODFWDPD]H
,QGLFDLL LQIHFLL XULQDUH L XURJHQLWDOH UHVSLUDWRULL 25/
GLJHVWLYH ELOLDUH DYRUW VHSWLF LQIHFLL SXHUSHUDOH JLQHFRORJLFH
gastrointestinale, dentare, cutanate, osteoarticulare.
Mod de administrare: JGHGRX RULSH]LvQLQIHFLLOHVHYHUH
SkQ OD J]L IU D VH GHSLL J GH VXOEDFWDP UHGXFHUHD
GR]HORUvQFD]GHLQVXILFLHQUHQDO
&RQWDLQGLFDLL DOHUJLH OD SHQLFLOLQH PRQRQXFOHR]D LQIHFLRDV
KHUSHV OHXFHPLH LQIHFLL VHQVLELOH QXPDL OD DPSLFLOLQ
PRQRWHUDSLHvQLQIHFLLOHJUDYH
5HDFLL DGYHUVH anemie, trombocitopenie, eozinofilie,
OHXFRSHQLHWXOEXUULGLJHVWLYHPLQRUHFRQGLGR]HGXUHULOD locul
GHLQMHFWDUHIOHELWHGXSDGPLQLVWUDUHDLY

9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
Sistemul electric este format dintr-un generator de curent

FX IUHFYHQ vQDOW FH SHUPLWH DMXVWDUHD LQWHQVLWLL IXQFLH GH
QHFHVLWL FRDJXODUH VDX WLHUH H[LVWkQG FD vQ FKLUXUJLD FODVLF
posibilitatea folosirii DWkWDFXUHQWXOXLPRQRSRODUFkWLELSRODU
6LVWHPXO GH LULJDUHDVSLUDLH permite realizarea att a
LULJULL XQHL ]RQH DFRSHULWH GH XQ FKHDJ FkW L D DVSLUULL IOXLGHORU
GLQ FDPHUD GH OXFUX ODSDURVFRSLF vQ VHQVXO IDFLOLWULL XQHL
YL]XDOL]ULRSWLPH.
Instrumentarul laparoscopic operator este format din
trocarele laparoscopice ce permit introducerea instrumentelor de
OXFUXGHODH[WHULRULQFDPHUDODSDURVFRSLFLVXQWIRUPDWHGLQWU-o
WHDF PHWDOLF VDX GLQ PDWHULDO SODVWLF FH SUH]LQW L R YDOY FH
poate fi FRQHFWDW OD LQVXIODWRU L XQ WURFDU FH IDFLOLWHD]
SDWUXQGHUHD WHFLL SULQ SHUHWHOH DEGRPLQDO GDWRULW YkUIXOXL VX
ascuLW&DLLQVWUXPHQWHRSHUDWRULLODSDURVFRSLFHH[LVWSHQVHGH
diferite tipuri, foarfeci, port-ace, aplicatoare de clipuri, staplere,
departatoare, etc., toate adaptate nevoii de a fi introduse prin
FDQXOFXSDUWHDDFWLYvQLQWHULRUXOFDPHUHLGHOXFUXODSDURVFRSLFH
LFX]RQDGHPDQHYUDUHODH[WHULRU
(FKLSD RSHUDWRULH HVWH IRUPDW GLQ FKLUXUJXO RSHUDWRU
operatorul camerei video, o asLVWHQW LQVWUXPHQWLVW L vQ DQXPLWH
cazuri un chirurg asistent.
3ULQFLSDOHOH PRPHQWH DOH XQHL LQWHUYHQLL FKLUXUJLFDOH
laparoscopice sunt:
1. pregatirea pacientului ce cuprinde: a. pregatirea
SHUHWHOXL DEGRPLQDO SULQ vQGHSUWDUHD SUXOXL YHULILFDUHD IDStului
F QX H[LVW IRFDUH LQIHFLRDVH FXWDQDWH L DVHSWL]DUHD FX VROXLL
VSHFLILFH D ]RQHL FH YD IL IRORVLW SHQWUX SODVDUHD WURFDUHORU GH
lucru; b. plasarea unei sonde de aspiratie naso-JDVWULFFHSHUPLWH

9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
GHFRPSULPDUHD VWRPDFXOXL SHQWUX D HYLWD SUH]HQD acestuia n
Mod de administrare: PJ]LvQGR]]LOQLFXQLFvQXUHWULWH

VH DGPLQLVWUHD] R VLQJXU GR] GH J vQ WUDWDPHQWXO LQIHFLHL
JHQLWDOH FX FKODP\GLD Q LQIHFLLOH JDVWUR-dudenale se
DGPLQLVWUHD]J]LWLPSGH]LOH
&RQWUDLQGLFDLL LQVXILFLHQKHSDWLFVHYHU
5HDFLL adverse: GLDUHH JUHD YUVWXUL GXUHUL DEGRPLQDOH
DPHHOLFHIDOHH
]RQD GH SXQFLRQDUH D DFXOXL 9HUHVV VDX D WURFDUHORU L D IDFLOLWD

vizualizarea organelor din etajul supramezocolic; c. plasarea unui
cateter vezical; d. antibioticoprofilaxie pre- sau intra-operatorie,
IXQFLHGHSDUWLFXODULWDWHDFD]XOXLHSXUWDUHDGHFWUHSDFLHQWGH
ciorapi elastici n scopul prevenirii incidentelor tromboembolice.
15. &20%,1$,,'($17,%,27,&(
2. plasarea n pozitia operatorie: functie de calea de abord

LRUJDQXOGHRSHUDWSDFLHQWXOHVWHDezat fie n decubit dorsal fie
n decubit lateral. In cazul oSHUDLLORUSHQWUXRUJDQHVXSUDRPELOLFDOH
(glanda suprarenal, rinichiul, ureterul lombar) monitorul este
SODVDWvQIDDRSHUDWRUXOXL, DFHVWDvPSUHXQFXFDPHUDPDQXOILLQG
SODVDLSHSDUWHDRSXVOH]LXQLLGHRSHUDW3HQWUXDIRORVLJUDYLWDLD
n scopul de a UHWUDFWDLQWHVWLQHOHPDVDRSHUDWRULHWUHEXLHvQFOLQDW
VSUH SDUWHD RSXV RUJDQXOXL GH RSHUDW Q FD]XO RUJDQHORU
VXERPELOLFDOH YH]LFD XULQDU SURVWDWD XUHWHU SHOYLQ VDX LOLDF
YDULFRFHO PRQLWRUXO VH SODVHD] OD SLFLRDUHOH SDFLHQWXOXL SR]Lia
operatorXOXL ILLQG SH SDUWHD GUHDSW D SDFLHQWXOXL L D
FDPHUDPDQXOXLSHSDUWHDVWDQJ
3. creerea camerei de lucru presupunerea insuflarea CO2
ILHvQFDYLWDWHDSHULWRQHDOILHLQVSDii anterior create prin disecie
oarb GLJLWDOLFXDMXWRUXOXQRUEDORDQHVSHFLDOHEDORQXO*DXUvQ
DULDSURSHULWRQHDOVDXUHWURSHULWRQHDO
LQWURGXFHUHD WURFDUHORU GH OXFUX WUHEXLH IFXW FX JULM
pentru a evita leziunile de organe intraabdominale, primul introdus
fiind trocarul folosit pentru laparoscop, celelalte trocare fiind
plasate sub control vizual direct.
5. timpul operator propriu-]LV GLIHU IXQFLH GH RUJDQXO
RSHUDWGHOH]LXQHLGHFDOHDGHDERUGDOHDV

A. AMOXICILINA
ACID CLAVULANIC (Augmentin)
3UH]HQWDUHIDUPDFHXWLFcp 375 mg, 625 mg, 1000 mg; fl: 600
mg, 1200 mg, 2200 mg; pulbere suspensie: 62,5 mg/5 ml, 156
mg/5 ml, 312 mg/ 5 ml;
$FLXQH WHUDSHXWLF LQKLE sinteza peretelui bacterian. Activ
pe: streptococ, pneumococ, meningococ, gonococ, listeria,
6WDILORFRFXO DXULX VHFUHWRU GH SHQLFLOLQD] L EDFLOOL *UDPQHJDWLYL VHFUHWRUL GH -lactamaze: Haemophilus influenzae, E.
coli,
Klebsiella, Proteus mirabilis, Shigella, Bacteroides fragillis.
,QGLFDLL LQIHFLL XULQDUH FX JHUPHQL VHQVLELOL OD $XJPHQWLQ
LQIHFLLUHVSLUDWRULL25/SRVWFKLUXUJLFDOH
Mod de administrare: $GXOL- oral 1 cp (625 mg; 1000 mg) x
]LvQLQIHFLLJUDYHx 4 / zi; parenteral: 1,2 g x ]LvQLQIHFLL
grave x 3 / zi.
5HDFLL DGYHUVH GLDUHH JUHD YUVWXUL FDQGLGR] HULWHP
FXWDQDWIHEUDDOHUJLF
&RQWUDLQGLFDLL DOHUJLL OD 3HQLFLOLQ SUXGHQ n I.H. doze mai
mici n I.R.
B. 3,3(5$&,/,1TAZOBACTAM (Perasin)
3UH]HQWDUH IDUPDFHXWLF IODFRDQH FX SXOEHUH SHQWUX VROXLH
LQMHFWDELOSHUIX]DELO FH FRQLQ J SLSHUDFLOLQD J
WD]REDFWDPVDXJSLSHUDFLOLQJWD]REDFWDP
$FLXQH WHUDSHXWLF este mai activ pe pseudomonas,
NOHEVLHOOOD L HQWHURFRF GHFkW FDUEHQLFLOLQD (VWH GHRVHELW GH
XWLODVRFLHUHDFXXQDPLQRJOLFR]LGvQLQIHFLLOHVHYHUH
,QGLFDLL LQIHFLL PHGLL L VHYHUH DOH WUDFWXOXL XULQDU LQFOXVLY
SLHORQHIULWD JLQHFRORJLFH LQIHFLL LQWUDDEGRPLQDOH LQIHFLL
FXWDQDWH L DOH HVXWXULORU PRL SQHXPRQLH QRVRFRPLDO
HQGRFDUGLWRVWHRPLHOLW
Mod de administrare: 1 fl. 4,5 g la 8 ore sau 1 fl. la 6 ore.

;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
,QGLFDLLLQIHFLLXULQDUHFXJHUPHQLVHQVLOELOL
Mod de administrare: vQLQIHFLLOHDFXWH 100 mg de 3 ori pe zi.
QLQIHFLLOHFRUQLFHGR]HOHVHvQMXPWHVF
&RQWUDLQGLFDLL DQXULH ROLJXULH LQVXILFLHQ UHQDO VDUFLQ
DOSWDUHGHILFLWGH*-6-PDH.
5HDFLL DGYHUVH JUHXUL YUVWXUL DOHUJLH OHXFRSHQLH
SDUHVWH]LLKHPROL]SULQGHILFLWGe G-6-3'+ILEUR]SXOPRQDU
SQHXPRQLHLQWHUVWLLDO
9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
&RPSOLFDLLOH FH SRW VXUYHQL vQ FXUVXO XQHL LQWHUYHQLL

chirurgicale laSDURVFRSLFH SH OkQJ FHOH VSHFLILFH LQWHUYHQLLORU
FKLUXUJLFDOHFODVLFHVHUHIHUODLQFLGHQWHSURGXVHODLQVHULDDFXOXL
9HUHVV OD LQVHULD WURFDUHORU VDX FHOH GHWHUPLQDWH GH JD]XO GH
lucru.
/D LQVHULD DFXOXL 9HUHVV VH SRW SURGXFH LQVXIODUH GH
14. MACROLIDELE
CO2 vQ DOW UHJLXQH GHFDW LQWUDSHULWRQHDO DVWIHO DSUkQG ILH
5HSUH]HQWDQLFRPSXLGHELRVLQWH]HULWURPLFLQDVSLUDPLFLQD
MRVDPLFLQD GHULYDL VHPLVLQWHWLFL UR[LWURPLFLQD FODULWURPLFLQD
diritromicina, azitromicina, rakitamicina, telitromicina).
prepneumoperitoneu, fie pneumoepipORQVDXLQVXIODUHVXEFXWDQDW

FDUH vQ FD] GH YROXP PDUH L IX]DUHD JD]XOXL SkQ vQ UHJLXQHD
WRUDFLF SRDWH GXFH FKLDU OD SQHXPRPHGLDVWLQ VDX SQHXPRWRUD[
PneumomediDVWLQXOSRDWHDSDUHDLvQFD]GHSURGXFHUHGHOH]LXQL
A. ERITROMICINA
3H]HQWDUHIDUPDFHXWLFcomprimate de 200 mg.
$FLXQH WHUDSHXWLF efect bacteriostatic pe germeni gram
pozitivi,
stafilococi
penicilinazo-secretori,
streptocici,
pneumococi,
unele bacterii gram negative din genul neisseria, haemophilus,
micoplasme.
,QGLFDLL LQIHFLL GLQ VIHUD 25/ L UHVSLUDWRULL LQIHFLL FXWDQDWH
VWDILORFRFLFH DQWLELRWLF GH vQORFXLUH OD SDFLHQLL FX DOHUJLH OD
peniciline.
Mod de administrare: 250-500 mg la 6 ore, sau 0,5 g - 1 g la 12
RUH SkQ OD PD[LP J]L 'R]HOH SRW IL GXEODWH vQ LQIHFLLOH
severe.
&RQWUDLQGLFDLL DOHUJLHDIHFLXQLKHSDWLFH
5HDFLLDGYHUVH JUHXULYUVWXULUDUDOHUJLHGLDUHHGLVIXQFLH
KHSDWLF
LDWURJHQHGHGLDIUDJPvQDFHVWHVLWXDLLSODVDUHDXQXLWXEGHGUHQ
SOHXUDOFXSUHVLXQHQHJDWLYILLQGREOLJDWRULX
2. La plasarea trocarelor de fapt vorbim de plasarea
primului trocar (cel folosit pentru laparoscop), restul fiind introduse
VXEFRQWURORSWLFVLLQDFHVWIHODYDQGRUDWDLQFLGHQWHORUPXOWPDL
PLF $X IRVW GHVFULVH OH]LXQL LQWHVWLQDOH GH DRUW YHQ FDY
OH]LXQL JDVWULFH VDX YH]LFDOH vQ PRPHQWXO LQVHULHL SULPXOXL WURFDU
Pentru a SUHYHQL DFHVW OXFUX LQVHULD WURFDUXOXL RSWLF VH IDFH SULQ
SURJUHVLD VD SHUSHQGLFXODU SH SHUHWHOH PXVFXODU FX SDUWHD
ERDQW D WURFaUXOXL VSULMLQLW vQ SRGXO SDOPHL vQ WLPS FH LQGH[XO
minii este extins n lungul canulei pentru a preveni penetrarea
exageraWDYkUIXOXLDVFXLWvQDEGRPHQQFD]GHH[LVWHQDDXQRU
B. AZITROMICINA
3H]HQWDUH IDUPDFHXWLF comprimate de 250 mg, 500 mg,
SXOEHUHSHQWUXVXVSHQVLHRUDOPJPOPJPO
$FLXQH WHUDSHXWLF SUH]LQ VSHFWUX EDFWHULDQ VLPLODU
HULWURPLFLQHL vQ SOXV ILLQG DFWLY L DVXSUD XQRU EDFWHULL JUDP
negative.
,QGLFDLL LQIHFLL DOH FDLORU UHVSLUDWRULL SLHOLL HVXWXULORU PRL
XUHWULWH QHFRPSOLFDWH FHUYLFLWH LQIHFLL JDVWUR-duodenale cu
Helicobacter pylori.

DGHUHQH YLVFHUR-SDULHWDOH ULVFXO GH OH]LXQH LQWHVWLQDO DWkW OD

LQVHULDDFXOXL9HUHVVFkWLODLQVHULDWURFDUXOXLRSWLFHVWHDWkWGH
PDUHvQFkWVHUHFRPDQGUHQXQDUHD OD DERUGXOFXDMXWRUXO acului
9HUHVV L SODVDUHD WURFDUXOXL RSWLF SULQWU-o mini-incizie ce se
VXWXUHD] XOWHULRU vQ MXUXO FDQXOHL SHQWUX D SUHYHQL SLHUGHULOH GH
gaz. De asemenea la plasarea trocarelor se pot produce leziuni ale
$
9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
vaselor din peretele abdominal acestea pot fi evitate prin
$FLXQHWHUDSHXWLFinhibarea sintezei proteice prin legarea de

subunitatea 50S, avnd efect bacteriostatic.
,QGLFDLL PLFURRUJDQLVPH JUDP SR]LWLYH DHUREH L DQDHUREH
LQGLIHUHQW GH UH]LVWHQD ID GH DOWH FODVH GH PHGLFDPHQWH
SQHXPRQLL LQIHFLL FXWDQDWH L DOH HVXWXULORU PRL LQIHFLL
enterococice, rezistente la alte clase de medicamete.
Mod de administare: p.o. sau i.v. lent n 30-120 minute, 600
mgX2/zi.
&RQWUDLQGLFDLL alergie.
5HDFLLDGYHUVH FHIDOHHJUHDYUVWXULFUHWHUHDHQ]LPHORU
KHSDWLFHFDQGLGR]HYDJLQDOHQHXURSDWLHSHULIHULF
SODVDUHD WURFDUHORU vQ FRQGLLLOH IRORVLULL WUDQVLOXPLQULL FX DMXWRUXO

laparoscopului plasat intraabdominal, n acest fel evitndu-se
vasele importante de la acest nivel.
&RPSOLFDLLOH GHWHUPLQDWH GH JD]XO GH OXFUX SUHVXSXQ
hipercarbia n cazXO LQWHUYHQLLORU GH OXQJ GXUDW 3HQWUX D
FRPSHQVD DFHDVWD FRPSOLFDLH DQHVWH]LVWXO WUHEXLH V FUHDVF
YHQWLODUHDSDFLHQWXOXL2FRPSOLFDLHPXOWPDLJUDYGDUGLQIHULFLUH
H[WUHP GH UDU HVWH HPEROLD JD]RDV DFHDVWD SXWkQG IL IDWDO Q
marea majoritate D FD]XULORU vQ FDUH DFHDVWD DSDUH VH GDWRUHD]
asocierii unei alte complicatii OH]LXQHYDVFXODUFXDFXO9HUHVV
XUPDW GH LQVXIODUHD GH JD] GLUHFW LQWUDYDVFXODU 6ROXLD
WHUDSHXWLF vQ DFHVW FD] HVWH HYDFXDUHD UDSLG D JD]XOXL GLQ
camera de lucru si plasarea pacientului ntr-R SR]LLH GH GHFXELW
lateral stng combinat cu Trendelemburg pentru a preveni
SWUXQGHUHDJD]XOXLvQDUWHUDSXOPRQDU(YDFXDUHDJD]XOXLSRDWH
ILIDFLOLWDWSULQSODVDUHDXQXLFDWHWHUYHQRVFHQWUDO
2 SDUWLFXODULWDWH D LQWHUYHQLLORU ODSDURVFRSLFH VH UHIHU OD
PRGXO vQ FDUH R PLF VDX FKLDU PHGLH VkQJHUDUH GLQ VXUVH
YHQRDVH SRDWH IL FRQWURODW SULQ FUHVWHUHD WHPSRUDU D SUHVLXQLL
JD]XOXLvQFDPHUDGHOXFUXSHQWUXDVFDGHDGHELWXOVkQJHUULLLD
SXWHDUHSDUDOH]LXQHD DSDUXW $FHVWD este si motivul pentru care
OD ILQDOXO RSHUDLHL SUHVLXQHD WUHEXLH VFD]XW SDQD OD PP +J
12. FOSFOMICINA
3UH]HQWDUHIDUPDFHXWLF plicuri de 3 g, comprimate de supt de
3 g pentru utilizarea n sfera ORL.
$FLXQH WHUDSHXWLF inhibarea piruvil-transferazei, intervenind
ntr-R ID] SUHFRFH D VLQWH]HL SHSWLGRJOLFDQXOXL HIHFW EDFWHULFLG
SH EDFWHULL JUDP SR]LWLYH L JUDP QHJDWLYH LQFOXVLv
pseudomonas aeruginosa, enterococci, proteus, klebsiella,
enterobacter, serratia.
,QGLFDLL LQIHFLL FX JHUPHQL VHQVLELOL GLQ VIHUD 25/ LQIHFLL
urinare necomplicate.
Mod de administrare: vQ LQIHFLLOH WUDFWXOXL XULQDU VH
DGPLQLVWUHD]vQGR]XQLFGH JvQDLQWHGHPDVLFXYH]LFD
XULQDU JRDO Q SURILOD[LD LQIHFLLORU WUDFWXOXL XULQDU VH
DGPLQLVWUHD] vQ GR] XQLF J vQDLQWH GH LQWHUYHQLD
FKLUXUJLFDOLvQFJODRUHGXSLQWHUYHQLDFKLUXUJLFDO
&RQWUDLQGLFDLL hipersensibilitate lD IRVIRPLFLQ DOSWDUH
LQVXILFLHQUHQDO
5HDFLL DGYHUVH RFD]LRQDO SRW DSUHD WXOEXUUL JDVWURLQWHVWLQDOHUDUSRDWHDSUHDUXVKFXWDQDW
SHQWUXDLQVSHFWDDSDULLDGHHYHQWXDOHVkQJHUULLQDFWLYHvQFXUVXO
13. NITROFURANI
LQWHUYHQLHLGDWRULWHIHFWXOXLGHEDURKHPRVWD]GHVFULVDQWHULRUQ
5HSUH]HQWDQL nitrofurantoin, furazoldon.
FD]XO XQRU FRPSOLFDLL KHmoragice ce nu pot fi controlate prin

PDQHYUH ODSDURVFRSLFH VH LPSXQH FRQYHUVLD LQWHUYHQLHL
ODSDURVFRSLFH vQ XQD FODVLF L HIHFWXDUHD KHPRVWD]HL SULQ
PHWRGHOHFKLUXUJLFDOHRELQXLWH

NITROFURANTOIN
3UH]HQWDUHIDUPDFHXWLFcomprimate de 100 mg.
$FLXQH WHUDSHXWLF bacteriostatic sau bactericid cu spectru
larg, active pe E. Coli, coci piogeni, Shighela, Samonella,
Aerobacer, Trihomonas vaginalis.

;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
(YROXLD WHKQLFLORU ODSDURVFRSLFH D GXV OD GLYHUVLILFDUHD
9. MONOBACTAMI
5HSUH]HQWDQLazotreonam.
3UH]HQWDUHIDUPDFHXWLF IODFRDQHGHPJLJ
$FLXQHWHUDSHXWLF activvi pe bacilli garm negative din familia
(QWHUREDFWHULDFHDHL3VHXGRPRQDVDHUXJLQRVDFKLDUvQFRQGLLL
GHDQDHURELR]
,QGLFDLL LQIHFLL SXOPRQDUH VDX XURORJLFH FX PLFURRUJDQLVPH
sensibile, gonoree.
Mod de administrare: i.m. sau i.v. 2g la 6-8 ore vQ LQIHFLLOH
severe, 1-2 g la 8- RUH vQ LQIHFLLOH VLVWHPLFH -1 g la 8-12
RUH vQ LQIHFLLOH XURORJLFH $MXVWDUHD GR]HORU vQ IXQFLH GH
clearance-XOGHFUHDWLQLQVDXvQFD]GHLQVXILFLHQKHSDWLF
&RQWUDLQGLFDLL DOHUJLHGHPRQVWUDWODSURGXV
5HDFLL DGYHUVH UHDFLL ORFDOH UXVK JUHD GLDUHH HR]LQRILOLH
FUHWHULWUDQ]LWRULLDOHQ]LPHORUKHSDWLFHWURPERIOHELWHODORFXOGH
injectare.
PRGDOLWLORU de abord aparnd astfel laparoscopia single port, mini

ODSDURVFRSLD ODSDUVRFRSLD FX YL]XDOL]DUH WULGLPHQVLRQDO L ELQH
nteles cel mai avansat sistem laparoscopic de la acest moment
ODSDURVFRSLDURERWLFDVLVWDW
Supravegherea postoperatorie D SDFLHLORU FX LQWHUYHQLL
ODSDURVFRSLFH DUH FD SDUWLFXODULWDWH PDMRU UDSLGLWDWHD FX FDUH
SDFLHQWXO vL UHFDSW PRELOLWDWHD OD RUH GH OD LQWHUYHQLD
FKLUXUJLFDOFKLDULvQFD]XOXQRULQWHUYHQWLLGHPDUHDPSORDUHFD
nefrectomia
sau
pieloplastia.
rest
suprimarea
sondei
XUHWURYH]LFDOHvQSULPHOHRUHLDWXEXOXLGHGUHQvQSULPHOH-3
]LOH vQ FD]XO vQ FDUH SODVDUHD XQXLD D IRVW QHFHVDU
VXSUDYHJKHUHD UHOXULL WUDQ]LWXOXL LQWHVWLQDO L HYLWDUHD DSDULLHL GH
10. '(5,9$,'(,0,'$=2/
5HSUH]HQWDQL metronidazol, tinidazol.
3UH]HQWDUH IDUPDFHXWLF comprimate 250 mg, 500 mg,
VXVSHQVLHRUDOGHPJPOVROXLHSHUIX]DELOGHPJPO
flacon 100 ml.
$FLXQH WHUDSHXWLF EDFWHULFLG SULQ DFWLYDUHD vQ FRQGLLL
anaerobe a nitrat-UHGXFWD]HL EDFWHULHQH FH LQWHUDFLRQHD] FX
AND microorganismelor.
,QGLFDLL active pe protR]RDUH EDFWHULL DQDHUREH L VSHFLL
microaerofile, antiparazitar, active pe Giardia, Trihomonas
vaginalis, Entameoba histoyitica.
Mod de administrare: p.o. 1-1,5 g/zi, chemoprofilaxia
FKLUXUJLFDOPJ[]LFXRUHvQDLQWHGHLQWHUYHQLHLYvQ
perIX]LHOHQW-1,5 g/zi.
&RQWUDLQGLFDLL WXOEXUUL DOH PGXYHL KHPDWRIRUPDWRDUH
LQVXILFLHQ KHSDWLFDVDXFDUGLDF3UHFDXLL vQFD] GHDJUDYDUH
DWXOEXUULORUQHXURORJLFHFHQWUDOHLSHULIHULFH
5HDFLL DGYHUVH DWD[LH FRQYXOVLL WXOEXUUL JDVWUR-intestinale,
leucopenie.
FRPSOLFDLL LQIHFLRDVH QRVRFRPLDOH XUPH] Srincipiile chirurgiei

clasice.
VIII.
/,72752,$(;75$&25325($/
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-(VWH IU vQGRLDO FHD PDL SXLQ DJUHVLY GLQWUH WRDWH PHWRGHOH
eficace.
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peste 80- GLQ WRDWH FD]XULOH GH OLWLD] UHQR-XUHWHUDO FDUH
impun un tratament agresiv.
-6H SRDWH IDFH IU DQHVWH]LH OD PDMRULWDWHD OLWRWULWRDUHORU
moderne).
-0XOL GLQWUH SDFLHQLL FX calculi mici sau mijlocii (sub 1 cm) pot fi
H[WHUQDL OD -12- RUH GXS SURFHGXU GDF HYROXLD HVWH
11. OXAZOLIDINONE
5HSUH]HQWDQL: linezolid.
3UH]HQWDUH IDUPDFHXWLF FRPSULPDWH GH PJ VROXLH
SHUIX]DELOPOPJGHVXEVWDQDFWLYSHPO

QRUPDO
-3RDWH IL UHSHWDW vQ FRQGLLL GH VLJXUDQ GXS - 28 de zile,

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COORDONATE TEHNICE ALE ESWL
UndeOH GH RF VXQW GH IDSW fronturi exclusiv pozitive de

XQGH FX IUHFYHQH PXOWLSOH FX HQHUJLH VWDELOLW L VFGHUH
SURJUHVLYComparativ cu ultrasunetele, aceste unde de RF sunt
SXLQ DWHQXDWH GH SDUFXUVXO ORU SULQ HVXWXUL SLHOH PXFKL L
lichide. (QHUJLD DFHVWRU XQGH HVWH GHVFUFDW OD LQWHUIDD GLQWUH
PHGLXOOLFKLGLDQXULQLFDOFXO,QGLIHUHQWGHPRGXOGHSURGXFHUH
XQGHOHGHRFDXFDHIHFWILQDOGH]LQWHJUDUHDVWUXFWXULORUPLQHUDOH
fragmentabile (marea majoritate a calculilor renali).
TrebuiH V QH LPDJLQP IURQWXO XQGHORU GH RF DYkQG R
RUJDQL]DUHFRQLFDDFXPUH]XOWGLQILJXUDXUPWRDUHILJ9,
CALCUL
SISTEM DE FOCALIZARE
6856$81'(2&
Fig.VI.10 - )URQWXOXQGHORUGHRF
)UDJPHQWDUHDFDOFXOLORUVHED]HD]SHIDSWXOFLPSHGDQD
DFXVWLF D FDOFXOLORU UHQDOL HVWH VHPQLILFDWLY GLIHULW ID GH FHD D
HVXWXULORU GLQ MXU 3ULQ VWUXFWXUL FX LPSHGDQ
DFXVWLF
DVHPQWRDUH XQGDGHRFWUHFHIUSLHUGHULGHHQHUJLH.
/D IUDJPHQWDUHD FDOFXOLORU SDUWLFLS L fenomenul de
FDYLWDLH produs de undele de RF 8QGHOH GHRF UHXHVF prin
LQIHFLLORU VXVSHFWDWH OD SDFLHQLL QHXWURSHQLFL L VHSWLFHPLHL Q

PHQLQJLWGR]DUHFRPDQGDWHVWHGHJOD 8 ore.
&RQWUDLQGLFDLL SDFLHQLL FX DQWHFHGHQWH GH UHDFLL GH
hipersensibilitate la acest produs.
5HDFLL DGYHUVH 5HDFLL ORFDOH OD ORFXO GH LQMHFWDUH LQIODPDLH
WURPERIOHELW GXUHUH OD ORFXO LQMHFWDULL 5HDFLL FXWDQDWH UDVK
prurit, urticarie. GasWURLQWHVWLQDOH GXUHUL DEGRPLQDOH JUHXUL
YUVDWXUL GLDUHH $ IRVW UDSRUWDW FROLWD SVHXGR-PHPEUDQRDV
+HPDWRORJLFH
WURPERFLWHPLH
UHYHUVLELO
HR]LQRILOLH
WURPERFLWRSHQLHLQHXWURSHQLH
B. IMIPENEM/CILASTATIN (Tienam)
3UH]HQWDUH IDUPDFHXWLF IODFRDQH FX SXOEHUH SHQWUX VROXLH
SHUIX]DELO FX FDSDFLWDWHD GH PO
ce contin
Imipenem/Cilastatin 500 mg/500 mg sau 250 mg/250 mg
$FWLXQHWHUDSHXWLF bactericid, intervenind la nivelul procesului
vital al sintezei peretelui celulei bacteriene.
,QGLFDLL XWLO LQ WUDWDPHQWXO LQIHFLLORU SROLPLFURELHQH L PL[WH FX
DJHQLDHURELDQDHURELSUHFXPLvQWUDWDPHQWXOLQLLDOvQDLQWHGH
LGHQWLILFDUHD DJHQLORU HWLRORJLFL PLFURELHQLLQIHFLL DEGRPLQDOH
LQIHFLL DOH FLORU UHVSLUDWRULL LQIHULRDUH LQIHFLL JLQHFRORJLFH
VHSWLFHPLLLQIHFLLDOHWUDFWXOXLJHQLWRXULQDULQIHFLLDOHRDVHORUVL
DUWLFXODLLORULQIHFLLDOHSLHOLLLHVXWXULORUPRLHQGRFDUGLWH
Mod de administrare: 1-2 g, i.v.divizat n 3-4 doze. Pentru
WUDWDPHQWXO LQIHFLLORU GH JUDYLWDWH medie se poate folosi de
asemenea un regim de administrare de 1 g de doua ori pe zi.
'R]D WUHEXLH UHGXV SHQWUX SDFLHQLL FX FOHDUDQFH DO FUHDWLQLQHL
POPLQ PS 6H UHFRPDQG FD GR]D WRWDO ]LOQLF V
QXGHSDHDVFJ]LVDXPJNJFRUS]L
CRQWUDLQGLFDLL QX VH DGPLQLVWUHD] vQ PHQLQJLWH SUHFDXLH vQ
caz de alergie la antibiotic betalactaminice.
5HDFLL DGYHUVH ORFDOH (ULWHP GXUHUH L LQGXUDLH ORFDO
WURPERIOHELW 5HDFLL DOHUJLFH L FXWDQDWH UDVK SUXULW XUWLFDULH
eritem multiform, sindrom Steven-Johnson, angioedem,
QHFUROL] HSLGHUPLF WR[LF GHUPDWLW H[IROLDWLY UDUHRUL
FDQGLGR]
IHEU UHDFLL DQDILODFWLFH 5HDFLL JDVWURLQWHVWLQDOH JUHDD
YUVWXUL GLDUHH SWDUHD GLQLORU 5HDFLL KHPDWRORJLFH
eozinofilie, leucopeniH QHXWURSHQLH LQFOXVLY DJUDQXORFLWR]
WURPERFLWRSHQLH WURPERFLWR] L VFGHUH D KHPRJORELQHL
SUHOXQJLUHDWLPSXOXLGHSURWURPELQ
IRUHOH GH SUHVLXQH FUHDWH OLFKLGXOXL GLQ YHFLQWDWHD FDOFXOXOXL V
!

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9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
creeze bule de gaz care se sparg rapid L violent, formnd
J. CEFEPIM
3UH]HQWDUHIDUPDFHXWLFSXOEHUHSWVROXLHLQMHFWDELOGHJ
$FLXQH WHUDSHXWLF DFLXQH DVHPQWRDUH FX FHIDORVSRULQHOH
GH JHQHUDLD D ,,,-D GDU PDL SXWHUQLF SH 3HXGRPRQDV
Haemophilus, Neisseria, Enterobacter, S. aureus, S. pneumonia.
,QGLFDLL sepWLFHPLH EDFWHULHPLH LQIHFLL DOH DSDUDWXOXL
UHVSLUDWRU LQIHFLL XULQDUH LQIHFLL DOH WUDFWXOXL ELOLDU IHEU OD
SDFLHQLLFXQHXWURSHQLH
Mod de administrare: i.v. n doza de 0,5-2 g sau i.m. profund n
doza de 0,5- J GH GRX RUL SH ]L 5HGXFHUHD GR]Hlor n
LQVXILFLHQDUHQDOvQIXQFLHGHFOHDUHFH-XOGHFUHDWLQLQ
&RQWUDLQGLFDLL DOHUJLH VH DGPLQLVWUHD] FX SUXGHQ vQ
VDUFLQLvQSULPHOHOXQLGHDOSWDUH
5HDFLL DGYHUVH DOHUJLH WXOEXUUL GLJHVWLYH HR]LQRILOLH
neutrofilie, tombocitopenie, nefrotoxicitate la doze mari,
IHQRPHQHQHXURWR[LFHFDQGLGR]GXUHULORFDOHGXSDLQMHFWDUH
microjeturi FH YRU ORYL VXSUDIDD SLHWUHL producnd eroziuni la

VXSUDIDDFDOFXOXOXL
7UHEXLH V vQHOHJHP L IDSWXO F IUDJLOLWDWHD FDOFXOLORU HVWH
vQ VWUkQV FRUHODLH FX UHHWD OXL ELRFKLPLF 'DF V-ar face un
clasament privind duritatea calculilor, pe locul nti ar fi desigur
oxalatul de calciu monohidrat, cistina LEUXVKLWXO. La categoria
"duritate medie" am putea introduce oxalatul de calciu dihidrat,
DFLGXOXULFLDUvQXOWLPDFDWHJRULHDFDOFXOLORUXRUGHIUDJPHQWDW
ar intra fosfatul amoniaco-magne]LDQ FDOFXOLL GH LQIHFLH S-au
IFXWFRUHODLL LvQWUHJUDGXOGHUDGLR-opacitate al FDOFXOXOXLL
duritatea lui, vis--vis de ESWL dar cele mai corcte estimari se
8. CARBAPENEMELE
fac prin CT pre ESWL, stabilindu-se i densitatea calculului (UH) i
5HSUH]HQWDQLertapenem, doripenem, imipenem, meropenem.
distana de la calcuOODSLHOHVNLQWRVWRQHGLVWDQFH&XH[FHSLD
A. MEROPENEM (Meronem)
3UH]HQWDUHIDUPDFHXWLF )ODFRQSHQWUXLQMHFLLLYVDXSHUIX]LL
ce FRQLQPJVDXJ PHURSHQHPVXEIRUPGHWULKLGUDWvQ
amestec cu carbonat de sodiu anhidru pentru constituire.
$FLXQHWHUDSHXWLF bactericid, intervenind la nivelul procesului
YLWDO DO VLQWH]HL SHUHWHOXL FHOXOHL EDFWHULHQH 8XULQD FX FDUH
penetreaz SHUHWHOH EDFWHULDQ QLYHOXO VX ULGLFDW GH VWDELOLWDWH
ID GH WRDWH EHWD-ODFWDPD]HOH VHULFH L DILQLWDWHD VD PDUFDW
SHQWUX 3%3 3HQLFLOOLQ %LQGLQJ 3URWHLQV H[SOLF DFLXQHD
EDFWHULFLG SXWHUQLF D PHURSHQHP vPSRWULYD XQXL VSHFWUX ODUJ
de bacterii aerobe si anaerobe.
,QGLFDLL 3QHXPRQLLLQFOXVLYSQHXPRQLLQRVRFRPLDOHLQIHFLLDOH
WUDFWXOXLXULQDULQIHFLLLQWUD-DEGRPLQDOHLQIHFLLJLQHFRORJLFHGH
H[HQGRPHWULWDLERDODLQIODPDWRULHSHOYLDQLQIHFLLFXWDQDWHL
ale tesuturilor moi; meningite; septicemii.
Mod de administrare: injectabil i.v. n bolus lent sau n perfuzie
LQWUDYHQRDV WLPS GH DSUR[LPDWLY - PLQ 'R]D ]LOQLF
UHFRPDQGDW HVWH PJ LY OD ILHFDUH RUH vQ WUDWDPHQWXO
SQHXPRQLHLLQIHFLLORUWUDFWXOXLXULQDULQIHFLLORUJLQHFologice, de
H[HQGRPHWULWDLQIHFLLORUFXWDQDWHLDOHHVXWXULORUPRLJLY
la 8 ore n tratamentul pneumoniilor nosocomiale, peritonitei,
!
FDOFXOLORUGHFLVWLQVHSRDWHVSXQHFradio-opacitatea este invers

SURSRULRQDOFXUDWDGHIUDJPHQWDUHDFDOFXOXOXL
APARATELE DE ESWL
2ULFH WLS GH OLWRWULWRU SUH]LQW XUPWRDUHOH VLVWHPH

componente:
x
VXUVDGHSURGXFHUHLPHFDQLVPXOGHGLULMDUHDXQGHORUGH
RFvQIRFDU
VLVWHPXOGHUHSHUDMLYL]XDOL]DUHDFDOFXOXOXL
PDVDPRELOFXSODWVXUVHLGHXQGHGHRF
SXSLWUXOGHFRPDQG
a) 6XUVHGHXQGHGHRF
1. (PLWRDUHOH supersonic (supersonic emitters) HOLEHUHD]

energia ntr-XQ VSDLX OLPLWDW SURGXFkQG XQGH GH RF DFXVWLFH L
SODVP$VWIHOGHXQGHGHRFDSDUvQQDWXUSHWLPSGHIXUWXQ
(fulgerul XUPDW GH WXQHW Q VLWXDLL DQXPLWH R DVWIHO GH XQG GH

9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
RFDFXVWLFSRDWHIUDJPHQWDFXVXFces calculii. Aceste litotritoare
5HDFLL DGYHUVH WXOEXUUL GLJHVWLYH FUHWHUHD 7*2

nefrotoxicitate, dureri locale la locul de administrare,
WURPERIOHELW IHQRPHQH QHXURWR[LFH FRQYXOVLL WXOEXUUL GH
FRQWLHQPLFULDQRUPDOH
GH WLS VSDUN JDS EXMLH SUHVXSXQ GHVFUFDUHD vQWU-un mediu

OLFKLGLDQ DSD GHJD]HLILDW D XQRU HQHUJLL PDUL vQWUH 9 L
9vQWUHGRLHOHFWUR]LVFXIXQGDLvQOLFKLG
2. (PLWRDUHOH FX DPSOLWXGLQH ILQLW crea] unde acustice
SXOVDWLOH SULQ GHSODVDUHD XQHL VXSUDIHH DFWLYDWH SULQ GHVFUFUL
HOHFWULFH([LVWGRXWLSXULGHDVWIHOGHHPLWRDUH
-(PLWRDUHHOHFWURPDJQHWLFH
-(PLWRDUHSLH]RHOHFWULFH
b) 6LVWHPXOGHIRFDOL]DUHDOXQGHORUGHRF
n diagrama de mai jos, VH SRDWH XRU UHPDUFD IDSWXO F
SXQFWXOVSUHFDUHVHvQGUHDSWXQGHOHGHRFSURGXVHvQFXYSULQ
GHVFUFDUHD HOHFWULF UHSHWDW GH -19kV, coincide cu calculul
ED]LQHWDO UHSHUDW UDGLRORJLF ELGLPHQVLRQDO L YL]XDOL]DW SH FHOH
H. CEFTAZIDIM (Ceftamil)
3UH]HQWDUH IDUPDFHXWLF SXOEHUH SHQWUX VROXLH LQMHQFWDELO
500 mg, 1 g, 2 g.
$FLXQHWHUDSHXWLF efect bactericid, cu activitate pe specii de
Proteus, Enterobacter, E. Coli, citrobacter, Salmonella,
Pseudomonas, Haemophilus,Nisseria, Bordetella, Yersinia;
Stafilococul auriu.
,QGLFDLL LQIHFLJUDYHFXVSHFLLVHQVLELOHVHSWLFHPLLPHQLQJLWH
Mod de administrare: J]LvQSUL]H'R]HOHVHDMXVWHD]vQ
IXQFLHGHFOHDUHQFH-XOGHFUHDWLQLQ
&RQWUDLQGLFDLL aOHUJLH VH DGPLQLVWUHD] FX SUXGHQ vQ
VDUFLQLvQSULPHOHOXQLGHDOSWDUH
5HDFLL DGYHUVH DOHUJLH WXOEXUUL GLJHVWLYH HR]LQRILOLH
neutrofilie, trombocitopenie, nefrotoxicitate la doze mari,
IHQRPHQHQHXURWR[LFHFDQGLGR]GXUHULORFDOHGXSDLQjectare.
douPRQLWRDUHILJ9,6UHPDUFPGHDVHPHQHDIDSWXOF

pacientul este imersat ntr-R FDG FX DS GHJD]HLILFDW FDUH
SHUPLWHXQGHORUGHRF VDMXQJODLQWHUIDDGLQWUHFDOFXO LXULQD
FRQLQXWvQbasinet
I.
CEFPIROM (Cefrom)
3UH]HQWDUHIDUPDFHXWLFflacoane 500 mg, 1000 mg, 2000 mg.

$FLXQH WHUDSHXWLF L LQGLFDLL FHIDORVSRULQ GH JHQHUDLD D
IV-D LQKLE VLQWH]D SHUHWHOXL EDFWHULDQ LQIHFLL DOH DSDUDWXOXL
XULQDU UHVSLUDWRU DOH SLHOLL L HVXWXULORU PRL EDFWHULHPLL
septicemii produse de germeni sensibili la cefrom.
Mod de administrare: i.v. 1-2 g la 12 ore; doza se reduce la
SDFLHQLLFXLQVXILFLHQUHQDO
&RQWUDLQGLFDLL KLSHUVHQVLELOLWDWH OD FHIDORVSRULQH VDUFLQ
DOSWDUHSUXGHQ- ODSDFLHQLLDOHUJLFLODDQWLELRWLFH-lactamice;
vQQHXWURSHQLHVHDMXVWHD]GR]HOH
5HDFLL DGYHUVH angioedem, bronhospasm, RF DQDILODFWLF
UDVK SUXULW XUWLFDULH VGU 6WHYHQV -RKQVRQ JUHD YUVWXUL
GLDUHH GXUHUL DEGRPLQDOH FROLW pseudo-PHPEUDQRDV
QHXWURSHQLHDJUDQXORFLWR]QHIULWDLQWHUVWLLDO
,QWHUDFLXQL PHGLFDPHQWRDVH SUREHQFLGXO FUHWH FRQFHQWUDLD
SODVPDWLF D FHIDORVSRULQHORU DWHQLH vQ FD]XO DVRFLHULL FX
GLXUHWLFHGHDQVVDXDPLQRJOLFR]LGH
Fig.VI.11.Diagrama litotritorului DornierHM-3

GXSMARSHALL LSTOLLER)

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LQIHFLL XULQDUH PHQLQJLWH SQHXPRQLL LQIHFLL 25/ SHULWRQLWH

septicemiLLQIHFLLRVRDVHFXWDQDWH
Mod de administrare: 1-2 g/zi ntr-RVLQJXU GR]
&RQWUDLQGLFDLL - DOHUJLH OD FHIDORVSRULQH SUXGHQ la cei cu
DOHUJLL OD SHQLFLOLQ SUXGHQ VDX VH YD HYLWD vQ VDUFLQ L OD
IHPHLOH FDUH DOSWHD] GR]H PDL PLFL OD SDFLHQLL FH SUH]LQW
I.R.sau I.H.
5HDFLL DGYHUVH GLDUHH JUHD YUVWXUL JORVLW OHXFRSHQLH
DQHPLHKHPROLWLFWURPERFLWRSHQLHSUXULWFXWDQDWXUWLFDUH
FHIDOHHIHEUIULVRDQH
Asocieri medicamentoase: vQ LQIHFLL FX 3VHXGRPRQDV HVWH
DYDQWDMRDVDVRFLHUHDFXXQ$*
F. CEFIXIM (Eficef)
9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
La celelalte tipuri de litotritoare electro-hidraulice mai

PRGHUQH FDGD FX DS FDUH GHVLJXU SXQHD SUREOHPH GH FRQIRUW
SDFLHQWXOXL D IRVW vQORFXLW FX R SXQJ VSHFLDO GH FDXFLXF
PHPEUDQ GH FXSODUH DGDSWDW FXYHL vQ FDUH VH SURGXF
GHVFUFULOH
HOHFWULFH
/LWRWULWRDUHOH
HOHFWURPDJQHWLFH
L
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SR]LLDFDOFXOXOXL
0RGDOLWLOHGHUHSHUDMDOHFDOFXOXOXLVXQWFHOHXWLOL]DWHL
vQGLDJQRVWLFXOOLWLD]HLIOXRURVFRSLDLHFRJUDILD
3UH]HQWDUHIDUPDFHXWLF capsule de 200 mg.

$FLXQH WHUDSHXWLF LQKLE sinteza peretelui bacterian; stabil
IDGH-ODFWDPD]
,QGLFDLL LQIHFLL DOH FLORU UHVSLUDWRULL 25/ DOH FLORU XULQDUH
FLORU biliare produse de streptococ, pneumococ, Moraxella,
Haemophilus, Nisseria, Serratia.
Mod de administrare: 400 mg pe zi n 2 prize.
&RQWUDLQGLFDLL DOHUJLH OD FHIDORVSRULQH SUXGHQ la cei cu
DOHUJLL OD SHQLFLOLQ SUXGHQ VDX VH YD HYLWD vQ VDUFLQ L la
IHPHLOH FDUH DOSWHD] GR]H PDL PLFL OD SDFLHQLL FH SUH]LQW
I.R.sau I.H.
5HDFLL DGYHUVH GLDUHH JUHD YUVWXUL JORVLW OHXFRSHQLH
DQHPLH KHPROLWLF WURPERFLWRSHQLH SUXULW FXWDQDW XUWLFDUH
FHIDOHHIHEUIULVRDQH
Reperajul radiologic vQ GRX SODQXUL DUH FHUWH DYDQWUDMH

majoritatea calculilor urinari sunt radioopaci; amplificatoarele de
LPDJLQHRIHUR EXQUH]ROXLHLQIRUPkQGFXPXOWSUHFL]LHGHVSUH
HYROXLDFDOFXOXOXLVXEWLUXOXQGHORUGHRFVHSRWORFDOL]DGHVLJXU
L vQ IXQFLH GH WLSXO GH OLWRWULWRU FDOFXOLL VLWXDL SH XUHWHU SHUPLWH
plasarea sondelor ureterale, nainte sau chiar n timpul lLWRWULLHLVDX
HYHQWXDOD LQWURGXFHUH D VXEVWDQHORU GH FRQWUDVW LQWUDYHQRV VDX
SULQ FDWHWHU XUHWHUDO SHQWUX R PDL EXQ YL]XDOL]DUH D FDOFXOLORU
UDGLRWUDQVSDUHQL
Reperajul
ecografic.
Avantajele
reperajului
calculilor
UDGLRWUDQVSDUHQLLHYLWDUHDULVFXOXLGHLUDGLHUHSUHXOGHFRVWLGH
G. CEFOTAXIM
Prezentare faUPDFHXWLF SXOEHUHSHQWUXVROXLHLQMHFWDELOLP
sau i.v. 500mg, 1g, 2g.
$FLXQH WHUDSHXWLF efect bactericid pe streptococ,
penumococi,
stafilococi
penicilinazo-secretori,
gonococi,
meningococ, Klebsilla, Enterobacter, Proteus, Salmonella,
Shigella, Citrobacter, Providenatia, Moraxela, clostridium.
,QGLFDLL LQIHFLL JUDYH VHYHUH VHSWLFHPLL HQGRFDUGLWH
meningite.
Mod de administrare: i.m. sau i.v. 12g/zi n 3-4 prize; n
LQIHFLLOH XULQDUH VH DGPLQLVWUHD] J]L 5HGXFHUHD GR]HL OD
MXPWDWHFkQGFlearence-ul creatininei scade sub 5 ml/min.
&RQWUDLQGLFDLL alergie.

vQWUHLQHUH PDL VF]XW DPSODVDUHD vQ RULFH LQFLQW VXQW

contrabalansate de imposibilitatea reperajului calculilor ureterali
ORPEDUL L SHOYLQL SUHFXP L HYDOXDUHD FkWHRGDW GLILFLO D
IUDJPHQWULLFDOFXOXOXL
Masa mRELO SH FDUH HVWH DH]DW SDFLHQWXO a FXQRVFXW L HD
PXOWLSOH DGDSWUL vQ VFXUWD LVWRULH D OLWRWULLHL H[WUDFRUSRUHDOH
0RGHOHOH PDL QRL SHUPLW QX QXPDL R PDL EXQ PRELOLWDWH D
SDFLHQWXOXL
GDU
L
SRVLELOLWDWHD

HIHFWXULL
PDQHYUHORU
9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
HQGRXURORJLFHFKLDULvQWLPSXOOLWRWULLHL
2. 3XSLWUXO GH FRPDQG, GH XQGH VXQW GHFODQDWH XQGHOH GH RF
HVWH VLWXDW vQ YHFLQWDWHD PRQLWRUXOXL PRQLWRDUHORU XQGH VH
YL]XDOL]HD] FDOFXOXO ,QGLIHUHQW GH WLSXO GH DSDUDW GH DLFL HVWH
UHJODW NLORYROWDMXO XQGHORU GH RF IUHFYHQD ORU L VXQW GHFODQDWH
PDL PXOW VDX PDL SXLQ ]JRPRWRDVHOH XQGH GH RF Q FD]XO
DSDUDWHORU FX UHSHUDM UDGLRORJLF SXSLWUXO GH FRPDQG HVWH ILH
instalat ntr-RvQFSHUHDOWXUDWILHSURWHMDWGHXQHFUDQGHVWLFO
VSHFLDOLPSHQHWUDELOSHQWUXUD]HOH X (fig.VI.12).
Klebsiella, Citobacter, Neisseria gonorrheae, Propionibacteria

DFQHVL%DFWHURLGHVVSSSHSWRFRFLSHSWRVWUHSWRFRFL
,QGLFDLL LQIHFLL DOH WUDFWXOXL XULQDU LQIHFLL 25/ LQIHFLL
UHVSLUDWRULLLQIHFLLFXWDQDWHFXJHUPHQLVHQVLELOLOD&HIDFORU
Mod de administrare: RUDO X]XDO PJ OD K vQ LQIHFLL
severe 500 mg la 8 h (doza max. 4 g/zi).
5HDFLL DGYHUVH HUXSLL FXWDQDWH SUXULW XUWLFDULH JUHD,
YUVWXUL UDU KHSDWLW WUDQ]LWRULH L LFWHU FROLVWDWLF
&RQWUDLQGLFDLL ODEROQDYLLDOHUJLFLODFHIDORVSRULQHSUXGHQ la
cei alergici la peniciline.
Asocieri medicamentoase: Aminoglicozide Metronidazol n
LQIHFLLVHYHUHDQDEROLL
D. CEFTIBUTEN (Cedax)
monitoare
3UH]HQWDUH IDUPDFHXWLF Capsule a 400 mg. Pulbere pentru

VXVSHQVLHRUDO- IODFRDQHFHFRQLQJSXOEHUHRELQkQGX-se
GXSUHFRQVWLWXLUHPJFHIWLEXWHQSHQWUXPOVROXLH
$FWLXQH WHUDSHXWLF Antibiotic beta-ODFWDPLF FX DFLXQH
antimicroELDQ EDFWHULFLG FH FRQVW vQ LQKLEDUHD SURFHVXOXL GH
VLQWH]DSHUHWHOXLFHOXOHORUPLFURELHQH
,QGLFDLL ,QIHFLL DOH FLORU UHVSLUDWRULL VXSHULRDUH IDULQJLWH
DPLJGDOLWH VLQX]LWH DFXWH RWLWH PHGLL ,QIHFLL DOH FLORU
UHVSLUDWRULL LQIHULRDUH EURQLte acute, perioade de acutizare ale
EURQLWHORU FURQLFH SQHXPRQLL DFXWH ,QIHFLL XULQDUH FRPSOLFDWH
sau nu. Enterite LJDVWURHQWHULWHODFRSLL
Mode de administrare: $GXOL 400 mg/zi. Capsulele pot fi
administrate independent de mese. Copii: 9 mg/kg/corp/zi de
VXVSHQVLHRUDO
&RQWUDLQGLFDLL /D SDFLHQLL DOHUJLFL OD FHIDORVSRULQH VDX OD
RULFDUHGLQWUHFRQVWLWXHQLLVL
5HDFLL DGYHUVH $X IRVW UDSRUWDWH UDU UHDFLL DGYHUVH
JDVWURLQWHVWLQDOHJUHDGLDUHHFHIDOHH
Pern cu ap
Calcul renal
Coloan de lichid
Generator de
Monitor
unde de oc
EKG
Reflector
Fig. VI.12 6FKHPDXQXLOLWRWULWRUHOHFWURKLGUDXOLFGHJHQHUDLDDGRXD
ESWL - ,1',&$,,
Se pot trata prin ESWL:

x
E. CEFTRIAXON (Cefort)
calculi caliceali superiori L PLMORFLL VLQJXUD FRQGLLH fiind

R WLM FDOLFHDO VXILFLHQW GH ODUJ FDUH V SHUPLW
IUDJPHQWHORUVSOHFHVSUHED]LQHW
calculi caliceali inferiori. Pentru a beneficia de ESWL

WUHEXLHVF vQGHSOLQLWH SHQWUX HOLPLQDUH QLte

criterii
3UH]HQWDUH IDUPDFHXWLF: flac: 259 mg, 500 mg, 1 g, 2 g.

$FLXQH WHUDSHXWLF LQKLE sinteza peretelui bacterian; stabil
ID GH -ODFWDPD] Spectru antibacterian: Stafilococul aureus,
Staf.epidermidis, Streptococus pneumoniae, Enterobacter, E.
coli, HaemRSKLOXV LQIOXHQ]DH L SDUDLQIOXHQ]DH .OHEVLHOOD
Neisseria
gonorheae,
Proteus
mirabilis,
Pseudomona
aeruginosa.
,QGLFDLL LQIHFLL XULQDUH LQIHFLL JHQLWDOH LQFOXVLY JRQRUHH
$
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
ceftibuten, cefotaxim, ceftizoxim, ceftriaxon,

FHIRSHUD]RQJHQHUDLDD,9DFHIHSLPFHISLURP
9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
ceftazidim,
anatomice favorabile: unghiul infundibulo-pelvic mai mare

o
de 70 XQJKLXO IRUPDW vQWUH GLUHFLD XUHWHUXOXL L GLUHFLD
A. CEFALEXIN
calicelui inferior); lungimea calicelui inferior < 3cm.
3UH]HQWDUH IDUPDFHXWLF capsule 250 mg, 500 mg si de 1 g,

SXOEHUHSHQWUXVXVSHQVLHRUDOPOPOPO
$FLXQH WHUDSHXWLF bactericid pe bacterii JUDP SR]LWLYH L SH
unele specii de bacili gram negativi.
,QGLFDLL LQIHFLL 25/ LQIHFLL UHVSLUDWRULL LQIHFLL XULQDUH L
cutanate cu germeni sensibili, n special gram pozitivi.
Mod de administrare: p.o. 0,5-1g, n 4 prize.
5HDFLLDGYHUVH JUHXULYUVWXULFUHWHULDOHWUDQVDPLQD]HORU
icter colestatic.
&RQWUDLQGLFDLLDOHUJLHLQIHFLLVHYHUHVHSWLFHPLL
calculi bazinetali mai mici de 2 cm n diametru.
calculi ureterali lombari SkQ vQFPDFURU aspect

radiologic
VXJHUHD] SRVLELOD IUDJPHQWDUH
calculi
semiopaci;
x
calculi ureterali iliaci GDF DSDUDWXO GH OLWRWULLH DUH

DFHDVWIDFLOLWDWH
calculi ureterali pelvini SHQWUX PXOL DXWRUL (6:/ fiind

SULPDRSLXQHvQDLQWHDXUHWHURVFRSLHL
B. CEFUROXIM (Zinnat)
3UH]HQWDUH IDUPDFHXWLF cps film 125 mg, 250 mg, 500 mg;
suspensie 125 mg/5 ml.
$FLXQH WHUDSHXWLF - spectru: Coci Gram-pozitivi: pneumococ,
Streptococ piogen, Stafilococul omini, Stafilococul epidermidis;
Bacili Gram-pozitivi: N. Pneumoni; E. coli, Proteus mirabilis,
Citobacter, Providentia, N. Influenzae.
,QGLFDLL LQIHFLL XULQDUH SQHXPRQLL PHQLQJLWH sinuzite cu
germeni sensibili.
Mod de administrare: LQIHFLL XULQDUH PJx2/zi; pneumonii,
EURQLWHPJx2/zi.
&RQWUDLQGLFDLL- KLSHUVHQVLELOLWDWHODFHIDORVSRULQHSUXGHQ la
SDFLHQLLDOHUJLFLODSHQLFLOLQH
5HDFLLDGYHUVH - HUXSLL FXWDQDWH XUWLFDULHVWULIHEULOHIRDUWH
UDUUHDFLLDQDILODFWLFHJUHDYUVWXULGLDUHH
Asocieri medicamentoase: se pot asocia cu AG sau
PHWURQLGD]ROvQLQIHFLLVHYHUH
&DOHD XULQDU VXEMDFHQW FDOFXOXOXL WUHEXLH V ILH

SHUPHDELO $FHDVWD HVWH XQD GLQ FRQGLLLOH GH ED] ce trebuie
YHULILFDW vQDLQWH GH RULFH WHQWDWLY GH OLWRWULLH 8URJUDILD LY vL
JVHWH L DLFL XWLOLWDWea de necontestat, preciznd att locul
REVWDFROXOXLFkWLJUDGXOGHSHUPHDELOLWDWHDFLLXULQDUH
&RH[LVWHQD LQIHFLHL XULQDUH FX OLWLD]D a constituit L
FRQVWLWXLHRSUREOHPIRDUWHVHULRDVGLQSHUVSHFWLYDWUDWDPHQWXOXL
L D HYHQWXDOHORU FRPSOLFDLL
7UDWDUHD HQHUJLF FRQIRUP
DQWLELRJUDPHL D HYHQWXDOHL LQIHFLL vQDLQWH GH OLWRWULLH HVWH

obligatorie.
&2175$,1',&$,,/((6:/
Absolute: sDUFLQDLQGLIHUHQWGHEXQDHYROXLH tXOEXUULGH

FUD]VDQJXLQQHFRQWURODELOHREVWDFROGLVWDOFDOFXOXOXLGH
C. CEFACLOR (Ceclor)
3UH]HQWDUH IDUPDFHXWLF: cps: 250 mg; 500 mg; suspensie
pentru DGPLQLVWUDUHRUDOPJPOPJPO
$FLXQHWHUDSHXWLFLLQGLFDLL FHIDORVSRULQ gen. III - LQIHFLL
cu stafilococi coagulazo-SR]LWLYL L QHJDWLYL L SHQWUX FHL
SURGXFWRUL GH SHQLFLOLQD] 6WUHSWRFRF S\RJHQHV VWUHSWRFRF
pneumonie, Moraxella catarrhalis, Haemophillus influenzae
LQFOXV VHFUHWRUL GH -ODFWDPD] ( FROL 3URWHXV PLUDELOLV

WUDWDW VWHQR] XUHWHUDO DOW FDOFXO HWF SDFLHQW FRPDWRV

QHFRRSHUDQW +7$ QHFRQWURODELO SDFLHQL OD FDUH FDOFXOXO
QX SRDWH IL DGXV vQ IRFDU REH]LWDWH JU ,,, GHIRUPUL DOH
coloanei vertebrale).

Relative: +7$ LQIHFLD XULQDU SDFLHQLL DIODL VXE

9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
WUDWDPHQW FX PHGLFDLH DQWLFRDJXODQW REH]LWDWHD
&RQVWUDLQGLFDLLHipersensibilitate la Colistin in antecedente.
DQHYULVPHDRUWLFHLVDXDOHDUWHUHLUHQDOHVDXFHLFXSDFH
6. CICLINELE
maker cardiac.
35(*7,5($3$&,(178/8,3(1758(6:/
3HQWUX SDFLHQLL FDUH vor urma ESWL pe un litotritor cu

UHSHUDM UDGLRORJLF WUHEXLH V VH HIHFWXH]H R SUHJWLUH
preoperatorie. 9RP DYHD vQ YHGHUH R EXQ SUHJWLUH D WXEXOXL
GLJHVWLYSHQWUXFDDHURFROLDLVDXPDWHULLOHIHFDOHVQXDFRSHUH
calculul vizat.
&RQVLGHUPFsunt EHQHILFHXUPWRDUHOHUHFRPDQGUL

evitarea cu 12-24 ore nainte de ESWL a consumului de

PkQFUXUL L EXWXUL FH SURYRDF IODWXOHQ EDORQDUH
IDVROHFDUWRILGXOFLXULIUXFWHEXWXULFDUERJD]RDVHFXVDX
IU]DKU
HYLWDUHD IXPDWXOXL L D FRQVXPXOXL Ge cafea nainte de

SURFHGXU
oo
FOLVPHYDFXDWRDUHvQMXUXORUHL vQSUH]LXDHIHFWXULL
OLWRWULLHL
HVWH LQGLFDW FRQVXPXO GH DOLPHQWH IU UH]LGXXUL FDUQH

ILDUW SDVWUDP XQF EUkQ] GH YDFL RX WDUL SkLQH
XVFDWLVDXSUMLW
VH RSUHWH FX FHO SXLQ -10 zile nainte de ESWL

WUDWDPHQWXO FX $VSLULQ VDX 7URPERVWRS SHQWUX D HYLWD
VkQJHUDUHD SRVWSURFHGXU ,QYHVWLJDUHD SDUDPHWULORU
FRDJXOULLHVWHREOLJDWRULHODWRLSDFLHQLL
'R]HOH X]XDOH PD[LPH VXQW GH XQGH GH RF SHU HGLQ
pentUX FDOFXOLL ED]LQHWDOL VDX FDOLFHDOL L GH XQGH GH RF
pentru calculii ureterali.
NGRIJIRI POST ESWL

5HSUH]HQWDQLtetraciclina, doxiciclina,minociclina.
A. DOXICICLINA : (doxycylinum)
Forma de prezentare: &DSVXOH FRQLQkQG PJ GR[LFLFOLQD
sub forma de clorhidrat.
$FLXQH WHUDSHXWLF Doxiciclina este un antibiotic DSDULQkQG
JHQHUDLHLDGRXDGHWHWUDFLFOLQH
,QGLFDLL ,QIHFLL DOH DSDUDWXOXL UHVSLUDWRU LQIHFLL DOH DSDUDWXOXL
XURJHQLWDO DQWLELRWLF GH SULP DOHJHUH vQ LQIHFLLOH SURYRFDWH GH
Chlamydia, Calymmatobacterium granulomatis (granulom
inghinal), UreaplaVPDXUHDO\WLFXP&DDOWHUQDWLYODWUDWDPHQWXO
FX SHQLFLOLQ vQ LQIHFLLOH SURYRFDWH GH JRQRFRFFL JRQRUHH
XUHWULWH +DHPRSKLOXV GXFUH\ VDQFUXO PRDOH L 7UHSRQHPD
SDOOLGXP DJHQWXO HWLRORJLF DO VLILOLVXOXL LQIHFLL JDVWURLQWHVWLQDOH
LQIHFLLRFXODUHDOHSLHOLLLHVXWXULORUPRL
Mod de administrare: 'R]D RELQXLW la adult este de 200 mg
doxiciclina n prima zi (intr-R VLQJXUD SUL] VDX vQ GRXD SUL]H
HJDOHXUPDWGHPJ]LQLQIHFLLOHJUDYHGR]DGH
LQWUHLQHUHYDILGHPJ7UDWDPHQWXOVHYDFRQWLQXDFHOSXLQ
]LOH GH OD GLVSDULLD VLPSWRPHORU EROLL 3RVRORJLH SDUWLFXODU
8UHWULWD JRQRFRFLF DFXW OD EUEDW 2 GR] XQLF de 300 mg
sau 100 mg de 2x/zi, timp de 2-4 zile. ,QIHFLLJRQRFRFLFHDFXWH
la femei: [ PJ]L SkQ la vindecare. DQFUXO SULPDU,
sifilisul secundar: PJ]L IUDFLRQDW vQ PDL PXOWH SUL]H FHO
SXLQ]LOHUretrita cu Chlamydia: 2 x 100 mg/zi timp de 7 zile.
Trahoma: 200 mg/zi timp de 40 de zile.
&RQWUDLQGLFDLL HipeUVHQVLELOLWDWH OD GR[LFLFOLQ VDUFLQD L
SHULRDGDGHDOSWDUH
5HDFLL DGYHUVH DQRUH[LH JUHD YUVWXUL GLDUHH JORVLW
HQWHURFROLWH VDX FROLW SVHXGRPHPEUDQRDV UHDFLL DOHUJLFH
3UHFDXLL Se va evita administrarea capsulelor de Doxiciclina la
EROQDYLLSUH]HQWkQGDOWHUULIXQFLRQDOHDOHHVRIDJXOXL
7. CEFALOSPORINELE
5HSUH]HQWDQL JHQHUDLD , FHIDOH[LQ FHIDGUR[LO FHIUDGLQ
FHID]ROLQ FHIDORWLQ FHIDSLULQ JHQHUDLD D ,,-a (cefaclor,
cefuroxime-axetil, cefprozil, cefuroxim, cefamandol, ceforanid,
FHIXQRFLG JHQHUDLD D ,,,D FHISRGR[LPD-axetil, cefixim,

;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
pozitivi inclusiv cei secretori de beta-lactamaza (stafilococi si

VWUHSWRFRFL ID GH WXOSLQL GH &ORVWULGLXP /LVWHULD
Lacttobacillus, Actinomyces, Bacillus.
,QGLFDLL ,QIHFLL VHYHUH FX JHUPHQL VHQVLELOL OD YDQFRPLFLQ
LQFOXVLY FROLW SVHXGRPHPEUDQRDV LQIHFLL FX WXOSLQL GH
VWDILORFRFL UH]LVWHL OD PHWLFLOLQD EHWD-lactamo-UH]LVWHQL VDX OD
SDFLHQLFXDOHUJLHODSHQLFLOLQ
Mod de administrare: Tratamentul este individualizat. In
general se administreaza i.v. sub forma de perfuzie 5 mg/ml cel
PXOW PJPLQ SXWkQG FUHWH GR]D FHO PXOW SkQD OD PJPO
/DSDFLHQLLFXIXQFLHUHQDOQRUPDOGR]D]LOQLFLYHVWHGH
J FkWH PJ OD RUH VDX J OD RUH /D SDFLHQLL FX
DIHFWDUHD IXQFLHL UHQDOH GR]HOH VXQW PDL PLFL vQ IXQFLH GH
clearance-XOODFUHDWLQLQ
5HDFLL DGYHUVH 5HDFLL DOHUJLFH vQURLUHD SULL VXSHULRDUH D
FRUSXOXL FX FRQWUDFWXU PXVFXODU ,Q FD]XO DGPLQLVWUDULL UDSLGH
afectarea functiei renale (n special n cazul asocierii cu
aminoglicozidH KLSRDFX]LH SULQ RWRWR[LFLWDWH /D SDFLHQLL FX
DIHFWDUHD IXQFLHL UHQDOH QHXWURSHQLH UHYHUVLELO IOHELWD OD ORFXO
DGPLQLVWUULL
&RQWUDLQGLFDLL +LSHUVHQVLELOLWDWHFXQRVFXW la produs.
5. POLIPEPTIDELE
9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
'XSOLWRWULLHRSDUWHGLQSDFLHQLvQFHSVHOLPLQHIUDJPHQWH
GH FDOFXO FKLDU vQ FXUVXO VSLWDOL]ULL QWUH L GLQ SDFLHQL
HOLPLQ fragmentele cu dureri, ce pot fi calmate printr-o strategie
VLPSO

restrngerea consumului de lichide;
administrarea de KETOROLAC TRAMADOL;

%LODQXO HGLQHL GH OLWRWULLH SHQWUX FDOFXOLL UHQDOL VH
poate face la 15- ]LOH RFD]LH FX FDUH UDGLRJUDILD UHQDO

VLPSOLHFRJUDILDYRULQIRUPDGHVSUHJUDGXOGHIUDJPHQWDUH
WRSRJUDILD IUDJPHQWHORU L UVXQHWXO HYHQWXDOHL REVWUXFLL
asupra rinichiului.
()(&7(/(1('25,7($/(81'(/25'(2&
Q FHHD FH SULYHWH DIHFWDUHD UHQDO, cel mai comun semn

clinic al agresiunii l constituie KHPDWXULD PDFURVFRSLF, din
IHULFLUHWUDQ]LWRULHDSUXWGXSRHGLQGH(6:/6HWLHDVW]L
F DFHDVW KHPDWXULH HVWH VHFXQGDU vQ SULPXO UkQG OH]LXQLORU
5HSUH]HQWDQLbacitracina, colistinum.
COLISTIN (sulfat de colistina)
3UH]HQWDUH IDUPDFHXWLF Comprimate continand 250.000 U.I.
GHVXOIDWGHFROLVWLQDLIODFRDQHGH8,L8,
$FLXQHWHUDSHXWLF EDFWHULRVWDWLFVLEDFWHULFLGVHH[HUFLWSULQ
deteriorarea membranei celulare a germenilor microbieni, att n
VWDGLXOGHPXOWLSOLFDUHFkWLvQUHSDXV
,QGLFDLL ,QIHFLL GLJHVWLYH FX JHUPHQL VHQVLELOL DWkW OD FRSLL
GLDUHH LQIHFWLRDV JDVWURHQWHULWH WR[LFR]H in asociere cu
IRUPDLQMHFWDELOSURILODFWLFLQFXUVXOHSLGHPLLORULQWUDVSLWDOLFHWL
FkW VL OD DGXOL JDVWURHQWHULWH HQWHURFROLWH GL]HQWHULH EDFLODU
SURILOD[LD VXSUDLQIHFLLORU OD FLURWLFL FROLWH PHWD- si postamibiene,
diverticulite, rectocolite hemoragice, neoplasme infectate ale
colonului). Sterilizarea (eventual asociat cu sulfamide) a
intestinului n cadrul pregatirii preoperatorii pentru interventii pe
tubul digestiv.
Mod de administrare: FRSLLSHVWHDQLVLDGXOLGHRULSH]L
cate 2 000 000 U.I.

SDUHQFKLPDWRDVH L vQ PLF PVXU DFLXQLL IUDJPHQWHORU DVXSUD

uroteliului.
$OWH FRPSOLFDLL FH DX IRVW GHVFULVH vQ OLWHUDWXU UXSWXUD
UHQDO KHPDWRDPH UHQDOH KHPDWRDPH VSOHQLFH KHPDWRDPH
pulmonare, pancreatita acuta, leziuni ale mucoasei gastrice sau
DOHFRORQXOXLVWRSFDUGLDFDXRLQFLGHQIRDUWHPLFGLQIHULFLUH
$
9,,'(5,9$,$85,1$5(;7(51,1&217,1(17
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
VII. '(5,9$,$85,1$5(;7(51,1&217,1(17
(UROSTOMIA)
'HULYDLD XULQDU UHSUH]LQW GHYLHUHD SULQWU-R LQWHUYHQLH
FKLUXUJLFDO D FXUVXOXL IOX[XOXL XULQDU L SRDWH IL WHPSRUDU VDX

GHILQLWLY /H]LXQLOH FDUH QHFHVLW DFHDVW VDQFLXQH WHUDSHXWLF
VXQW FHO PDL DGHVHD DIHFLXQL DOH WUDFWXOXL XULQDU LQIHULRU
intHUHVkQG YH]LFD XULQDU vQ PDMRULWDWHD FD]XULORU L SRW IL OH]LXQL
PRUIRORJLFH FRQJHQLWDOH WXPRUL LQIHFLL WUDXPDWLVPH LUDGLHUH
VDXIXQFLRQDOHQHXURORJLFH(VWHQHFHVDUSHQWUXDvQORFXLVDXD
XQWDRSRULXQHVHYHUDIHFWDWDWUDFWXOXLXULQDULscopul este de a
FRQVHUYDIXQFLDUHQDO
&HOH PDL FXQRVFXWH IRUPH GH GHULYDLH XULQDU LQFRQWLQHQW
sunt ureterostomiile cutanate directe, transileale sau transcolice.
Ureterostomiile cutanate directe presupun deconectarea
XQXLD VDX DPEHORU XUHWHUH GH YH]LFD XULQDU L DGXFHUHD ORU OD
VXSUDIDD SHUHWHOXL DEGRPLQDO FX IRUPDUHD XQHL VWRPH SULQ FDUH
GUHQHD]FRQWLQXXXULQD
cazul
ureterostomiilor
cutanate
transileale
sau
transcolice XUHWHUHOH VXQW GHFRQHFWDWH GH YH]LFD XULQDU L

DQDVWRPR]DWH OD H[WUHPLWDWHD SUR[LPDO D XQXL VHJPHQW
LQWHVWLQDO L]RODW LOHDO VDX FROLF D FUXL H[WUHPLWDWH GLVWDO HVWH
HVWHDGXVODVXSUDIDDDEGRPHQXOXLSHQWUXDIRUPDVWRPD
3ULQFLSDOHOH LQGLFDLL SHQWUX HIHFWXDUHD GHULYDLLORU XULQDUH
VXQWWXPRULOHYH]LFDOH LQILOWUDWLYHGXSFLVWHFWRPLDUDGLFDOVDX
DIHFLXQL FDUH DIHFWHD] VHYHU IXQFLD DSDUDWXOXL XULQDr inferior
DQRPDOLL FRQJHQLWDOH WUDXPDWLVPH FLVWLW FURQLF GLVIXQFLL
neurologice etc.).
Dispozitive pentru urostomie

4. GLICOPEPTIDELE
5HSUH]HQWDQL teicolpanina, vancomicina, televancin.
'HULYDLLOHXULQDUHSRWILcontinente sau incontinente.
3UH]HQWDUHIDUPDFHXWLF: cps 400 mg

$FLXQHWHUDSHXWLFLGHPFLSURIOD[RFLQ
,QGLFDLLWUDWDPHQWXOLQIHFLLORUFXWXOSLQLVHQsibile la QRUIOR[DFLQ
SLHORQHIULWH
FLVWLWH
SURVWDWLWH
XUHWULW
JRQRFRFLF
JDVWURHQWHULW
Mod de administrare: XUHWULWD JRQRFRFLF PJ SUL] XQLF;
SURVWDWLWPJx]LVSWPkQL; cistita 400 mgx2/zi, 3-5 zile;
pielonefrite 400 mgx2/zi, 14-21 zile.
&RQWUDLQGLFDLL KLSHUVHQVLELOLWDWH OD FKLQRORQH VDX H[FLSLHQL
FRSLL VDUFLQ DOSWDUH SUHFDXLL OD SDFLHQLL FX $9& VDX
DIHFLXQLFDUGLR-vasculare.
5HDFLL DGYHUVH GXUHUL DEGRPLQDOH JUHD FROLW pseudoPHPEUDQRDVUDVKFXWDQDWprurit, fotosensibilitate.
A. TEICOLPLANINA (targocid)
3UH]HQWDUHIDUPDFHXWLF: flacoane 200 mg, 400 mg.
$FLXQH WHUDSHXWLF L LQGLFDLL LQIHFLL JUDYH FX JHUPHQL
Gram-pozitivi: urinare, respiratori, digestive, endocardite,
RVWHRPLHOLWH SURILOD[LH SUHRSHUDWRULH ID GH JHUPHQLL *UDPpozitivi.
Mod de administrare: i.m., i.v. 400 mg x 1-]LvQLQVXILFLHQ
UHQDO GR]HOHQXVHDMXVWHD]vQSULPHOH]LOHGHWUDWDPHQWOD
un clearance al creatininei de 40-60 ml/min doza se va reduce la
MXPWDWH
&RQWUDLQGLFDLLKLSHUVHQVLELOLWDWHODVXEVWDQDDFWLYVDUFLQ
DOSWDUHSUXGHQ QXVHHOLPLQSULQGLDOL]KLSHUVHQVLELOLWDWH
vQFUXFLDW FX YDQFRPLFLQD WHVWDUHD IXQFLHL UHQDOH L KHSDWLFH
n cursul tratamentului.
5HDFLL DGYHUVH locale: HULWHP GXUHUL WURPERIOHELW generale:
UDVK SUXULW IHEU JUHD YUVWXUL GLDUHH HR]LQRILOLL
OHXFRSHQLHWURPERFLWRSHQLHWURPERFLWR]QHXWURSHQLHDPHHOL
cefalee.
B. VANCOMICINA (clorhidrat de vancomicina)
3UH]HQWDUHIDUPDFHXWLFFlacoane a 500 mg (cutie cu 1 fl.).
$FLXQH WHUDSHXWLF $QWLELRWLF FX DFWLXQH EDFWHULFLG FDUH VH
UHDOL]HD] SULQ DOWHUDUHD SHUPHDELOLWLL SHUHWHOXL FHOXODU VL D
sintezei ARN bacterian. Produsul HVWH DFWLY ID GH FRFLL JUDP-
$
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
5HDFLLDGYHUVHJUHDGLDUHHGXUHULDEGRPLQDOHLFWHU arsuri,
HUXSii cutanate, urticarie, fotosensibilitate, sdr. Stevens
-RKQVRQ QHIULW LQWHUVWLLDO DUWUDOJLL KDOXFLQDLL WURPERFLWR]
anemie.
$VRFLDLLPHGLFDPHQWRDVHPeniciline, Metronidazol.
9,,'(5,9$,$85,1$5(;7(51,1&217,1(17
([LVW R JDP ODUJ GH VLVWHPH GH FROHFWDUH SHQWUX

SDFLHQLL FX XURVWRPLH GDU WRDWH SRW IL vPSULWH vQ GRX FDWHJRULL
principale: QSLHVXQLFVDXFXGRXSLHVH
6LVWHPXOvQSLHVXQLFFXSULQGHDWkWSXQJDFROHFWRDUHFkW
LIROLDDGH]LYHVWHIOH[LELOLRFXSXQYROXPPDLPLF
B. OFLOXACIN:
3UH]HQWDUH IDUPDFHXWLF cps filmate 200 mg, 400 mg; sol
SHUIX]DELOIOPOPJPO
$FLXQHWHUDSHXWLFLGHPFLSURIOR[DFLQ
,QGLFDLL SLHORQHIULW FLVWLWH SURVWDWLWH XUHWULWH JRQRFRFLFH L
non-JRQRFRFLFH LQIHFLL JLQHFRORJLFH LQIHFLL UHVSLUDWRULL 25/
gastrointestinale, cu germeni sensibili la RIOR[DFLQ WXEHUFXOR]D
SXOPRQDU FX PLFREDFWHULL UH]LVWHQWH OD WXEHUFXORVWDWLFHOH
majore.
Mod de administrare: 200-PJ]LSRODRUHVDXvQGR]
XQLF; LQIHFLL VHYHUH -800 mg, 7-10 zile; LQVXILFLHQ UHQDO
FOHDUDQFHFUHDWLQLQ!POPLQGR]X]XDOFOHDUDQFHvQWUH
LPOPLQGLQGR]DX]XDO
&RQWUDLQGLFDLL KLSHUVHQVLELOLWDWH OD RIOR[DFLQ sau chinolone,
DQWHFHGHQWH GH WHQGLQRSDWLH DVRFLDW FX IORURFKLQRORQH;
SUXGHQ DQWHFHGHQWHGHFRQYXOVLLRIHULDFWLYLWLGHSUHFL]LH
ReDFLL DGYHUVH IHEU YUVWXUL GLDUHH GXUHUL DEGRPLQDOH
DQRUH[LH XVFFLXQHD JXULL PHWHRULVP FRQVWLSDLL PLDOJLL
DWUDOJLL FRQYXOVLL FHIDOHH WXOEXUUL GH YHGHUH VRPQROHQ
KDOXFLQDLL HUuSLL FXWDQDWH SUXULW OHXFRSHQLH HR]LQRILOLH
trombocitopenie.
C. LEVOFLOXACINA (Tavanic)
3UH]HQWDUH IDUPDFHXWLF: cps filmate 250 mg, 500 mg; sol
SHUIX]DELOPJPJPJPO
$FLXQHIDUPDFHXWLFLGHPFLSURIOR[DFLQ
,QGLFDLLLQIHFLLDOHDSDUDWXOXLXURJHQLWDOUHVSLUDWRU25/
Mod de administrare: RUDOPJ]LSUL] XQLFSHUIX]LHLY
PJ]LSUL]XQLF
&RQWUDLQGLFDLL FRSLL DGROHVFHQL vQ FUHWHUH KLSHUVHQVLELOLWDWH
la chinolone, deficit de G-6-PDH; SUHFDXLL - convulsii n
DQWHFHQGHQWHLQVXILFLHQUHQDO
5HDFii adverse: GLDUHH DPHHOL FHIDOHH YHUWLM PHOHQ FROLW
pseudo-PHPEUDQRDVKLSRJOLFHPLHHUXSLLFXWDQDWH
D. NORFLOXACIN:
$
6LVWHPXOFXGRXSLHVHFXSULQGHIROLDDGH]LYODFDUHHVWH
DWDDWIODQDFDUHSHUPLWHFXSODUHDSXQJLL colectoare.
7RDWH VLVWHPHOH FXSULQG R YDOY DQWLUHIOX[ FH vPSLHGLF

vQWRDUFHUHD XULQLL FWUH VWRP L XQ URELQHW FH SHUPLWH JROLUHD
SHULRGLFDGLVSR]LWLYXOXLFROHFWRUDFUXLFDSDFLWDWHHVWHFXSULQV
vQWUHLP/
3HQWUX D PUL YROXPXO FROHFWDW FX HYDFXDUHD PDL UDU OD
VLVWHPHOH GHVFULVH PDL VXV VH SRW DWDD SXQJL SHQWUX GUHQDM
nocturn sau pungi, ce pot fi fixate la nivelul unuia din membrele
LQIHULRDUHFRDSVVDXJDPE
1*5,-,5($3$&,(178/8,&8'(5,9$,(85,1$5
(;7(518526TOMIE)
Crearea unei urostomii definitive are un impact major fizic

L SVLKLF DVXSUD SDFLHQLORU VFKLPEkQG PXOWH DVSHFWH DOH YLHLL
FRWLGLHQH &RQVLOLHUHD SUHRSHUDWRULH UHDOL]DW GH personalul
VSHFLDOL]DW VWRPD QXUVH!) aduce beneficii majore n planul

9,,'(5,9$,$85,1$5(;7(51,1&217,1(17
HYROXLHL SRVWRSHUDWRULL L SH WHUPHQ OXQJ D SDFLHQWXOXL FX

XURVWRPLH LQFRQWLQHQW &RQVLOLHUHD VH SRDWH H[WLQGH FX HIHFWH
EHQHILFH SHQWUX SDFLHQW L DVXSUD PHPEULORU DSURSLDL DL IDPLOLHL
acestuia.
,QIRUPDLLOH WUHEXLH V LQFOXG HOHPHQWH OHJDWH GH
inteUYHQLD FKLUXUJLFDO XURVWRPLD L UROXO DFHVWHLD vQJULMLUHD
VWRPHLLGLVSR]LWLYHOHXWLOL]DWHSDFLHQLLSRWILvQYDLSUHRSHUDWRU
V-L vQJULMHDVF VWRPD L V-L VFKLPEH GLVSR]LWLYXO FROHFWRU
6WDELOLUHD SUHRSHUDWRULH D ORFXOXL vQ FDUH YD IL SODVDW stoma este
XQHOHPHQWLPSRUWDQWSHQWUXDVLJXUDUHDHWDQHLWLLLDVFKLPEULL
facile a sistemului colector.
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
B. AMIKACIN:
3UH]HQWDUHIDUPDFHXWLFflacoane 2 ml, 4 ml (350 mg/ml); fiole
2 ml, 50 mg/ml, 125 mg/ml, 250 mg/ml.
$FLXQHWHUDSHXWLFLGHPJHQWDPLFLQ
,QGLFDLL LQIHFLL DOH DSDUDWXOXL XURJHQLWDO UHVSLUDWRU VLVWHPXOXL
RVWHRDUWLFXODU 61& DOH SLHOLL L HVXWXULORU PRL LQIHFLL
LQWUDDEGRPLQDOHFXJHUPHQLVHQVLELOLODDPLNDFLQ
Mod de administrare: i.m., i.v., - GXS HYDOXDUHDIXQFLHL renale
LDFOHDUDQFH-ul creatininei; 15 mg/kgc/zi GR]XQLFVDXvQ3 doze administrate la intervale de timp egale vQ LQVXILFLHQ
UHQDOVHUHFRPDQGDMXVWDUHDGR]HORUvQIXQFLHGHFOHDUDQFH-ul
GHFUHDWLQLQ
&RQWUDLQGLFDLLKLSHUVHQVLELOLWDWHODDPLNDFLQ n antecendente;
SUXGHQODSDFLHQLLFXPLDVWHQLHJUDYLVVDX%RDO3DUNLQVRQ
5HDFLL
DGYHUVH
ototoxicitate,
nefrotoxicitate,
bloc
QHXURPXVFXODU HUXSLL FXWDQDWH IHEU SDUHVWH]LL DQHPLL
DUWUDOJLL JUHD YUVWXUL KLSRWHQVLXQH DUWHULDO FUL]H GH DVWP
EURQLF
,QWHUDFLXQL PHGLFDPHQWRDVH QX VH UHFRPDQG asocierea cu
alte medicamente ototoxice sau nefrotoxice.
Asocieri medicamentoase: efect sinergic n asociere cu
peniciline.
3. CHINOLONE
5HSUH]HQWDQL: ciprofloxacin, ofloxacin, levofloxacin, norfloxacin,
pefloxacin, enoxacin, moxifloxacin, lomefloxacin, gemifloxacin,
gatifloxacin, sparfloxacin, trovafloxacin.
A. &,352)/2;$&,1
ngrijirea postoperatorie
,PHGLDW GXS LQWHUYHQLD FKLUXUJLFDO VWRPD WUHEXLH V ILH
DFRSHULW FX XQ GLVSR]LWLY GH FROHFWDUH WUDQVSDUHQW SHQWru a
SHUPLWH VXSUDYHJKHUHD IDFLO D DFHVWHLD ,QVSHFLD VWRPHL vQ
SHULRDGD SRVWRSHUDWRULH LPHGLDW WUHEXLH V ILH HIHFWXDW FX R
IUHFYHVLPLODUVXSUDYHJKHULLFDUGLRYDVFXODUH
!
3UH]HQWDUH IDUPDFHXWLF cps 250 mg, 500 mg, 750 mg; fiole
POPJILRO; flacoane 50 ml, 100 ml (100 mg/50 ml, 200
mg/100 ml).
$FLXQH WHUDSHXWLF LQKLE ADN JLUD]D EDFWHULDQ sau
WRSRL]RPHUD],,EORFkQGGLYL]LXQHDFHOXODU
,QGLFDLL LQIHFLL JHQLWDOH SLHORQHIULWH FLVWLWH SURVWDWLWH LQIHFLL
UHVSLUDWRULL 25/ RFXODUH ELOLDUH D RDVHORU L DUWLFXODLLORU
spectru Coci Gram-SR]LWLYLLEDFLOL*UDP-negativi.
Mod de administrare: oral 250-500 mg x 1-2 ori/zi; sol
SHUIX]DELO-400 mg de 1-RUL]LODSDFLHQLLYkUVWQLFLVDXFX
LQVXILFLHQUHQDOVHDMXVWHD]GR]HOHvQIXQFLHGHFOHDUDQFH-ul
FUHWLQLQHLLJUDYLWDWHDEROLL
$
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
C.
9,,'(5,9$,$85,1$5(;7(51,1&217,1(17
'UHQDMXO XULQDU WUHEXLH V ILH FRQWLQXX LDU VLVWHPXO GH
OXACILINA
3UH]HQWDUH IDUPDFHXWLF capsule 250 mg, 500 mg, 1000 mg,

LSXOEHUHLQMHFWDELOIODFRQGHPJPJLPJ
$FLXQH WHUDSHXWLF EDFWHULFLG LQKLE VLQWH]D SHSWLGRJOLFDQL
DQWUHQkQGOL]DLPRDUWHDFHOXODU
,QGLFDLLLQIHFLLVWDILORFRFLFHORFDOL]DWHVDXJHQHUDOL]DWH
Mod de administrare: 2-3 g/zi n 4- SUL]H VROXLLOH LQMHFWabile
VHSUHSDULPHGLDWvQDLQWHGHLQMHFWDUHVHDGPLQLVWUHD]LYOHQW
VDXLPSURIXQGvQDFHOHDLGR]H
&RQWUDLQGLFDLLDOHUJLHLQIHFLLVHQVLELOHODSHQLFLOLQD*VDXDOWH
peniciline.
5HDFLL DGYHUVH DOHUJLH vQFUXFLDW FX DOWH SHQLFLOLQH UDUHRUL
WXOEXUUL UHQDOH DOEXPLQXULD KHPDWXULD SRDWH GHWHUPLQD
FUHWHUHD7*2
colectare trebuie s ILH JROLW UHJXODW SHQWUX D DVLJXUD FRQIRUWXO

SDFLHQWXOXLLDUHGXFHSUHVLXQHDDVXSUDVWRPHL
,QVSHFLD VWRPHL WUHEXLH V GHFHOH]H RULFH VHPQ GH
LVFKHPLH 6WRPD QRUPDO DUH FXORDUHD UR] VDX URX VLPLODU
PXFRDVHL EXFDOH DVSHFWXO HGHPDWRV LQLLDO YD GLVpare n
XUPWRDUHOH - OXQL LDU vQ XULQ L vQ MXUXO VWRPHL VH REVHUY
acumulare de mucus.
,PHGLDWFHVWDUHDFOLQLFRSHUPLWHSDFLHQWXOYDILLPSOLFDW
vQ VFKLPEDUHD VLVWHPXOXL FROHFWRU QDLQWH GH GHFODQDUHD DFHVWHL
SURFHGXUL HVWH LPSRUWDQW asigurarea
tuturor
materialelor
necesare.
2. AMINOGLICOZIDE
5HSUH]HQWDQL: SURGXLGHELRVLQWH]VWUHSWRPLFLQQHRPLFLQ
NDQDPLFLQ WREUDPLFLQ VSHFWLQRPLFLQ SDURPRPLFLQ
JHQWDPLFLQ VLVRPLFLQ SURGXL GH VHPLVLQWH] DPLNDFLQ
QHWLOPLFLQ
A. GENTAMICINA:
3UH]HQWDUHIDUPDFHXWLFfiole 2 ml, 40 mg/ml.
$FLXQH WHUDSHXWLF LQKLE subunitatea 30 S a ribozomilor
EORFkQGVLQWH]DSURWHLFEDFWHULDQ
,QGLFDLL LQIHFLLFX&RFL*UDP-pozitivi LQHJDWLYL L%DFLOL Gramnegativi ale aparatului urogenital, respirator, oftalmologice, ORL.
Mod de administrare: inj 2-3 mg/kgcorp/zi n 2-SUL]HSkQ la
5 mg/kgcorp/zi n 3-4 prize.
&RQWUDLQGLFDLLhipersensibilitatHODDPLQRJOLFR]LGHSUXGHQ n
LQVXILFLHQ UHQDO EROL QHXURPXVFXODUH DIHFLXQL YHVWLEXODUH
VDXLFRKOHDUHYkUVWQLFL
5HDFLL DGYHUVH YHUWLM QLVWDJPXV VGU 0HQLHUH WXOEXUUL GH
HFKLOLEUXKLSRDFX]LHSHQWUXVXQHWHvQDOWHVDXVXUGLWDWHFRPSOHW
tXOEXUULKHPDWRORJLFHDOHUJLFHJUHXULYUVWXUL
,QWHUDFLXQLPHGLFDPHQWRDVHFXDOWHVXEVWDQHRWRWR[LFHVDX
nefroWR[LFHEORFDQLQHXURPXVFXODUL efect sinergic.
Asocieri medicamentoase: peniciline efect sinergic.
$!
7LPSLLSULQFLSDOLDLVFKLPEULLVLVWHPXOXLGHXURVWRPLHVXQW
VXSULPDUHDFXEOkQGHHDSXQJLLLDIROLHLDGH]LYH
LQVSHFLD VWRPHL L D WHJXPHQWXOXL GLQ MXUXO

acesteia;
VSODUHDWHJXPHQWXOXLSHULVWRPDO
uscarea tegumentului peristomal;
aplicarea
produselor
de ngrijire
tegumentului
peristomal;
DSOLFDUHDDWHQWDQRXOXLVLVWHPGHXURVWRPLHSHQWUX
DDVLJXUDHWDQHLWDWHDDFHVWXLD
$SD FDOG L WDPSRDQHOH GH EXPEDF VXQW GH RELFHL
VXILFLHQWHSHQWUXVSlarea tegumentului peristomal; alternativa este
UHSUH]HQWDW GH HUYHHOH XPHGH VSHFLDO FRQFHSXWH SHQWUX
FXUDUHDWHJXPHQWXOXLGLQMXUXOVWRPHL
)ROLDDGH]LYWUHEXLHVILHSUHFLVGHFXSDWGXSPULPHD
LIRUPDVWRPHLSHQWUXDSURWHMDWHJXPHQWXOGLQMXUXODFHVWHLDLD
DVLJXUDHWDQHLWDWHDQXWUHEXLHXLWDWIDSWXOFVWRPDvLYDUHGXFH

9,,'(5,9$,$85,1$5(;7(51,1&217,1(17
WUHSWDW YROXPXO FHO SXLQ OXQL GXS LQWHUYHQLH DVWIHO vQFkW L

GHFXSDMXO IROLHL WUHEXLH V ILH PRGLILFDW FRUHVSXQ]WRU 3LOR]LWDWHD
SHULVWRPDO SRDWH UHGXFH DGHUHQD dispozitivului colector sau
poate determina dureri la desprinderea foliei, motiv pentru care
PDMRULWDWHD SDFLHQLORU SUHIHU V UDG VSWPkQDO WHJXPHQWXO
respectiv.
$YvQG vQ YHGHUH IDSWXO F vQ XULQD GUHQDW SULQ XURVWRPLH
VH HYLGHQLD] vQ PRG RELQXLW un numar semnificativ de bacterii
(bacteriurie), tratamentul antibiotic nu este recomandat la
SDFLHQLLDVLPSWRPDWLFLFKLDUGDF SUH]LQW uroculturi pozitive.
$SRUWXODGHFYDWGHOLFKLGHIUDFLRQDWSHSHULRDGD]LOHLHVWH
HVHQLDOSHQWUXDUHGXFHULVFXOGHLQIHFLLXULQDUH1XHVWHQHFHVDU
HYLWDUHDYUHXQXLDOLPHQWODSDFLHQLLFXXURVWRPLH
&RPSOLFDLL
&RPSOLFDLLOH GHULYDLLORU XULQDUH H[WHUQH LQFOXG stenoza

stomei, KHUQLD SDUDVWRPDO, LQIHFLD tractului urinar superior,
formarea de calculi si deteriorarea IXQFLRQDO UHQDO. n plus
SRW DSDUH FRPSOLFDLL OHJDWH GH IRORVLUHD LOHRQXOXL WHUPLQDO vQ
GHULYDLDXULQDUDFLGR]PHWDEROLFKLSHUFORUHPLFKLSRNDOLHPLH
KLSRYLWDPLQR]%GHPLQHUDOL]DUHRVRDVSURGXFLHH[FHVLYGH
mucus, anomalii de metabolizare a medicamentelor.
,ULWDLD WHJXPHQWXOXL SHULVWRPDO SRDWH IL JHQHUDW GH
contactul prelungit cu urina, leziuni mecanice (produse la
vQORFXLUHD GLVSR]LWLYXOXL FROHFWRU LQIHFLL IROLFXOLW HWF DIHFLXQL
dermatologice
(psoriazis,
dermatite
etc.)
sau
imunologice
GHUPDWLWGHFRQWDFW
+HUQLD SDUDVWRPDO DSDUH FD R ERPEDUH D ]RQHL GLQ MXUXO
VWRPHL L VH SRDWH SURGXFH OD LQWHUYDO GH OXQL VDX DQL GH OD
SUDFWLFDUHD XURVWRPLHL 3DFLHQWXO SRDWH IL DVLPSWRPDWLF GDU GDF

;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
9,,0(',&$0(17()2/26,7(135$&7,&$852/2*,&
I.
ANTIBIOTICE
1. PENICILINE ( lactamice)
5HSUH]HQWDQL: peniciline naturale (penicilina G, penicilina V,
procain penicilina, benzathil penicilina), peniciline rezistente la
betalactamaze (meticilina, nafcilina, oxacilina, cloxacilina,
dicloxacilina, flucoxacilina), aminopenicilinele (ampicilina,
amoxicilina), carboxipenicilinele (carbenicilina, ticarcilina),
ureidopenicilinele (azlocilina, mezlocilina, piperacilina).
A.
AMPICILINA
3UH]HQWDUH IDUPDFHXWLF capsule 250 mg, 500 mg, 1000 mg,

LIODFRDQHGHPJPJLPJ
$FLXQHWHUDSHXWLFLQKLEVLQWH]DSHUHWHOXLEDFWHULDQ
,QGLFDLL LQIHFLLXRDUHL PHGLLGHWUDFWUHVSLUDWRUWUDFWXULQDU
ELOLDU IHEU WLIRLG WXVH FRQYXOVLYH OHSWRVSLUR]H LQIHFLL
SRVWFKLUXUJLFDOH GLYHUVH WHUDSLD LQLLDO D PHQLQJLWHORU FX
JHUPHQL QHLGHQWLILFDL LQIHFLL JUDYH VHSWLFHPLD HQGRFDUGite,
meningite, peritonite.
Mod de administrare: vQLQIHFLLOHXRDUHLPHGLLSR-4 g/zi la
KvQLQIHFLLOHVHYHUHLY-12 g/zi n 4 prize.
&RQWUDLQGLFDLL DOHUJLH LQIHFLL FX SLRFianic, anaerobi,
eterobacter.
5HDFLLDGYHUVHHUXSLLFXWDQDWH
Asocieri medicamentoase: DPSLFLOLQVXlbactam (ampiplus).
B.
$02;,&,/,1
3UH]HQWDUH IDUPDFHXWLF: cps 250 mg, 500 mg; pulbere in

suspensie 125 mg/5 ml, 250 mg/5 ml.
$FLXQHWHUDSHXWLFLQGLFDLLLGHP$PSLFLOLQ
Mod de administrare: oral 250 500 mg/8h.
&RQWUDLQGLFDLL LGHP$PSLFLOLQ
5HDFLLDOHUJLFH LGHP$PSLFLOLQ
Asocieri medicamentoase: $PR[LFLOLQ $F&ODYXODQLF
(Augmentin).
$
,;35267$7(&720,$5$',&$/
YDULDQWDWUDQVSHULWRQHDOLGHLQVXIODLD&22.
&RPSOLFDLLOH SRVWRSHUDWRULL SUHFRFH FXSULQG WURPER]D
YHQRDV SURIXQG D PHPEUHORU LQIHULRDUH HPEROLD SXOPRQDU
FRQVWLWXLUHDXQXLOLPIRFHOLLQIHFLDSOJLLRSHUDWRULL
9,,'(5,9$,$85,1$5(;7(51,1&217,1(17
VHJPHQWXO GH DQV LQWHVWLQDO HVWH WUDQJXODW FHHD FH LPSOLF L

VXSULPDUHDGUHQDMXOXLXULQDUHVWHQHFHVDULQWHUYHQLDFKLUXUJLFDO
GHXUJHQ
5HWUDFLD VWRPHL HVWH GLDJQRVWLFDW OD FD]XULOH OD FDUH
&RPSOLFDLLOH SRVWRSHUDWRULL WDUGLYH VXQW LQFRQWLQHQD
DFHDVWDQXPDLSURLHPLQIDGHQLYHOXOWHJXPHQWXOXLSHULVWRPDO
XULQDU L LPSRWHQD 5HFXSHUDUHD SURJUHVLY D FRQWLQHQHL VH
$SDULLD DFHVWHL FRPSOLFDLL HVWH JHQHUDW GH GLILFXOWL
UHDOL]HD] SH SDUFXUVXO PDL PXOWRU OXQL vQ WLPS FH IXQFLD
LQWUDRSHUDWRULL LPSRVLELOLWDWHD FUHULL XQHL XURVWRPLL IU D IL vQ
VH[XDO QHFHVLW SvQ la 2 ani pentru atingerea nivelului
tensiune, cu eventuala ischemiere a acesteia), radioterapie
preoperator.
SRVWRSHUDWRULH LQIHFLL FURQLFH DOH WHJXPHQWXOXL SHULVWRPDO VDX

FUHWHUHDvQJUHXWDWHDSDFLHQWXOXL3HQWUXDFRUHFWDSUREOHPDLD
HYLWD OLSVD GH HWDQHLWDWH VH SRW XWLOL]D SDVWH GH XPSOHUH FH
PRGLILF UHOLHIXO UHJLXQLL UHVSHFWLYH JDUQLWXUL VDX VLVWHPH GH
colectare cu profil convex.
,QIHFLLOH XULQDUH VLPSWRPDWLFH LQFOXVLY SLHORQHIULWH VXQW
UHODWLY IUHFYHQWH OD SDFLHQLL XURVWRPL]DL LDU SUH]HQD PXFXVXOXL
pare a fi un element important n acest sens. Pentru a preveni
DSDULLD DFHVWRU FRPSOLFDLL LQFOXVLY D OLWLD]HL DSDUDWXOXL XULQDU
VXSHULRU VH UHFRPDQG R GLHW KLSHUSURWHLF FDUH V SURmoveze
SURGXFHUHD XQHL XULQL DFLGH VFGHUHD DSRUWXOXL GH FLWULFH
DFLGLILHUHD XULQLL FX FORUXU GH DPRQLX L DGPLQLVWUDUHD GH
FRQFHQWUDWGHPHULRUFUDQEHUU\
$OWHUDUHD IXQFLHL UHQDOH UHSUH]LQW R FRPSOLFDLH PDMRU
JHQHUDW GH SLHORQHIULWD UHFLGLYDQW DVRFLDW FX REVWUXFLH
SRVWUHQDOVWULFWXULDQDVWRPRWLFHVWHQR]DVWRPHLVDXXUROLWLD]
,QWHUYHQLLOHFKLUXUJLFDOHUDGLFDOHSHOYLQHSRWDIHFWDIXQFLDVH[XDO
D SDFLHQLORU LDU DFHVW OXFUX SRDWH IL DJravat de impactul
SVLKRORJLF7UDWDPHQWXOGLVIXQFLHLHUHFWLOHDUHODED]DGPLQLVWDUHD
LQKLELWRULORUGHIRVIRGLHVWHUD]VLOGHQDILOHWF
6XSUDYHJKHUHDSHWHUPHQOXQJDSDFLHQLORUFXXURVWRPLH
$

9,,'(5,9$,$85,1$5(;7(51,1&217,1(17
,;35267$7(&720,$5$',&$/
HIHFWXDW GH FDGUH VSHFLDOL]DWH WUHEXLH FRQWLQXDW vQ DPEXODWRU
IX.
35267$7(&720,$5$',&$/
prin controale la intervale prestabilite de timp, cu posibilitatea
3URVWDWHFWRPLD UDGLFDO SUHVXSXQH DEODLD vQWUHJLL
HYDOXULL GH XUJHQ vQ FD]XO DSDULLHL XQRU FRPSOLFDLL
SURVWDWH vPSUHXQ FX YH]LFXOHOH VHPLQDOH XUPDW GH

UHFRQVWUXFLDFROXOXLYH]LFDOLDQDVWRPR]DYH]LFR-XUHWUDO
35 SRDWH IL HIHFWXDW GHVFKLV SH FDOH UHWURSXELDQ VDX
SHULQHDO VDX ODSDURVFRSLF vQ YDULDQWHOH FODVLF VDX DVLVWDW
robotic.
35 HVWH LQGLFDW FD tratament curativ OD SDFLHQLL FX
ERDOSURVWDWLFPDOLJQvQVWDGLXORFDOL]DWODFDUHVSHUDQDGH
YLD GHSHWH DQL ([LVW R WHQGLQ GH H[WLQGHUH D
LQGLFDLLORU35ODSDFLHQLLFXULVFFUHVFXWGHSURJUHVLHWXPRUDO
(PSA > 20 ng/mL sau scor Gleason > 8 sau stadiu cT3), la care
HVWH QHFHVDU L HIHFWXDUHD OLPIDGHQHFWRPLHL SHOYLQH H[WLQVH
bilateral, pentru a asigura un control superior al cancerului de
SURVWDWSHWHUPHQOXQJQDFHVWVHQVXURORJXOWUHEXLHVIDF
parte dintr-R HFKLS PXOWLGLVFLSOLQDU FDUH DQDOL]HD] ILHFDUH
FD] LDU SDFLHQWXO WUHEXLH V FXQRDVF WRDWH RSLXQLOH
WHUDSHXWLFHLVILHLQIRUPDWGHFRPSOLFDLLOH35
0RUELGLWDWHDDVRFLDWFX35SRDWHILVHPQLILFDWLYLHVWH
Q PDUH SDUWH GHSHQGHQW GH H[SHULHQD HFKLSHL FKLUXUJLFDOH
&RPSOLFDLLOH LQWUDRSHUDWRULLLPHGLDWHLQFOXGKHPRUDJLDOH]DUHD
UHFWXOXLVDXDXUHWHUHORU+HPRUDJLDLQWUDRSHUDWRULHVHYHUHVWH
PDL IUHFYHQW vQ DERUGXO UHWURSXELDQ FDUH LPSXQH L
VHFLRQDUHD FRPSOH[XOXL YHQRV GRUVDO ID GH FHO SHULQHDO
VvQJHUDUHDHVWHPDLUHGXVvQYDULDQWHOHODSDURVFRSLFH
/H]DUHD UHFWXOXL HVWH PDL UDU vQ DERUGXO UHWURSXELDQ vQ
FRPSDUDLH FX FHO SHULQHDO GDU SRDWH IL VXWXUDW LPHGLDW IU
VHFKHOH SH WHUPHQ OXQJ $ERUGULOH ODSDURVFRSLFH DVRFLD]
riscuri specifice suplimentare legate de acces (mai ales n

$$
VIII. TRANSPLANTUL RENAL
&RPSOLFDLLOH LQIHFLRDVH apar n diferite perioade
posttransplDQW L VXQW FX ULVF FUHVFXW OD DFHDVW FDWHJRULH GH
I.
'(),1,,(
SDFLHQL GDWRULW H[SXQHULL QRVRFRPLDOH vQ FRQWH[WXO VWDWXVXXL
Transplantul renal este un proces compex prin care un rinichi

RELQXWSULQUHFROtare chirurgLFDOGHODXQdonator este implantat la
imunosupresiv.
un receptor FDUH QHFHVLWD R IRUP GH VXSOeHUH D IXQFLHL UHQDOH

ILLQGvQVWDGLXOILQDOGHERDOUHQDOFURQLF
Sursa organelor SRDWH IL XQ GRQDWRU YLX vQUXGLW GH RELFHL L
compatibil din punct de vedere imunologic cu primitorul sau un
GRQDWRU vQ PRDUWH FHUHEUDO FkQG VH SUDFWLF GH RELFHL UHFROWri
multiorgan. Odat FX ULQLFKLL VH SRW UHFROWD L FRUGXO SOPkQLL
ficatul, pancreasul, intestinul, cornea, vase sangvine, tesut osos,
etc.
Receptorii VXQWUHSUH]HQWDLGHSDFLHQLFXLQVXILFLHQUHQDO
FURQLF FDUH QHFHVLW R IRUP GH VXSOeHUH D IXQFLHL UHQDOH FDUH
VXQW OXDL vQ HYLGHQ L WHVWDL GLQ SXQFW GH YHGHUH LPXQRORJLF
viUXVRORJLFLDDOWRUSDWRORJLLLDIODLSHROLVWGHDWHSWDUH
(9$/85,35(23(5$725,,
II.
A. EVALUAREA DONATORILOR VII

'RQWRULL YLL UHSUH]QW VXUVD PDMRU GH RUDJH vQ PXOWH UL
SULQWUHFDUHL5RPkQLD
Evaluarea donatorului viu LPSXQHXUPWRDUHOHLQYHVWLJDLL:
x
'HWHUPLQDUHDFRPSDWLELOLWLLvQVLVWHPXO$%2
Crossmatch,
Determinarea gradului de matching HLA.
(YDOXDUHD VWDWXVXOXL GH VQWDWDWH VH UHDOL]HD] SULQ WHVWH

FOLQLFH SDUDFOLQLFH GH ODERUDWRU L LPDJLVWLFH WHVWH DOH IXQFLHL
UHQDOHLWHVWHDGLLRQDOH
$

$QDPQH]LH[PHQIL]LFFRPSOHW
Teste de laborator: HLG, probe de coagulare,
transplDQWULL QHFUR]D WXEXODU DFXW UHDFLL GH UHMHW
IXQFLH UHQDO IXQFLH KHSDWLF Jlicemie, ioni
umoral sau celular, cauze non-imunologice),
plasmatici, proteine WRWDOHOLSLGRJUDP

x
)XQFLRQDUHD vQWkU]LDW D JUHIHL vQ SHULRDGD LPHGLDW
'LVIXQFLD SUHFRFH D JUHIHL vQ SULPHOe 2-3 luni
5DGLRJUDILH SXOPRQDU RSLRQDO WHVWH GH IXQFLH
posttransplant, (rejetul acut, obstacol urinar, fiVWXO
SXOPRQDUYHQWLODWRULLLVDXUHVSLUDWRULL
XULQDU
EKG, optional ecocardiografie
pielonefrLWD
([DPHQ VXPDU GH XULQ VHGLPHQW XURFXOWXU
hipovolemia, hipotensiunea).
XULQDK FOHDUFHQFH FUHDWLQQLQ SURWHLQXULD
QHIURWR[LFLWDWHD
DFXW
imunosupresoarelor,
PLFURDQJLRSDWLD
'LVIXQFLD WDUGLY D JUHIHL
WURPERWLF
GXS OXQL GH OD
probe de concentrare, microalbuminurie,
transplantare, (boli renale intrinseci QHIURSDWLDFURQLF
(FRJUDILHDEGRPLQDO
DJUHIHLQHIURWR[LFLWDWHDFURQLFDLPXQRVXSUHVRDUHORU
ArterioJUDILHUHQDODQJLR-RM, CT,
UHMHWXO DFXW WDUGLY QHIULWHOH LQWHUVWLLDOH VWHQR]D GH
6FLQWLJUDPUHQDOSHQWUXHYDOXDUHDUDWHLGHILOWUDUH
DUWHUUHQDOREVWUXFLLGHWUact urinar, stricturi uretrale,
JORPHUXODULDIXQFLRQDOLWLLILHFUXLULQLFKL
OLWLD]
(YDOXUL PLFURELRORJLFH VHURORJLH OXHV WHVWH
Rejetul acut (refractaUODFRUWLFRWHUDSLHLODKHPRGLDOL]SRDWH
virusologice (VHB, VHC, CMV, HIV, virus Epstein-
QHFHVLWDQHIUHFWRPLHGHVDOYDUHDYLHLLEROQDYXOXLDWXQFLFkQG
Barr, virus herpes simplex, zoster, toxoplasma),
ODDQXULHVHDGDXJLRVQJHUDUHLPSRUWDQW
([DPHQ JLQHFRORJLF DO VkQXOXL L DO prostatei n

FD]XULVHOHFLRQDOWH
D. &203/,&$,,&+,585*,&$/(
&RPSOLFDLL
YDVFXODUH
tomboza
arterial
sau
venoaVVWHQR]DDUWHULDO
&RQWUDLQGLFDLLOHGRQULL

Boli renale (reducerea clearence-XOXLGHFUHDWLQLQID

de valorile normale conform
vrstei, proteinuria,
microhematuria, istoric famLOLDO GH ERDO SROLFKLVWLF

DXWRVRPDO GRPLQDQW QHIURFDOFLQR]D OLWLD]D UHQDO
anomalii urologice importante),

Incompatibilitate n sitemul ABO,
Cross-match pozitiv,
+7$VHYHUFXOH]LXQLRUJDQLFH

&RPSOLFDLL XURORJLFH FROHFLL IOXLGH ILVWXO XULQDU urinom OLPIRFHO REVWUXFLL GH WUDFW XULQDU KHPDWXULH OLWLD]
reflux vezico-XUHWHUDOGLVIXQFLHHUHFWLOQHRSOD]LL
E. COM3/,&$,,0(',&$/(,
,1)(&,2$6(
&RPSOLFDLL PHGLFDOH boli cardio-vasculare, boala
LVFKHPLF FRURQDULDQ +7$ KLSHUOLSHPLD '= SRVWWUDQVSODQW
bolile maligne, afecLXQLOH KHSDWLFH EROLOH JDVWUR-intestinale,
guta, complLFDLLRVRDVH
$
LPXQRVXSUHVLYLDIXQFLRQDOLWDLLJUHIHLUHQDOH Antibioterapia
Diabet zaharat,
este obligatorie timp de 10 zile postoperator, ideal fiind ca
,QIHFLLGRYHGLWH+,99+&9+%
polnavul (la externare) sDLERXURFXOWXUQHJDWLY
1HRSOD]LLEROLDXWRLPXQHFXYLVFHUDOL]DUHUHQDO
Boli cronice severe pulmonare, cardiace, hepatice,
B. IMUNOSUPRESIE
Tratamentul imunosupresiv n transplantul de organe
autoimune, neurologice,
DUH UROXO GH D PHQLQH XQ HFKLOLEUX vQWUH SUH]HQD JUHIHL L
Sarcina,
UVSXQVXO LPXQ DO UHFHSWRUXOXL 6XQW WUHL SHULRDGH LPSRUWDQWH
Toxicomani,
ale imunosupresiei:
7XOEXUULGHFRDJXODUH
,QGXFLD utilizDUHD XQHL PHGLFDLL FX FDSDFLWDWH
$WXQFL FkQG GRQDWRUXO DUH R SDWRORJLH UHQDO DVRFLDW
LPXQRVXSUHVLYvQDOWSHRSHULRDGVFXUWFXVFRSXO
PLQRU FKLVW VROLWDU UHQDO KLGURQHIUR] FRQJHQLWDO SLHORQ
GH D VFGHD ULVFXO GH UHMHW DFXW vQ SULPHOH OXQL
GXEOX XUHWHU UHWURFDY UHJXOD QH REOLJ V ODVP DFHVWXLD
posttransplant,
ULQLFKLXOFDUHDUHRIXQFLRQDOLWDWHPDLEXQ
3HULRDGD GH PHQLQHUH SUHFRFH FDUDFWHUL]DW SULQ
'HRDUHFH GXUDWD PHGLH GH IXQFLRQDUH D XQXL ULQLFKL
stabilirea unor regimuri imunosupresive individuale
transplantat este de 10-DQLPD[LPDQLODDFHODLEROQDY
(primele luni posttransplant),
sHSRDWHHIHFWXDXQDOWWUDQVSODQWvQ]RQDLOLDFFRQGURODWHUDO
3HULDGD GH PHQLQHUH FURQLF utilizarea unor doze

reduse
(minim
eficiente),
relativ
constante
B. EVALUAREA
de
imunosupresoare care vor fi modificate numai n cazul
DONATORILOR
MOARTE
&(5(%5$/
2ULFH SDFLHQW DIOD vQ FRPD SURIXQG FDUH SRDWH HYROXD
DSDULLHLXQRUFRPSOLFDLLVSHFLILFHDFHVWHLSHULRDGH
VSUH PRDUWH FHUHEUDO WUHEXLH FRQVLGHUDW XQ SRWHQLDO GRQDWRU
6XEVWDQHOH XWLOL]DWH VXQW LQKLELWRULL GH FDOFLQHXULQ
GH RUJDQH6XQW GRX HWDSH HVWHQiale n acest moment:
ciclosporina, tracolimus, sirolimus, corticosteroizii, anticorpi
stabilirea GLDJQRVWLFXOXL GH PRDUWH FHUHEUDO L ELODQXO GH
antilimfocitari
organe.
monoclonali
(OKT3,
anti-Tac,OKT4)
sau
SROLFORQDOLDQWLPHWDEROLLD]DWLRSLQD00)P-TOR inhibitori).

C. ',6)81&,('(*5()
'LDJQRVWLFXOSR]LWLYGHPRDUWHFHUHEUDO
x
(WLRORJLD L VWDUWHJLLOH WHUDSHXWLFH DOH GLVIXQFLHL GH JUHI
FRPD SURIXQG DUHDFWLY DEVHQD UHIOH[HORU
UHQDO VXQW GLIHULWH vQ IXQFLH GH WLPSXO VFXUV GH OD
transplantare:
([ FOLQLF QHXURORJLF FDUH V HYLGHQLH]H VWDUHD GH

trunchiului cerebral,
$EVHQD YHQWLODLHL VSRQWDQH FRQILUPDW SULQ WHVWXO

de apnee,
$
$
x
x
'RX WUDVHH ((* HIIHFWXDWH OD LQWHUYDO GH RUH
GHVXERUHGHODUHFROWDUHLDUHFKLSDFKLUXUJLFDOWUHEXLHV
care sa indice lipsa electrogenezei corticale,
realizeze anastomozele vasculare n maxim 40 de minute.
Excluderea altor cauze care ar putea produce un
VI.
URMARIRE POSTTRANPLANT
A. 8505,5($326723(5$725,(
tablou clinic L XQ WUDVHX ((* DVHPQWRDUH FX

n
cHOHGLQPRDUWHFHUHEUDO
x
x
x
urmarirea
LQWHUYHLL FKLUXUJLFDOH GHVFKLVH PDMRUH WUHEXLH IFXW GH FDWUH
ELODQ ELRORJLF XULQDU L VDQJuin, screening pentru
medicul anestezist-reanimDWRU L VH UHIHU OD PHQLQHUHD L
LQIHFLL YLUDOH 9LUXVXULOH KHSDWLFH $%&' HIV,
reechilibrarea
virusuri din grupul herpes, citomegalus, Epstein-
bD]LFFXDWHQWDPRQLWRUL]DUHDGLXUH]HLRUDUH
VFUHHQLQJ
SHQWUX
LQIHFLL
EDFWHULHQH
hemodinamic,
hidro-electUROLWLF L DFLGR-
n primele zile postoperaWRU WUHEXLH PHQLQXWH Psurile
(hemoculturi, uroculturi, culturi din sput),
de suport KHPRGLQDPLFPRQLWRUL]DUHDGLXUH]HLLFRPSHQVDUHD
&RUG HFRJUDILH FDUGLDF (.* &3. &3.-MB,
SROLXULHL SDFLHQWXO WUDQVSODQWDW SXWDQG XQHRUL DYHD R GLXUH]
troponina,
FDUH V GHSDHDF O h. Deasemenea este importaQW
Plamni: Rx torace, evaluare gaze sangvine,
urmrirea drenajului pe tuburile plasate in spaiul retroperitoneal
FXOWXUGLQVSXWD
L SUHYH]LFDO SDQVDPHQWXO ]LOQLF vQ FRQGLLL VWULFWH GH VWHULOLWDWH
)LFDW HFRJUDILH DEGPLQDO HFR-Doppler pedicul
GDWRULW ULVFXOXL PDMRU GH LQIHFLH DYkQG vQ YHGHUH Vtatusul
KHSDWLFELODQKHSDWLFFRPSOHW
imunologic, echografii 'RSSOHUSHQWUXDSUHFLHUHDYDVFXODUL]DLHL
Rinichi: ecografie abdomino-SHOYLQ HFR-Doppler
UHQDOHLDHYHQWXDOHORUFROHFLL
SHGLFXO
UHQDO
GLXUH]
FUUHDWLQLQ
VHULF
SURWHLQXULDKHPDWXULDXURFXOWXU
x
LPHGLDW
Teste de laborator (grup sangvin, Rh, tipizare HLA,
Barr),
x
SRVWRSHUWDWRULH
SDFLHWXOXL LQFOXGH PDVXULOH GH UHDQLPDUH VSHFLILFH RULFUHL
%LODQXOGHRUJDQH
x
perioada
ulterior, DILUHORUGHVXWXU
&RQWUDLQGLFDLLDEVROXWHSULYLQGGRQDUHDGHRUJDne:
Suprimarea sondei ureterale JJ la aproximativ 6
Istoric de neoplazie,
,QIHFLL YLUDOH L EDFWHULHQH VHURORJLH SR]LWLY +,9

6,'$ KHSDWLW DFXW YLUDO $%& WXEHUFXOR] VHSVLV
LQIHFLL
]LOH SRVWRSHUDWRU VDX FkQG QX VH PDL vQUHJLVWUHD] GUHQDM

suprimarea sondei uretrovezicale la 13-14 zile postopeUDWRU L,
3DQFUHDVDPLOD]HLOLSDVHVHULFHJOLFHPLH
VHYHU
ScurtaUHDLXOWHULRUVXSULPDUHDWXEXULORUGHGUHQOD-5
YLUDOH
VLVWHPLFH-UXMHRO
adenovirus, meningoencefalite),

UDELH
VSWPkQL SRVWWUDQVSODQW GH DVHPHQHD vQ FRQGLLL VWULFWH GH

VWHULOLWDWHODVDODGHRSHUDLL
8UPULUHD XOWHULRDU D PRGDOLWLL GH YLQGHFDUH L
cicatrizare a plagii operatorii prin controale perioadice clinicHL
HFRJUDILFH GDU L PRQLWRUL]DUHD QHIURORJLF D WUDWDPHQWXOXL

ficatul, pancreasul, ULQLFKL VSOLQD 'LQWUH RUJDQHOH PHQLRQDWH
FRUGXOUH]LVWFHOPDLSXLQODLVFKHPLDUHFHLDUULQLFKLXOUH]LVW
DFWLYLWDLhomosexuale) ULVFFUHVFXWGHLQIHFLH+,9
&RQWUDLQGLFDLLUHODWLYHSULYLQGGRQDUHDGHRUJDQH
cel mai mult .

IV.
Istoric de promiscuitate (toxicomanie iQWUDYHQRDV
PREZERVARE
3UH]HUYDUHD EXQ L FRUHFW D ULQLFKLXOXL vQWUH PRPHQWXO
EDFWHULHPLHVDXIXQJHPLHVHURORJLH+&9SR]LWLYGDF
UHFROWULL L PRPHQWXO LPSODQWULL DUH XQ URO LPSRUWDQW vQ

fuQFLRQDOLWDWHDXOWHULRUDJUHIHLUHQDOH
3UH]HUYDUHD UHQDO VH DGUHVHD] OLPLWULL OH]LXQLORU GH
,QIHFLLYLUDOHLEDFWHULHQHLQIHFLLEDFWHULHQHORFDOL]DWH
receptorul are srRORJLH+&9SR]LWLY
,VWRULFGHPDUHLYHFKLIXPWRUULVFGHDWHURVFOHUR]
9kUVWD DQL FX DIHFLXQL YDVFXODUH VHYHUH GLDEHW
ischemie (reducerea timpului de LVFKHPLH FDOG OD PD[LP
zaharat, HTA, sau alte boli care ar putea interesa
min L GH UHSHUIuzie. Perioada maxim de prezervare prin
IXQFLDUHQDO
racire pentru rinichi este de 31 de ore. Q SUDFWLF OD vQFHSXW
*UHI UHQDO VXERSWLPDO FOHDUDQFH FUHDWLQLQ
rinichiL VXQW VSODWL GH VkQJH FX R VROXLH UHFH LDU XOWHULRU
50ml/mLQQXHVWHDFFHSWDWSHQWUXWUDQVSODQWDUHDXQXL
vPSDFKHWDL L VFXIXQGDL vQWU-R VROXLH UHFH KLSHURVPRODU FX
singur rinichi).
FRQVWLWXHQL LPSHUPHDELOL FD PDQLWROXO UDILQR]D ODFWRELRQDWXO

FHDXFRPSR]LLHHOHFWUROLWLFVLPLODUVSDLXOXLLQWUDFHOXODU
V.
IMPLANTARE
probleme etice, juridice legate de prelevarea de organe

(contactarea familiei, informarea acestei privind moartea
7UDQVSODQWXOUHQDOHVWHRSURFHGXUFKLUXUJLFDOPDMRUFH
SUHVXSXQH R FRPSRQHQW
'XS vQGHSOLQLUHD FHORU GRX HWDSH WUHEXLH UH]ROYDWH
FHUHEUDO RELQHUHD FRQVLPPkQWXOXL SULYLQG GRQDUHD GH
YDVFXODU L R FRPSRQHQW
RUJDQH GDU L PRQLWRUL]DUHD L VXVLQHUHD IXQFLLORU YLWDOH DOH
FKLUXUJLFDO XURORJLF 'H FHOH PDL PXOWH RUL UHFROWDUHD L
GRQDWRUXOXLvQPRDUWHFHUHEUDOSkQODPRPHQWXOSUHOHYULLGH
transplantarea rinichiului (de la donatorul viu) se face succesiv
organe.
vQ GRX VOL GH RSHUDLL GH FWUH GRX HFKLSH FKLUXUJLFDOH
C. EVALUAREA RECEPTORILOR
&RQH[LXQHDYDVFXODUVHHIHFWXHD]GHRELFHLODYDVHOHLOLDFH
7UDQVSDOQWXO UHQDO HVWH LQGLFDW WXWXURU SDFLHQLORU FX
GDU XQHRUL SRDWH IL QHFHVDU FRQH[LXQHD OD DRUW L YHQD FDY
LQVXILFLHQUHQDOFURQLF vQVWDGLXOFDUHQHFHVLW RIRUP
LQIHULRDU 5HFRQVWUXFLD WUDFWXOXL XULQDU VH IDFH SULQ uretero-
GH VXSOLHUH D IXQFLHL UHQDOH FDUH QX DX FRQWUDLQGLFDLL
cistonHRVWRPLHFXGLIHULWHOHVDOHYDULDQWHGHWHKQLFFKLUXUJLFDO
majore.
SH VWHQW WXWRUH VRQGD XUHWHUDO -- vQWU-R PDQLHU DQWLUHIOX[
&RQWUDLQGLFDLLDEVROXWH pentru transplant:
SURFHGHXO:DVKQLFNQWRWGHDXQDWUHEXLHVOLPLWPODPD[LP
6SHUDQDGHYLDWVXEXQDQ
perioada de ischemie rece a rinichiului (optima este o pHULRDG
Neoplasme recente netratabile,
,QIHFLLDFXWHVDXLQIHFii cornice netratabile,

,QIHFLL+,9VDX6,'$
Probleme
psihosociale:

boli
psihice
(YDOXDUHD EROLORU UHQDOH FX SRWHQWLDO GH UHFXUHQ

IRFDO
(glomeruloscleroza
majore
VHJPHQWDO
QHFRQWURODWHWR[LFRPDQLHQRQFRPOLDQD
JORPHUXORQHIULWD PHPEUDQRDV QHIURSDWLD ,J$
Mismatch n sistemul ABO,
glomerulonefritele membranoproliferative,
Cross-match SR]LWLY vQWUH OLPIRFLWHOH GRQDWRUXOXL L
5HFXUHQD SH JUHID UHQDO D EROLORU VLVWemice

QHIURSDWLD OXSLF DPLORLGR]D SXUSXUD +HQRFK-
serul primitorului.
&RQWUDLQGLFDLLUHODWLYH
Schonlein, sindromul hemolitic uremic, nefropatia
,QIHFLLDFWLYH
GLDEHWLF
%RDOFRURQDULDQ,
QHROSD]LLOH
Hepatite active,
ateroscleroza,
Ulcere peptice active,
LQVXILFLHQDFDUGLDFFRQJHVWLY'= etc).
%RDOFHUHEURYDVFXODU
IDFWRULPHGLFDOLFKLUXUJLFDOLLPXQRORJLFLLSVLKR-sociali care ar
SXWHDLQIOXHQDVXSUDYHXLUHDSHWHUPHQOXQJDSDFLHQWXOXLLD
grefei renale.
(YDOXDUHDPHGLFDOSUHRSHUDWRULHFDUHHVWHHIHFWXDWGH
FWUHHFKLSDGHQHIURORJLFXSULQGH
HTA,
ERDOD
FLVWLQR]D
FRURQDULDQ
vasculopatiile,
AVC,
crossmaching
Elementul cheie pentru transplantul renal de succes, este
UHSUH]HQWDW GH DELOLWDWHD LGHQWLILFULL FRUHFWH D SRWULYLULL
histoFRPSDWLELOLWLL GLQWUH SULPLWRU L GRQDWRU SHQWru
un
SURJQRVWLF IDYRUDELO GH IXQFLRQDOLWDWH YLQGHFDUH L GH YLD

SHQWUX DFHWL SDFLHQL DYkQG vQ YHGHUH SRVLELOiWDWHD DSDULLHL
IHQRPHQXOXLGHUHMHWJD]GYV alogreIUHQDO
$QDPQH]LH[FOLQLFFRPSOHW
Ex. de laborator HLG; probe de coagulare,

biochimie, probe hepatice, lipidograma, serologie,
tipizare HLA (anticorpi citotoxici),
III.
5[3XOPRQDU(.*
8URFXOWXU
([JLQHFRORJLFPDPRJUDILHH[SURVWDW
Ex. imagistice renale, cistouretrografie,
Consulturi:
RECOLTARE
Recoltrea rinichiului pentru transplant de la donatorul

vQYLD se poate efectua prin oricare dintre tehicile nefrectomiei
(abord
transperitoneal,
lombar,
laparoscopic).
Majoritatea
FHQWUHORU GH WUDQVSODQW UHFRPDQG UHFROWDUHD ULQLFKLXOXL VWkQJ
urologic,
pneumologic,
gastroenterologic, hematologic, psihiatric,
!
LQIHFLLOH
SULPDU
(YDOXDUHD LPXQRORJLF - tipizarea HLA, maching L
Evaluarea pre-WUDQVSODQWDUHFHSWRULORUWUHEXLHVLGHQWLILFH
cardiologic,
KLSHUR[DOXULD
YHQD UHQDO PDL OXQJ GDU SRDWH IL UHFROWDW L ULQLFKLXO GUHSW
GDFFRQGLLLOHDQDWRPLFHSOHGHD]SHQWUXRUHFROWPDLIDFLO
5HFROWDUHDULQLFKLXOXLGHODGRQDWRUvQPRDUWHFHUHEUDO
HVWH GH FHOH PDL PXOWH RUL R HWDS vQ FDGUXO UHFROWULL
multiorgan, fiind astfel recoltate n ordine cordul, plamnul,

Ghid Urologie Alb Negru

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Descrierea CIP a Bibliotecii Naionale a Romniei

Editura Gr. T. Popa

&7/,1 35,&23 &21)(5(1IAR UNIVERSITAR, DOCTOR N

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DR. LIVIU TODOSI $6,67(1781,9(56,7$5'2&72517,,1(

Lger - Semiologie Chirurgicale, Masson et Cie, 1964;

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