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DAN MISCHIANU

GHID PRACTIC IN
UROLOGIE

Editura *U73RSD80),$,

2015


Descrierea CIP a Bibliotecii Naionale a Romniei
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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Badea R, Dudea S, Mircea P, Stamatian F -Tratat de FDUH FDUDFWHUL]HD] VWUHD DFWXDO D SDFLHQWXOXL DQWHFHGHQWHOH

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8Q DEVROYHQW GH IDFXOWDWH GH PHGLFLQ WUHEXLH V ILH
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FRQFLV L FRPSOHW 'LQ QHIHULFLUH REVHUYP F DFHDVW
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Calomfirescu N, Voinescu V Tratamentul endoscopic al FRPSOHWDUHLPSOLFRGXEOUHVSRQVDELOLWDWH
stricturilor uretrale, Editura Academiei Romne Din punct de vedere al HYROXLHL cazului de investigat ne
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stones, Medical and surgical management, Lippincott Raven XURORJLF GHRELFHL vQXUPFXFHYDWLPSELOHWXOGHLHLUHLIRDLD
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FRUHFWH%LOHWXOGHLHLUHGLQVSLWDOWUHEXLHVRIHUe medicului curant
M 0,7 10,7 mcg/l
VDX GH DOW VSHFLDOLWDWH SRVLELOLWDWHD GH D WL FURQRORJLF WRDWH Prolactina
F 2,3 15,9 mcg/l
GDWHOHLPSRUWDQWHvQHYROXLDEROLL
M 0 10 mcg/l
7UHEXLH V DYHP JULM V QRWP FX JULM antecedentele Somatotrop (STH)
F 2 5 mcg/l
personale vQSULPXOUkQGFHOHXURORJLFHFKLDUGDF aparent, nu au Tireotropina (TSH) 0,5 4,0 mUl/l
ROHJWXUGLUHFWFXVXIHULQDDFWXDO$VWIHOHSLVRDGHOH UHSHWDWH  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 100 400 pg/ml
2DOWSUREOHPSHVWHFDUHGLQJUDEVDXQHWLLQ, se trece Suprarenale
XRUHVWHSUREOHPDUHDFLLORUDOHUJLFH 9RPQRWDGHFLFXPD[LP Aldosteron (clinostatism) 25 450 pM/l
sHULR]LWDWH UHDFLLOH DOHUJLFH FXQRVFXWH OD antibiotice DWHQLH PDL (ortostatism) 110 860 pM/l
Cortizol 280 700 nM/l

 $
XIII. VALORILE NORMALE ALE PARAMETRILOR BIOLOGICI I. )2$,$'(2%6(59$,($3$&,(178/8,852/2*,&

AGL 300 700 mg/l DOHV OD SDFLHQLL FX UHSHWDWH HSLVRDGH GH LQIHFLH vQ DQWHFHGHQWH
Acizi biliari 0 4,3 mcg/ml FDUHDXSULPLWDQWLELRWLFHGLYHUVHvQFRPELQDLLPDULLUHSHWDWH L
70 115 mg/dl la VXEVWDQHOHGHFRQWUDVWLRQLFHDXUHSXWDLDGH a produce astfel
*OXFR]
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
Markeri tumorali n urologie a. WXPRULOHYH]LFDOHIXPWRU"GHFkWWLPSLFkWHLJUL
Rinichi pe zi? a lucrat n mediu toxic (industria cauciucului,
3+, IRVIRKH[R] L]RPHUD] 15 75 Ul/l SLHOULHL SUHOXFUDUHD SHWUROXOXL HWF  FkL DQL"
9H]LFDXULQDU antecedente TBC? (n perspectiva eventualei
TPA (antigenul celular LQWURGXFHULDLQVWLODLLORUFX%&* 
< 95 Ul/l
polipeptidic) b. /LWLD]Dparinii cu litiaz renal? eliminator de calculi?
Prostata 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? leucemie? limfoame? boala Paget?
3$3 IRVIDWD]DSURVWDWLFDFLG < 2 mcg/dl
tratament cronic cu corticosteroizi? vitamina D,
Testicul
preparate de calciu, diuretice? consum exagerat de
AFP (alfafetoproteina) 8OO
carne, brnzeturi, sare, sucuri cu zahar?
-+&* JRQDGRWURILQDFRULRQLF
< 5 Ul/l $WXQFLFkQGQRWPLVWRULFXOXQXLSDFLHQWWUHEXLHVDYHPvQ
XPDQ
YHGHUHLVLWXDLDFLQGLYLGXOSRDWHWULDQLFXXQVLQJXUULQLFKLIU
63 1 JOLFRSURWHLQVSHFLILF M 0,5 1 mcg/l a avea simptome deosebite. Rinichiul unic congenital sau
sarcinii)
IXQFLRQDO WUHEXLH DYXW vQ YHGHUH DWXQFL FkQG GLVFXWP FX XQ
3DUDPHWULLXULQDULSHQWUXHOXFLGDUHDFRPSR]LLHLOLWLD]HLUHQDOH
SDFLHQWFXDQXULHREVWUXFWLYLQWHUYHQLWGLQVHQLQ
Amoniac 35 50 mM/24h
Examinarea pacientului urologic constituie tema unui alt
Acid uric 2,4 4,5 mM/24h
FDSLWRO DO OXFUULL LQ V PHQLRQH] F H[DPHQXO SH DSDUDWH L
Calciu 2.5 8 MMOL/24h
VLVWHPHYDILIFXWFRUHFWLFRPSOHWGXSUHJXOLOHvQYDWHOD
Magenziu 0.5 12 MMOL/24h
Semiologie n anul III.
Acid oxalic < 0,5 mM/24h
6WDJLXOGH8URORJLHVHGRYHGHWHXQEXQSULOHMGHDYHULILFD
pH 57

 
I. )2$,$'(2%6(59$,($3$&,(178/8,852/2*,& XIII. VALORILE NORMALE ALE PARAMETRILOR BIOLOGICI

vQ SUDFWLF QRLXQLOH GREkQGLWH OD &DUGLRORJLH 1HIURORJLH Proteine


Ftiziolologie ntruct PXOWLSDFLHQLvQYkUVWFXDIHFLXQLXURORJLFH 66 87 g/l
SUH]LQWFRPRUELGLWL +7$GLDEHWWXOEXUULGHULWPHWF FDUHSRW 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 150 600 mg/dl


M 23 350 mcg/l
coexistente la pacientul urologic aflat n grija lui. Feritina
F 17 270 mg/l
7RDWHDFHVWHREVHUYDLLWUHEXLHVVHUHJVHDVFPHWLFXORV
Haptoglobina 1,0 3,2 g/l
notate, n IRDLDGHREVHUYDLHvQRUGLQHFURQRORJLFvQWU-RPDQLHU
Ig A 0,5 3,3 g/l
FODUFRQFLVHOLJLELOLSUHFLV
Ig D 3 400 mg/dl
Referindu-ne la acest document medico-legal 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

Q IRDLD GH REVHUYDLH VXQW GHDVHPHQHD QRWDWH L Albumine 52 65.1 %


1 - globuline 1 3%
codificate toate manevrele medicale sau chirurgicale efectuate
2 - globuline 9.5 14.4 %
SDFLHQWXOXLSHSDUFXUVXOLQWHUQULL. ncepnd de la recolatrea de
- globuline 6 9.8 %
DQDOL]H L HOHFWURFDUGLRJUDPD FDUH VH HIHFWXHD] GH UXWLQ OD WRL
- globuline 10.7 20.3 %
SDFLHQLL FRQWLQXQkG FX LQYHVWLJDLL LPDJLVWLFH HFRJUDILH 5596
/LSLGHLPHWDEROLL
UIV, CT, UPG, Rx. toracic, probe ventilatorii, etc.) consulturi
Bilirubina WRWDO 0 1,1 mg/dl
LQWHUFOLQLFH L LQWHUVSLWDOLFHWL GXS FD] GDU L LQWHUYHQLL - GLUHFW 0.05 0.3 mg/dl
FKLUXUJLFDOHFDUHSRWVILHXQLFHVDXVXFFHVLYHPXOWLSOHvQFDGUXO Colesterol total 120 200 mg/dl
DFHOHLDL LQWHUQUL 7RDWH DFHVWH GDWH PHGLFDOH VXQW QRWDWH vQ - liber 45 85 mg/dl
RUGLQHFURQRORJLFvQIRDLDGH RVHUYDLH - HDL 55 100 mg/dl
&HWUHEXLHPHQLRQDWODHYROXLH" - LDL 0 130 mg/dl

x VWDUHD JHQHUDO D SDFLHQWXOXL EXQ VDWLVIFWRDUH


 
XIII. VALORILE NORMALE ALE PARAMETRILOR BIOLOGICI I. )2$,$'(2%6(59$,($3$&,(178/8,852/2*,&

LQIOXHQDW 
8 130 Ul/l x GLXUH]DWHQVLXQHDDUWHULDOSXOVXO HYHQWXDOGHILFLWXOGH
)RVIDWD]DDOFDOLQ 34 104 U/L puls!)
M 2500 8500 Ul/l
Colinesteraza x aspectul macroscopic al urinei (sau al lichidului de lavaj
F 2800 4700 Ul/l SRVWRSHUDWRUODSDFLHQLLRSHUDLFODVLFVDXHQGRVFRSLF 
Creatinkinaza 26 170 U/L x OD FHL RSHUDL FODVLF DVSHFWXO SDQVDPHQWXOXL LQILOWUDW
CK - MB 0 - 25 U/L SXUXOHQW KHPDWLF FXUDW  L HYHQWXDOHOH PDQHYUUL DOH
M 10 71 U/L
tubului de dren (mobilizarea tubului de dren, scurtarea sau
- GPT 6 42 U/L
F suprimarea lui);
25 100 mg/dl
x DSDULLD XQHLHYHQWXDOHUHDFLLDOHUJLFHvQFXUVXOVSLWDOL]ULL
GLDH < 4 Ul/l
ODDQWLELRWLFHVXEVWDQGHFRQWUDVW 

M 5 18 Ul/l x PDQHYUHOH GLDJQRVWLFH SUDFWLFDWH vQ ]LXD UHVSHFWLY


GOT
(cistoscopie, cateterism ureteral, ureteropielografie
F 5 15 Ul/l
UHWURJUDGXUHWURJUDILHHWF 
M 5 23 Ul/l
GPT ,DWPDLMRVXQH[HPSOXODXQSDFLHQWFX785-P, fost purtator
F 5 19 Ul/l
de sonda 4 saptamini,ziua a II-a postoperator:
LDH 135 214 U/L
HBDH 68 140 Ul/l
LAP 11 35 Ul/l
Data Tratament (YROXLH
Lipaza 13 60 U/L
12.01.2013 1. Sulperazon fl II 6WDUHJHQHUDOEXQDIHEULO
)$DFLG 5 14 Ul/l
2. Gentamicina f III 'LXUH]POXULQXRU
Parametrii renali 3. Algocalmin f III KHPDWLF
3,4 7,0 mg/d
4. )UD[LSDULQI,
M
< 800 mg/24H U 5. Ser Glucozat 10%
Acid uric 2000ml
2,4 5,7 mg/dl
F 6. Ser Fiziologic 3DFLHQWXOL-a
< 700 mg/24h U 1000ml reluat tranzitul pentru gaze.
10 50 mg/dl
Uree 7. Diazepam tb I 7ROHUDQGLJHVWLYEXQ7$
18 35 g/24h U = 140/75 puls= 78b/min.
M 0,7 1,3 mg/dl
F 0.6 1.2 mg/dl
&UHDWLQLQ
0,5 1,7 g/24h
$
 
II. EXAMENUL CLINIC AL APARATULUI UROGENITAL XIII. VALORILE NORMALE ALE PARAMETRILOR BIOLOGICI
Indice Quick > 70 %
II. EXAMENUL CLINIC AL APARATULUI UROGENITAL
&, 
([SRUDUHD FOLQLF D DSDUDWXOXL XURJHQLWDO WUHEXLH V 17 24 sec
INR 0.8 1.3
GHFXUJ ILUHVF GH VXV vQ MRV DGLF GLQVSUH ORMHOH UHQDOH VSUH
UHJLXQHD KLSRJDVWULF L EXUVHOH VFURWDOH VDX UHJLXQHD JHQLWDO OD Parametrii ASTRUP
IHPHL 'LQ VWDUW DFHVW H[DPHQ DUH GRX ODWXUL FH WUHEXLH XUPDULWH arterial 65 105 mmHg
pO2
FXDWHQLH venos 30 60 mmHg

a) Latura VXELHFWLY ce cuprinde totalitatea elementelor arterial 31 44 mmHg


pCO2
venos 38 53 mmHg
patologice ce vor fi descrise de pacient;
pH 7,34 7,44
b) Latura RELHFWLY care FRQVW vQ H[DPHQXO IL]LF LQVSHFLH
Bicarbonatul standard 24 28 MMOL/L
SDOSDUHSHUFXLH HIHFWXDWUHVSHFWLYXOXLSDFLHQW
Baze exces - 2,5 - + 2,5 mM/l
([DPHQXORELHFWLYYDFXSULQGHJUDGXDODVHVXESXQFWH
6DWXUDLDDUWHULDOvQR[LJHQ 95 98 %
1) Explorarea PLFLXQLL;
Parametrii plasmatici/serici (OHFWUROLL oligoelemente
2) ([SRUDUHDFOLQLFDrinichilor
3) A zonei hipogastrice 98 107 MMOL/L
4) A XUHWUHLLDSHQLVXOXL Clor 140 280 mM/24h
5) A scrotului LDFRQLQXWXOXLVFURWDO
6) A perineului, prostatei L YH]LFXOHORU VHPLQDOH 3,5 5,1 MMOL/L
Potasiu
(tactul rectal); 35 90 mM/24h U
Calciu total 8.5 10.2 mg/dl

EXAMENUL 0,&IUNII 0,65 1,05 MMOL/L


Magneziu 2,47 8,88 mM/24h U
Acesta presupune F YRP LQYLWD SDFLHQWXOSDFLHQWD V
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 120 220 mM/24h U
YL]XDOL]D H[LVWHQD WXOEXUULORU PLFLRQDOH L D PRGXOXL FXP VH Sodiu

PDQLIHVWHOH jet urinar ntrerupt, jet n doi timpi, jet deformat 16 49 mM/24h U
UVXFLW vPSUDWLDW ILOLIRUP FX SLFWXU  VDX SLHUGHUHD 0,81 1,53 mM/l
A
QHFRQWURODWDXULQLL ([DPLQDWRUXOYDYHGHDLFRQVHPQDvQIRDLD Fosfat, anorganic 1,16 1,9 mM/l
C
GHREVHUYDLHLaspectul urinii8ULQDOLPSHGHJDOEHQFULVWDOLQ 16 49 mM/24h U

VH GHRVHEHWH GH XULQD WXOEXUH SLXULF GLQ LQIHFLLOH XULQDUH YH]L Enzime
- amilaza 28 100 U/L

 $
XIII. VALORILE NORMALE ALE PARAMETRILOR BIOLOGICI II. EXAMENUL CLINIC AL APARATULUI UROGENITAL

XIII. VALORILE NORMALE ALE PARAMETRILOR BIOLOGICI ILJ ,,  VDX XULQD EUXQ URLDWLF GLQ KHPDWXULD PDFURVFRSLF
YH]LILJ,, 5DUHRULSRWILRELHFWLYDWHLSQHXPDWXULDSDUWLFXODU
M 2 - 10 mm/h de exemplu, fistulelor uro-intestinale, chiluria iar daca pacientul
VSH
F 5 15mm/h HVWH VXILFLHQW WLPS VXE REVHUYDLH SXWHP HYDOXD  ROLJXULD VDX
M 13 17 g/dl poluria.
Hb
F 11,5 16 g/dl

Ht M 40 54 %
F 37 47 %
6
Eritrocite M 4,5 6,5 x 10 /l
6
F 3,9 5,3 x 10 /l
MCV- volumul mediu eritrocitar 80 100 fl
MCH +JHULWURFLWDU 27 32 pg
MCHC Hg HULWURFLWDUPHGLH 32 36 g/dl
3
Adult 4 10 x 10 /l
3
Leucocite Copil 6 15 x 10 /l
3
Sugar 6 18 x 10 /l
3
Trombocite 150 450 x 10 /l
CRP 0 - 5 mg/l
Procalcitonina 0.02 - 0.5 ng/ml
Neutrofile 50 75 %
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. EXAMENUL CLINIC AL APARATULUI UROGENITAL XII. CAIETUL STAGIULUI DE UROLOGIE

Fig. II.7 Diagnosticul Hematuriei macroscopice proba celor 3 pahare


5HQDODVLPSO
8URJUDILH
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 &7501
anatomice. 
Cu toate acestea: 7UDWDPHQWPHGLFDPHQWRV
a) ,QVSHFLDUHJLXQLLOREDUHSRDWHHYLGHQLD
x Cicatrici ORPEDUH PDUWRUH DOH XQRU RSHUDLL 

efectuate anterior
7UDWDPHQWXURORJLF
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 3DUWLFXODULWLDOHFD]XOXL
ntlnit)
x 0DULUHD L GHIRUPDUHD regiunii lombare cel mai 
adesea unilateral (n tumorile renale, chisturile


UHQDOH PDL YROXPLQRDVH  GDU L ELODWHUDO OD
&RFOX]LLFRPHQWDULL
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 DULQLFKLXOXL vQWkOQLWXQHRULvQSWR]D
UHQDO L, 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 II. EXAMENUL CLINIC AL APARATULUI UROGENITAL

Caietul stagiului de urologie PDL PXOWH LQIRUPDLL GHFkW FODVLFD PDQHYU *LRUGDQR
SUH]HQWVDXDEVHQW  YH]LILJ,, 
1XPHVLSUHQXPH)2
Vrsta DQL 6H[
0RWLYHOHLQWHUQULL

$+&

$3)

$33


&RQGLLLGHYLDLPXQF
)LJ,,&ROLFDQHIUHWLF L. Lger, Semiologie Chirurgicale, Masson et
Cie, 1964; p. 391
&RPSRUWDPHQWH IXPDWDOFRROHWF 

d) $VFXOWDLD regiunii lombare OD FDUH SUHD PXOL DX

MedicatLHGHIRQG UHQXQDW - L D UHJLXQLL DEGRPLQDOH DQWHULRDUH SRDWH


depista, la un pacient hipertensiv, zgomotul de suflu sau

Istoricul bolii:  GHXUXLWXUFRQWLQXLSXWHUQLFSDUWLFXODUXQHLVWHQR]HGH


DUWHU UHQDO VDX LOXVWUDWLY SHQWUX R ILVWXOD UHQDO DUWHULR-

 YHQRDV

Analize efectuate:
3. EXAMENUL CLINIC AL ZONEI HIPOGRASTRICE (VEZICA
6DQJH
URINARA)
 'DWRULWD SURLHFLHL VDOH UHWURVLPIL]DUH vQ UHJLXQHD
8ULQD
 KLSRJDVWULF YH]LFD XULQDU FkQG HVWH JRDO HVWH QHYL]XDOL]DELO
QHSDOSDELOQHSHUFXWDELO/DXQSDFLHQWVODE JOREXOYH]LFDOHVWH
8URFXOWXUD
(FKRJUDILH YL]LELOLSDOSDELO YH]LILJ,, 

 
$! 
II. EXAMENUL CLINIC AL APARATULUI UROGENITAL XII. CAIETUL STAGIULUI DE UROLOGIE

5HQDODVLPSO
8URJUDILH


&7501

7UDWDPHQWPHGLFDPHQWRV



7UDWDPHQWXURORJLF




3DUWLFXODULWLDOHFD]XOXL




&RFOX]LLFRPHQWDULL







)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
infiltrative cu sediu trigonaO VDX SHULFHUYLFDO SUHFXP L OLWLD]D
YH]LFDO YH]LILJ,, 



 $
XII. CAIETUL STAGIULUI DE UROLOGIE II. EXAMENUL CLINIC AL APARATULUI UROGENITAL

Caietul stagiului de urologie

Nume VLSUHQXPH)2
Vrsta DQL 6H[
0RWLYHOHLQWHUQULL

$+&

$3)

Fig. II.14- QWUHUXSHUHDMHWXOXLXULQDUGDWRULWOLWLD]HLYH]LFDOH


$33

,QVSHFLD UHJLXQLLKLSRJDVWULFHYL]XDOL]HD]XQHRULPDLDOHVSHQWUX

&RQGLLLGHYLDLPXQF SULYLULOH DYL]DWH SUH]HQD XQHL GHIRUPUL URWXQGH-RYRLGDOH VLWXDW


PHGLDQ QHGHSODVDELO vQ GHFXELW ODWHUDO FX D[XO PDUH SH OLQLD

&RPSRUWDPHQWH IXPDWDOFRROHWF  SHULRPELOLFDO XQHRUL QHGXUHURDV VSRQWDQ L OD SDOSDUH DOWHRri


DWkW GH ELQH WROHUDW vQFDW SDFLHQWXO QLFL QX LL IDFH SUREOHPH

MedicatLHGHIRQG (evident greu de observat la obezi).


Palparea UHJLXQLL KLSRJDVWULFH VXPDW FX SHUFXLD respectivei

UHJLXQLL SRDWH V HYLGHQLH]H DFHDVW HQWLWDWH FURQLF JOREXO


,VWRULFXOEROLL
YH]LFDO YH]LILJ,,)
 5HWHQLD DFXW GH XULQ 5$8  VDX UHWHQLD FURQLF GH XULQ

LQFRPSOHWVDXFRPSOHWL]DWDXFDH[SUHVLHFOLQLFDFHODLQXPLWRU
Analize efectuate: comun: globul vezical DFXW VDX LQVWDODW FURQLF JORE YH]LFDO
SanJH
PRDOH SH R YH]LF GHWUXVRU LQHILFLHQW  Echografia ne este de
 PDUH DMXWRU vQ D HYDOXD UHJLXQHD KLSRJDVWULF VL FRQLQXWXO
8ULQD
vezical (mai ales reziduul vezical!).

4..EXAMENUL CLINIC AL PENISULUI SI AL URETREI
8URFXOWXUD ,QVSHFLD SHQLVXOXLSRDWHYL]XDOL]DGLYHUVHVLWXDLLfimoza
(FKRJUDILH
FRQJHQLWDOGRELQGLW hipospadiasVDXPDLSRDWHILYL]XDOL]DWL
YDULDQWD GHVFKLGHULL PHDWXOXL XUHWUDO SH IDD GRUVDO D SHQLVXOXL


$ 
II. EXAMENUL CLINIC AL APARATULUI UROGENITAL XII. CAIETUL STAGIULUI DE UROLOGIE

epispadias. Acesta poate fi penian sau total variant extrofiei 5HQDODVLPSO


YH]LFDOHJUHXUH]ROYDELOFKLUXUJLFDO 8URJUDILH

7RW DFWXO LQVSHFLHL FOLQLFH DWHQWH SRDWH YL]XDOL]a
uretroragia scurgerea de snge la nivelul meatului uretral ntre &7501

PLFLXQL YH]LILJ,,
7UDWDPHQWPHGLFDPHQWRV



7UDWDPHQWXURORJLF




3DUWLFXODULWLDOHFD]XOXL



Fig. II.15.Uretroragia. 
sau uretroreea SUH]HQD VHFUHLHL XUHWUDOH SXUXOHQWH vQ LQIHFLL &RFOX]LLFRPHQWDULL

XUHWUDOHDQWHULRDUH XUHWULWDFXW SUH]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


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XII. CAIETUL STAGIULUI DE UROLOGIE II. EXAMENUL CLINIC AL APARATULUI UROGENITAL

Caietul stagiului de urologie H[LVWHQD XQRU VXSXUDLL EDODQR-SUHSXLDOH balanopostitele sau


FKLDUSUH]HQDXQRUFDOFLILFULODDFHVWQLYHO
1XPHVLSUHQXPH)2
Vrsta DQL 6H[ Palparea SHQLVXOXL SRDWH V VHVL]H]H FHO PDL DGHVHD
0RWLYHOHLQWHUQULL SUH]HQD LQGXUDLHL SODVWLFH a corpilor FDYHUQRL PDODGLD

/D3H\URQLH DGLFH[LVWHQDXQRU]RQHGXUHULJLGHODQLYHOXO

$+& FRUSLORU FDYHUQRL FDUH IDF LQWURPLVLXQHD GLILFLO GLQ FDX]D


UHFXUEULLSHQLVXOXLHUHFW

$3) 3DWRORJLDXUHWUDODIHPLQLQ SRDWHFRQVWDvQUDUHFD]XULL


n:
$33
 - stenoze de meat uretral
- leziuni inflamatorii
&RQGLLLGHYLDLPXQF
- HFWURSLRQXOGHPXFRDVXUHWUDO vizualizabil sub forma

XQHL WXPRUHWH URLL-YLRODFHH SURODEDWH LUHGXFWLELOH D SRULXQLL


&RPSRUWDPHQWH IXPDWDOFRROHWF  DQWHULRDUHDXUHWUHLQRPLQDOL]DWGUHSWpolip de meat uretral

- fistulele uretrale vizualizate prin examen cu valvele.


MedicatLHGHIRQG 5. (;$0(18/ &/,1,& $/ 6&5278/8, , $/ &21,1878/8,

68.
,VWRULFXOEROLL ,QVSHFLD L SDOSDUHD WUHEXLH V VH DGUHVH]H DWkW

vQYHOLXOXLVFURWDOFkWLFRQLQXWXOXLVX

 Vom cerceta :
- Posibila PULUH GH YROXP a hemiscrotului: GXUHURDV n
Analize efectuate:
6DQJH inflaPDLLOH HSLGLGLPXOXL WHVWLFXODU L vQ WUDXPDWLVPH RUKL-
epididimare; QHGXUHURDV vQ WXPRUL WHVWLFXODUH L HSLGLGLPDUH

8ULQD KLGURFHOLGLRSDWLFKHPDWRFHOVDXFKLVWHHSLGLGLPDUHSHUVLVWHQGH
 canal peritoneo-vaginal (hidrocel comunicant).

- 3UH]HQD unui orificiu fistulos prin care se scurge puroi n cazul


8URFXOWXUD
(FKRJUDILH unui abces orhiepididimar fistulizat la scrot;
- 3UH]HQD semnelor inflamatorii (rubor, tumor, calor, dolor) n

HSLGLGLPLWHLRUKLHSLGLGLPLWH


$ 
II. EXAMENUL CLINIC AL APARATULUI UROGENITAL XII. CAIETUL STAGIULUI DE UROLOGIE

- Inegalitatea FHORU GRX EXUVH VFURWDOH FX HYHQWXDO, lipsa unui 5HQDODVLPSO
WHVWLFXO GLQ EXUV $FHDVWD VH QXPHWH criptorhidie ELODWHUDO 8URJUDILH

SkQODGLQFD]XUL  YH]LILJ,, FkQGWHVWLFXOXO este oprit pe
WUDLHFWXOSHFDUHvQPRGQRUPDODUWUHEXLVvOXUPH]H GHVFHQVXV &7501

testis) sau ectopie WHVWLFXODU GDF WHVWLFXOXO VH JVHWH SH XQ
7UDWDPHQWPHGLFDPHQWRV
traiect aberant.
- $IHFLXQL YDVFXODUH varicocel idiopatic, torsiune de cordon 

VSHUPDWLFPDQLIHVWDWSULQHGHPVFURWDO Tratament urologic: 
- Tumorile solide (testiculare, epididimare) sau lichide (chiste de 

epididim, de cordon); 
- Hernia inghino-VFURWDO vera sau KHUQLH SULQ SHUVLVWHQD
3DUWLFXODULWLDOHFD]XOXL
canalului peritoneo-vaginal.

Palparea EXUVHORU VFURWDOH HIHFWXDW vQ RUWR- L 
FOLQRVWDWLVPFRQVWDWLvQWUHWHHOHPHQWHOHVHPLRORJLFH GHVFULVH 

anterior: &RFOX]LLFRPHQWDULL
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]DFRQVLVWHQDVD RPRJHQIHUP


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


 $
XII. CAIETUL STAGIULUI DE UROLOGIE II. EXAMENUL CLINIC AL APARATULUI UROGENITAL

Caietul stagiului de urologie

Nume VLSUHQXPH)2
Vrsta DQL 6H[
0RWLYHOHLQWHUQULL

$+&

$3)

$33


&RQGLLLGHYLDLPXQF

&RPSRUWDPHQWH IXPDWDOFRROHWF 

Fig II.17. (OHPHQWH GH GLDJQRVWLF DOH GLIHULWHORU DIHFLXQL LQIODPDWRULL RUKL-
MedicatLHGHIRQG epididimare.

6.EXAMIN$5($ 3(1,68/8, 35267$7(, , $ 9(=,&8/(/25


,VWRULFXOEROLL SEMINALE

 7XHXO UHFWDO - TR presupune examenul organelor


 JHQLWDOH L XULQDUH LQWHUQH SURVWDW YH]LFXOH VHPLQDOH XUHWU

Analize efectuate: YH]LFXULQDU


SanJH ,QGLFDLLOH75 QXVXQWVWULFWOHJDWHGHSDWRORJLDXURORJLF

GH DFHHD LPSRUWDQD GDWHORU FOLQLFH RELQXWH FkW L WHKQLFD GH



8ULQD HIHFWXDUH DX LPSRUWDQ PXOWLGLVFLSOLQDU 3HQWUX D H[HPSOLILFD
 DFHDVWD PHQLRQP vQ FRQWLQXDUH FkWHYD VSHFLDOLWL vQ FDUH

8URFXOWXUD examenul este recomandat:


(FKRJUDILH x 75 HIHFWXDW GH FKLUXUJXO FH SUDFWLF FKLUXUJLD

DEGRPLQDO VDX DEGRPLQR-SHOYLQ GLJHVWLYD  fundul


GH VDF 'RXJODV GXUHURV LSWXO IXQGXOXL GH VDF
$
$ 
II. EXAMENUL CLINIC AL APARATULUI UROGENITAL XII. CAIETUL STAGIULUI DE UROLOGIE

SHULWRQHDO GLQ SHULWRQLWH VDX SHOYL-SHULWRQLWH LQGXUDLD 5HQDODVLPSO


Douglas-XOXL FDUH GXS SXQFLRQDUH SRDWH FRQfirma Urografie: 

H[LVWHQD KHPRSHULWRQHXOXL  VILQFWHUXO L FDQDOXO DQDO
SHQWUX ILVWXOH VDXL VXSXUDWLL DQR-perianale, hemoroizii, &7501

FRUSL VWUDLQL HQGRUHFWDOL  FRQLQXWXO GLJHVWLY DVSHFWXO
7UDWDPHQWPHGLFDPHQWRV
VFDXQXOXL VDX D PDWHULLORU IHFDOH UPDVH SH PQX
PHOHQVDXUHFWRUDJLH FDYLWDWHDUHFWDO WXPRU  

x TR efectuat de urolog permite explorarea prostatei, 7UDWDPHQWXURORJLF
veziculelor seminale, uretrei posterioare FDQG H[LVW XQ 

cateter uretral L D YH]LFLL XULQDUH QH LQWHUHVHD] 
UDSRDUWHOH DQDWRPLFH VXSOHHD VDX ULJLGLWDWHD SHUHWHOXL
3DUWLFXODULWLDOHFD]XOXL
sensLELOLWDWHD L PRELOLWDWHD DFHVWRUD 3HQWUX H[SORUDUHD

SURVWDWHL VH LPSXQH SDOSDUHD ELPDQXDO PkQD VWkQJ 
FXSULQ]kQGKLSRJDVWUXOLDUPkQDGUHDSW UHSUH]HQWDWGH


indexul examinator XUPHD] PLFUL WUDQVYHUVDO L &RFOX]LLFRPHQWDULL
ORQJLWXGLQDOHEOkQGH HIHFWXDWGXSFOLVPHYDFXDWRULHL

HYDFXDUHD YH]LFLL XULQDUH &HOH PDL EXQH LQIRUPDLL OH
RELQHPDWXQFLFkQGIDFHPWXHXOUHFWDOVXEUDKLDQHVWH]LH 

x TR efectuat de ginecolog SRDWHRIHULLQIRUPDLLOHJDWHGH
VWDWLFD SHOYLQ ERPEDUHD LQGXUDUHD VDX VHQVLELOLWDWHD

fundului de sac Douglas (pelviperitonite, hemoperitoneu,

WXPRDUH RYDULDQ VDXL VDUFLQ HFWRSLF FRPSOLFDWH vQ
HYROXLH LQIRUPDLLOHRIHULWHGH('5LFRURERUDWHGH(DV,

SRW VWDELOL VLPSOLILFD GLDJQRVWLFXO GLIHUHQLDO L SRW HYDOXD
mai corect stadiul evolutiv al bolii.

x TR efectuat de oncologul care conduce
hormonoterapia GLQ FDQFHUXO GH SURVWDW  VDXL
FKLPLRWHUDSLD VLVWHPLF GLQ WXPRULOH YH]LFDOH LQILOWUDWLYH 


 
XII. CAIETUL STAGIULUI DE UROLOGIE II. EXAMENUL CLINIC AL APARATULUI UROGENITAL

Caietul stagiului de urologie SRDWHILXWLOvQPRQLWRUL]DUHDHYROXLHLEROLL VWDGLXOORFDOL]DW


sau local avansat);
1XPHVLSUHQXPH)2
Vrsta DQL 6H[ x TR efectuat de gastroenterolog DMXW OD GLIHUHQLHUHD
0RWLYHOHLQWHUQULL +'6 KHPRUDJLH GLJHVWLY VXSHULRDU PHOHQ  GH +',

KHPRUDJLH GLJHVWLYH LQIHULRDU UHFWRUDJLH  L SRDWH

$+& OPXUL GDF FDX]D DQR-UHFWDO H[SOLF VkQJHUDUHD


UHFWRFROLWDKHPRUDJLFSROLSR]FROR-UHFWDOGLYHUWLFXOLW

$3) WXPRU DQR-UHFWDO  XQHRUL FRODERUDUHD FKLUXUJXOXL FX


JDVWURHQWHURORJXOILLQGEHQHILF
$33
 x 75 HIHFWXDW GH FKLUXUJXO GH FKLUXUJLH LQIDQWLO este
DEVROXW REOLJDWRULX DWXQFL FkQG QH DIOP vQ IDD XQXL
&RQGLLLGHYLDLPXQF
VLQGURP RFOX]LY vQ RFOX]LD LQWHVWLQDO FX PHFDQLVP GH
invaginare);
&RPSRUWDPHQWH IXPDWDOFRROHWF 
x TR efectuat de medicul de familie (nu n mod sistematic)

SRDWH DMXWD OD GLIHUHQLHUHD XQHL DIHFLXQLL XURORJLFH 5&8


MedicatLHGHIRQG FX JORE YH]LFDO  GH XQD JLQHFRORJLF XWHU ILEURPDWRV

WXPRDUH RYDULDQ  7XHXO UHFWDO HIHFWXDW GH PHGLFXO GH


,VWRULFXOEROLL familie a ajutat in descoperirea a 17% din cazurile de

 QHRSODVP GH SURVWDW vQ )UDQD vQ  QWRWGHDXQD TR


 VHIDFHFXDFRUGXOSDFLHQWXOXLLFXEOkQGHH XQHRULLVXE

anestezie loco-UHJLRQDO  FXWkQG V QX DJUDYP VDX V


Analize efectuate:
6DQJH DPSOLILFPVXIHULQDFOLQLF
Contraindicatiile TR sunt:

8ULQD x 5HIX]XOH[DPHQXOXL GHFWUHEROQDY 
 x $EVHQD UHFWXOXL L D FDQDOXOXL DQDO DPSXWDLH DEGRPHQ-

8URFXOWXUD SHULQHDOGHUHFW 
(FKRJUDILH x 6XSXUDLL DQR-SHULQHDOH vQ ID]D DFXW  ILVXUL DQDOH

DVVRFLDWH FX VSDVP VILQFWHULDQ KHPRURL]L FRPSOLFDL


WURPERIOHELWKHPRURLGDO VWHQR]DUHDRULILFLXOXLDQDOVDX


 
II. EXAMENUL CLINIC AL APARATULUI UROGENITAL XII. CAIETUL STAGIULUI DE UROLOGIE

VFOHUR]DUHD FDQDOXOXL DQDO SRVWLQIHFLRDV VDX SRVW 5HQDODVLPSO


UDGLF  OH]LXQL WUDXPDWLFH DQR-perineale (perversiuni 8URJUDILH

VH[XDOHFRUSLVWULQLHQGRUHFWDOLQWURGXLvQVFRSHURWLF 
Tehnica de examinare: &7501

x 'XS HYDFXDUHD YH]LFL XULQDUH VRQG HYDFXDWRULH  i a
7UDWDPHQWPHGLFDPHQWRV
DPSXOHL UHFWDOH FOLVP HYDFXDWRULH  VH SRDWH HIHFWXD
EROQDYXOXLvQVHGDLHLVHSDUFXUJXUPWRDUHOHHWDSH


3R]LLDEROQDYXOXL 7UDWDPHQWXURORJLF
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
3DUWLFXODULWLDOHFD]XOXL
endorectal +/- PBP).
x 3R]LLD JLQHFRORJLF PDQHYUD SRDWH IL H[HFXWDW L GH 

DOLVSHFLDOLti la finele examenului ginecologic);

x 3R]LLD JHQX-SHFWRUDO JHQX-FXELWDO cu pacient &RFOX]LLFRPHQWDULL

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
x /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
tabelul II.1)

!
  
XII. CAIETUL STAGIULUI DE UROLOGIE II. EXAMENUL CLINIC AL APARATULUI UROGENITAL

7$%(/,,3URWRFROXOWXHXOXLUHFWDO
Caietul stagiului de urologie
$186,5(&7
1 Tonus normal diminuat Crescut
1XPHVLSUHQXPH)2 sfincterian
Vrsta DQL 6H[ 2 ,QGXUDLH Da Nu
0RWLYHOHLQWHUQULL 3 Noduli Da Nu
4 )RUPDLXQH Da Nu
7XPRUDO
5 Polipi Da Nu
AHC:  6 Carcinom Da Nu
inelar

7 )LVXU Da Nu
DQDO
$3) 8 Abces anal Da Nu
9 Fistule Da Nu
anale
$33 10 6FOHUR] Da Nu
 DQDO
11 Hemoroizi Da Nu
&RQGLLLGHYLDLPXQF SUH]HQL
35267$7
12 6XSUDID 1HWHG 1HUHJXODW

&RPSRUWDPHQWH IXPDWDOFRROHWF  13 Simetrie 6LPHWULF $VLPHWULF


14 DQ Accentuat ters Nedecelabil
median
MedicatLHGHIRQG 15 Contur Neted Rugos

16 Margini Bine terse


delimitat
,VWRULFXOEROLL 17 0ULPHD 1RUPDO 0ULW 0LFRUDW
prostatei
18 &RQVLVWHQD (ODVWLF 'XU Moale 3VWRDV )OXFWXHQW

 19 Mobilitatea 0RELO $GHUHQW
mucoasei
ID GH
Analize efectuate: SURVWDW
6DQJH
20 Sensibilitate la GXUHURDV 1HGXUHURDV
 durere
8ULQD 21 1RGXOLSUH]HQL Da Nu
22 Localizarea Lob drept Lob stng
 nodulilor
23 3UH]HQD ]RQHORU Da Nu
8URFXOWXUD indurate
dureroase
(FKRJUDILH 24 0XFRDVDUHFWDO 0RELO )L[
25 Sensibilitatea Da NU
GXUHURDV D
HVXWXULORU
invecinate
 
! 
II. EXAMENUL CLINIC AL APARATULUI UROGENITAL XII. CAIETUL STAGIULUI DE UROLOGIE

5HQDODVLPSO
(WDSHOH VXFFHVLYH DOH H[DPHQXOXL GXS SURWHMDUHD 8URJUDILH

GHJHWXOXL H[DPLQDWRUXOXL FX PQX L OXEULILHUHD VD FX YDVHOLQ
presupun: &7501

- vQGHSUWDWHD SOLXULORU DQDOH, evaluare tonusului
7UDWDPHQWPHGLFDPHQWRV
VILQFWHUXOXLDQDO 6HPQXOFODSHWHLGHSLDQ 
- H[SORUDUHD FRQLQXWXOXL HQGRUHFWDO L HYLGHQLHUHD 

traiectelor fistuloase, a hemoroizilor, sau a tumorilor rectale, 7UDWDPHQWXURORJLF
DPSXODUHVDXLDFRUSLORUVWULQLUHFWDOL 

- H[SORUDUHDVXFFHVLYa uretrei posterioare FDUHQHFHVLW 
un reper uretral VRQG VDX GLODWDWRU PHWDOLF  D SURVWDWHL
3DUWLFXODULWLDOHFD]XOXL
FRQIRUPDLHVLPHWULHVHQVLELOLWDWHRPRJHQLWDWH IRORVLQGPLFUL

EOkQGH ORQJLWXGLQDOH L WUDQVYHUVDOH GLPHQVLXQL DSUR[LPDWLYH 
H[LVWHQDVDXWHUJHUHDDQXOXLPHGLDQ  

- a vezicii urinare (cu eventual semn al KHPDWXULHL &RFOX]LLFRPHQWDULL
SURYRFDWH GHVFULVH GH 3URI 'U 2 )UDQNH  L D IXQGXOXL GH VDF

Douglas
- a lumenului rectal WXPRUL VWHQR]DQWH SROLSR] 

UHFWRFROLFUHFWRFROLWXOFHUR-KHPRUDJLFIOHJPRQGHIRVLschio-

UHFWDOILVWXOL]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
YH]LFXOLQFDSGHWDXU - coarnele fiind veziculele seminale).



 
XII. CAIETUL STAGIULUI DE UROLOGIE ,,,(;3/25$5($,0$*,67,&1852/2*,(

Caietul stagiului de urologie ,,,(;3/25$5($,0$*,67,&1852/2*,(


Tehnici de explorare
Nume si SUHQXPH)2
1. ECOGRAFIA
Vrsta DQL 6H[
0RWLYHOHLQWHUQULL 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
$3)
QHFHVLW R LQYHVWLLH LQLLDO GDU DSRL HVWH QHFRVWLVLWRDUH VH SRDWH
$33 practicDvQFRQGLLLGHFOLQLFDPEXODWRULXVDXFDELQHWGHPHGLFLQ

GH IDPLOLH  PDWHULDOHOH FRQVXPDELOH VXQW SXLQH L LHIWLQH SRDWH IL
&RQGLLLGHYLDLPXQF HIHFWXDW L IU SUHJWLUH OD SDFLHQL vQ FROLF FKLDU L OD IHPHL

gravide, putnd fi utilizatFXVXFFHVvQFRQWURDOHOH SDFLHQLORU


&RPSRUWDPHQWH IXPDWDOFRROHWF  3ULQGHILQLLHHFRJUDILDHVWH

- RPHWRGvQWLPSUHDORIHULQGLPDJLQLGLQDPLFHGDUHVWH

MedicatLHGHIRQG RPHWRGVXELHFWLYLGHSHQGHQWGHH[DPLQDWRU
(FKRJUDILDDUHLRVHULHGHOLPLWHFDUHWUHEXLHFXQRVFXWH

,VWRULFXOEROLL 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
Analize efectuate:
LQGLFDWFDVFUHHQLQJvQDQDOL]DSDWRORJLHL]RQDOH
6DQJH
Ecografele pot fi dotate cu diverse tipuri de transductore.
 Q SUDFWLFD XURORJLF FHO PDL DGHVHD VXQW QHFHVDUH  WLSXUL GH
8ULQD
 transductori: transductor convex de 2,5 - 3,4-5 MHz care este util
vQLQYHVWLJDUHDRUJDQHORUDEGRPLQDOH ULQLFKLYH]LFSURVWDWFkQG
8URFXOWXUD
(FKRJUDILH VHIRORVHWHFDOHDWUDQVDEGRPLQDOHWF WUDQVGXFWRUOLQLDUGH
MHz util pentru organe aflate imediat sub piele (testicule, uretra,

HWF LVRQGHHQGRUHFWDOHFHSHUPLWUHDOL]DUHDXQRUSXQFLL-biopsii.


 
,,,(;3/25$5($,0$*,67,&1852/2*,( XII. CAIETUL STAGIULUI DE UROLOGIE

3H OkQJ H[SORUDUHD XOWUDVRQRJUDILF FODVLF FDUH RIHU 5HQDODVLPSO


date limiWDWHvQDQXPLWHSDWRORJLLFkQGPHGLFXOWUHEXLHVDSHOH]H 8URJUDILH

la computer-tomografie sau RMN pentru un diagnostic ct mai
H[DFWRLQYHVWLJDLHUHFHQWDSDUXWHUHSUH]HQWDWGHHFRJUDILDFX &7501

VXEVWDQ GH FRQWUDVW $FHDVWD XWLOL]HD] PLFURVIHUH GH
7UDWDPHQWPHGLFDPHQWRV
perfluorocarbRQ VDX D]RW FH VH DGPLQLVWUHD] LQWUDYHQRV vQ
FLUFXODLD VLVWHPLF Q SUDFWLFD XURORJLF DFHDVWD LQYHVWLJDLH H 

IRORVLW SHQWUX GLDJQRVWLFDUHD WXPRULORU UHQDOH FKLWLORU UHQDOL 7UDWDPHQWXURORJLF
FRPSOLFDLDQJLRPLROLSRDPHORUVDXa infarctelor/ischemiei renale. 

a. (FRJUDILDUHQDO este indicat n : 
- LQIHFLLDOHWUDFWXOXLXULQDU
3DUWLFXODULWLDOHFD]XOXL
- hematurie

- REVWUXFLL 
- mase tumorale 

- calculi &RFOX]LLFRPHQWDULL
- 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
GLIHUHQGHOXQJLPHvQWUHFHLGRLULQLFKLGHPD[LPFP
n decursul procedurii parenchimul renal ne apare
hipoecogen FRPSDUDWLYFXVLQXVXOUHQDOLDUJURVLPHDOXLLQGLFHOH

$
 $
XII. CAIETUL STAGIULUI DE UROLOGIE ,,,(;3/25$5($,0$*,67,&1852/2*,(

Caietul stagiului de urologie SDUHQFKLPDWRVWUHEXLHVILHPLQLPPPPHGLRUHQDO-25 mm


la poli.
1XPHVLSUHQXPH)2
Vrsta DQL 6H[ (FRJUDILD SRDWH GHSLVWD IRUPDLXQL vQORFXLWRDUH GH VSDLX
0RWLYHOHLQWHUQULL FX VWUXFWXU OLFKLGLDQ WUDQVVRQLF  VROLG KLSHU VDX

KLSRHFRJHQ LPL[WFXVDXIUFDOFLILFUL

$+& 7XPRULOH UHQDOH SRW IL EHQLJQH VDX PDOLJQH L SRW IL
GHSLVWDWH HFRJUDILF vQ SURSRULH GH -  FKLDU L DWXQFL FkQG

$3) sunt de numai 1-2 cm.


Diagnosticul ecografic al litiazei se poate face atunci cnd
$33
 calculii au peste 3-PPLDSDUFDLPDJLQLLQWHQVHFRJHQHFXFRQ
GHXPEUSRVWHULRULQGLIHUHQWGHQDWXUDORUELRFKLPLF
&RQGLLLGHYLDLPXQF
+LGURQHIUR]D +1   vPEUDF HFRJUDILF XQ DVSHFW  DSDUWH

FX GLODWDLL FDOLFHDOH FRQIOXHQWH  vQWU-R ]RQ FHQWUDO - calicele


&RPSRUWDPHQWH IXPDWDOFRROHWF  GLODWDWH FRQIOXHD] vQ ED]LQHWXO GLODWDW 'DF VH DVRFLD] L

dilatarea ureterului SRDUWQXPHOHGH ureterohidronefroza (UHN.)


MedicatLHGHIRQG b. Ecografia vezicii urinare (VU)

(FRJUDILD HVWH PHWRGD GH SULP LQWHQLH vQ H[DPLQDUHD


,VWRULFXOEROLL VU. Abordul poate fi suprapubian, endocavitar (ecografie

 WUDQVXUHWUDO HQGRYH]LFDO  WUDQVUHFWDO VDX WUDQVYDJLQDO (VWH


 HVHQLDOVHIHFWXPHFKRJUDILDFkQGYH]LFDHVWHSOLQSHQWUXDQH

Analize efectuate: IHULGHLQWHUSUHWULHURQDWH(FRJUDILDSHUPLWHGHFHODUHD


6DQJH - unor anomalii parietale (tumori vegetative sau infiltrative,

diverticuli intramurali)

8ULQD - D FDOFXOLORU D FRUSLORU VWULQL LQWUDYH]LFDOL IUDJPHQWH GH
 VRQGVRQGGRXEOH-

8URFXOWXUD - a diverticulilor
(FKRJUDILH - PDOIRUPDLLORU MRQFLXQLL XUHWHUR-vezicale (megaureter,

ureterocel)
- reziduului vezical.
$
 
,,,(;3/25$5($,0$*,67,&1852/2*,( XII. CAIETUL STAGIULUI DE UROLOGIE

5HDOL]DW GH XQ HFKRJUDILVW FX H[SHULHQ HFKRJUDILD 5HQDODVLPSO


'RSSOHU D YH]LFLL XULQDUH vQ FROLFD UHQDO SRDWH SXQH vQ HYLGHQ 8URJUDILH

SUH]HQDVDXDEVHQDHOLPLQULLXULQLLSHRULILFLLOHXUHWHUDOH. De
DVHPHQL SUH]HQD WZLQNOLQJ-XOXL FkQG VH XWLOL]HD] HFKRJUDILD &7501

'RSSOHUSRDWHFUHWHVHPQLILFDWLYUDWDGHWHFWULi calculilor ureterali
7UDWDPHQWPHGLFDPHQWRV
pelvini.
c. Ecografia prostatei LDYH]LFXOHORUVHPLQDOH 

3URVWDWD VH HYLGHQLD] HQGRFDYLWDU WUDQVUHFWDO VDX  OD 7UDWDPHQWXURORJLF
baza vezicii urinare n cazul ecografiei transabdominale, 

suprapubiene. 
6HSRWHYLGHQLD
3DUWLFXODULWLDOHFD]XOXL
- hipertrofia de SURVWDW

- DEFHVHOHIRUPDLXQLOHFKLVWLFH 
- OLWLD]DSURVWDWLF 

- patologia veziculelor seminale (agenezie, hipoplazie &RFOX]LLFRPHQWDULL
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
'XSXPSOHUHDQWHURJUDGVDXUHWURJUDGVHYL]XDOL]HD]OXPHQXO
WUDQVVRQLFPUJLQLWGHSHUHLLKLSHUHFRJHQL
e. (FRJUDILDWHVWLFXODU

$
 
XII. CAIETUL STAGIULUI DE UROLOGIE ,,,(;3/25$5($,0$*,67,&1852/2*,(

Caietul stagiului de urologie (FRJUDILDWHVWLFXODUHVWHXWLOL]DWSHQWUXH[DPLQarea:


- hidrocelului,
Nume si SUHQXPH)2
Vrsta DQL 6H[ - tumorilor testiculare
0RWLYHOHLQWHUQULL - FKLWLHSLGLGLPDUL

- VXSXUDLLWHVWLFXODUHKHPDWRFHOLDDOWRUOH]LXQL

$+& - examinarea testiculului ectopic.


n mod normal testiculul este ovoid, de aproximativ 3,5 cm lungime

$3) LFPOLPHFXRHFRJHQLWDte medie. Mediastinul apare ca o linie


HFRJHQ SDUDOHO FX HSLGLGLPXO &DSXO HSLGLGLPXOXL HVWH VLWXDW
$33
 ODWHUDO GH SROXO VXSHULRU DO WHVWLFXOXOXL L DUH XQ GLDPHWUX GH -15
mm.
&RQGLLLGHYLDLPXQF
2. RADIOGRAFIA RENALA SIMPLA (RRS) sau radiografia

DEGRPLQDO VWDQGDUG poate aduce LQIRUPDLL DVXSUD SDWRORJLHL


&RPSRUWDPHQWH IXPDWDOFRROHWF  reno-uretero-YH]LFDOHIUDXWLOL]DVXEVWDQHGHFRQWUDVW &DHWDS

REOLJDWRULHvQWHKQLFDXURJUDILFSHRUHQDOVLPSOVHXUPUHWH
MedicatLHGHIRQG SUHJWLUHD LQWHVWLQXOXL SR]LLRQDUHD SDFLHQWXOXL L D FDVHWHL

DOHJHUHDFRUHFWDHOHPHQWHORUGHH[SXQHUHLGHYHORSDUH
,VWRULFXOEROLL 3RDWHHYLGHQLDSUH]HQDGH

- RSDFLWL VXJHVWLYH SHQWUX LPDJLQL GH FDOFXOL GDF VXQW



 SURLHFWDWH SH DULD VLVWHPXOXL SLHORFDOLFHDO XUHWHU YH]LF 
,QWHUSUHWDUHDFRUHFWVHIDFHFRURERUkQGGDWHOHGHOD556FXFHOH
Analize efectuate:
6DQJH de la UIV.
- PRGLILFUL LVDX OH]LXQL RVWHRDUWLFXODUH la nivelul scheletului

8ULQD investigat
 - metastaze osoase ODED]LQVDXFRORDQ

x 556 VH HIHFWXHD] FX SDFLHQWXO vQ GHFXELW SH


8URFXOWXUD
(FKRJUDILH 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*,( XII. CAIETUL STAGIULUI DE UROLOGIE

RSDFLWLOH UHQDOH RDVHOH LOLDFH L PDUJLQHD VXSHULRDU D VLPIL]HL 5HQDODVLPSO


pubiene. 8URJUDILH

x &D HWDS REOLJDWRULH vQ WHKQLFD XURJUDILF SH R
UHQDO VLPSO VH XUPUHWH SUHJWLUHD LQWHVWLQXOXL SR]LLRQDUHD &7501

SDFLHQWXOXL L D FDVHWHL DOHJHUHD FRUHFW D HOHPHQWHORU GH
Tratament medicamentos: 
H[SXQHUHLGHYHORSDUHSRDWHHYLGHQLDSUH]HQDGHJD]ODQLYHOXO
WXEXOXLGLJHVWLY HVWHELQHVDDPkQPvQDFHVWHFRQGLLLLQMHFWDUHD


VXEVWDQHLGHFRQWUDVWLVDSUHJWLPPDLELQHSDFLHQWXOvQDOWD]L 7UDWDPHQWXURORJLF
3. UROGRAFIA INTRAVENOASA (UIV) 
3UHVXSXQHHIHFWXDUHDUDGLRJUDILHi renale simple + UIV +


FLVWRJUDILD  FLVWRXUHWURJUDILD PLFLRQDO L FLVWRJUDILD
SRVWPLFLRQDO UH]LGXXO  3DUWLFXODULWLDOHFD]XOXL

x SUHJWLUHDSDFLHQWXOXL 
a. PHGLFDPHQWRDV antialergice, antihistaminice, 

sedative, cortizon; &RFOX]LLFRPHQWDULL
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
PRGHUDWH JUHXULFOGXUURHDORFDOODORFXOLQMHFLHLXUWLFDULH 

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

$
 
XII. CAIETUL STAGIULUI DE UROLOGIE ,,,(;3/25$5($,0$*,67,&1852/2*,(

Caietul stagiului de urologie x la 20 min film morfologic SLHORFDOLFHDO  L


XUHWHUDO FDOLFHOH L ED]LQHWXO VXQW YL]LELOH SOLQH GH
1XPHVLSUHQXPH)2
Vrsta DQL 6H[ XULQ DPHVWHFDW FX VXEVWDQ GH FRQWUDVW QFHS V
0RWLYHOHLQWHUQULL VH YDG L SRULXQL GLQ XUHWHU vQ FRUHODLH FX

SHULVWDOWLFDXUHWHUDO

$+& x Cistografia UHSOHLHPLFLRQDOSRVWPLFLRQDO

Manevre din timpul examenului:

$3) Se poate face si UIV n decubit ventral pungile stagnante se


RSDFLILD]PDLELQHLDUGDFLPDJLQLOHQXVXQWFODUHVHSRDWHIDFH
$33
 R FRPSUHVLXQH H[HUFLWDW OD QLYHOXO VWUkPWRULL VXSHULRDUH D
pelvisului. Aceasta manevr HVWH FRQWUDLQGLFDW OD SHUVRDQH vQ
&RQGLLLGHYLDLPXQF
YkUVW DIHFLXQL REVWUXFWLYH UHQR-ureterale sau vezicale,
traumatisme ale aparatului urinar &kWHRGDWD SRDWH IL QHFHVDU
Comportamente ( IXPDWDOFRROHWF 
UHLQMHFWDUHD vQ FXUVXO DFHOXLDL H[DPHQ D XQHL QRL GR]H GH

VXEVWDQGHFRQWUDVWSHQWUXDPHOLRUDUHDFDOLWii imaginii.
MedicatLHGHIRQG x &OLHHWDUGLYH la 1h, 2h sau mai mult (daca la 24 h

ULQLFKLXO QX HOLPLQ ULQLFKL PXW XURJUDILF  VH IDF vQ IXQFLH GH
,VWRULFXOEROLL JUDGXO GLVWHQVLHL vQ VFRSXO SUHFL]ULL VHGLXOXL REVWUXFLHL XQHRUL vQ

 procubit.
 Urografia n perfuzie VH XWLOL]HD] OD SDFLHQLL FX XUHPLH

PRGHUDWLQMHFWkQGX-VHPO.JFRUSGHVXEVWDQUDGLRRSDF
Analize efectuate:
6DQJH GLOXDL vQ GH[WUR]  $GPLQLVWUDUHD GH GLXUHWLF )XURVHPLG 
GXSILOPXOGHODPLQVHLQMHFWHD]LYILROHGH)XURVHPLG

8ULQD L VH IDF FOLHH GLQ  vQ  PLQ WLPS GH  PLQ (VWH LQGLFDW vQ
 GLDJQRVWLFXO IXQFLRQDO DO KLGURQHIUR]HL FRQJHQLWDOH Urografia

8URFXOWXUD PLQXWDW test Ravasini XWLOL]DW vQ VWXGLXO WHQVLXQLL


(FKRJUDILH UHQRYDVFXODUH FRQVW vQ HIHFWXDUHD GH ILOPH GLQ PLQXW vQ PLQXW

vQFHSkQGGHODVIkULWXODGPLQLVWUULL VXEVWDQHLGHFRQWUDVW 6'& 

4. INVESTIGATIILE RADIOLOGICE RETROGRADE ALE

$

 
,,,(;3/25$5($,0$*,67,&1852/2*,( XII. CAIETUL STAGIULUI DE UROLOGIE

APARATULUI URINAR
5HQDODVLPSO
$WXQFL FkQG H[DPHQXO 8,9 QX UHXHWH V IXUQL]H]H GDWH Urografie: 
VXILFLHQWH GLDJQRVWLFXOXL L VXQW HIHFWXDWH GH XURORJ vPSUHXQ FX

medicul radiolog: uretroJUDILD UHWURJUDG XUHWHURSLHORJrafia, &7501
SLHORJUDILDDQWHURJUDG 
7UDWDPHQWPHGLFDPHQWRV
a. 8UHWURJUDILDUHWURJUDG
 HVWH XWLOL]DW vQ GLDJQRVWLFDUHD REVWDFROHORU XUHWUDOH vQ 

FRPSOHWDUHD XQHL XURJUDILL FUHLD vL OLSVHWH WLPSXO PLFLRQDO
7UDWDPHQWXURORJLF
WUHEXLHHIHFWXDWOHQWSHQWUXDQXVHproduce extravazat spongio- 
cavernos n timpul manevrei; 

x Dac DQWHULRU HVWH PRQWDW R FLVWRVWRPLH VH SRDWH
realiza o uretrografie bipolar (antero- L UHWURJUDG), injectnd 3DUWLFXODULWLDOHFD]XOXL

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
&RFOX]LLFRPHQWDULL
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
XUHWHUDO L VH DVFHQVLRQHD] XQ FDWHWHU XUHWHUDO VWDQGDUG SkQ OD
QLYHOXO MRQFLXQLL SLHORXUHWHUDOH XQGH VH YD LQMHFWD VXEVWDQD GH
FRQWUDVWUH]XOWkQGSLHORJUDILDUHWURJUDG

$!
  
XII. CAIETUL STAGIULUI DE UROLOGIE ,,,(;3/25$5($,0$*,67,&1852/2*,(

Caietul stagiului de urologie x VXEIOXRURVFRSLHLPDJLQHD835HVWHGLQDPLFSRDWHIL


DPSOLILFDW SUHOXFUDW vQUHJLVWUDW GLQDPLF VDX VWDWLF FRQWULEXLQG
1XPHVLSUHQXPH)2
Vrsta DQL 6H[ decisiv la stablirea diagnosticului;
0RWLYHOHLQWHUQULL 835 HVWH IRORVLW SHQWUX GLDJQRVWLF vQ OLWLD]D UHQR-

WUDQVSDUHQW VWHQR]H XUHWHUDOH GH GLIHULWH HWLRORJLL WXPRUL

$+& uroteliale uretero-pielo-caliceale; rinichi mut urografic


QHIXQFLRQalWURPER]GHDUWHUUHQDO

$3) 5. 5$',2*5$),$ 38/021$5 vQ XURORJLH HVWH QHFHVDU vQ


evaluarea preoperatorie a pacientului (leziuni pleuro-
$33
 SXOPRQDUH HWF  L vQ HYDOXDUHD SRVWRSHUDWRULH GXS
nefrectomie, etc.).
&RQGLLLGHYLDLPXQF 6. 7202*5$),$&20387(5,=$7

x 0HWRGD FRQVW vQ SRVLELOLWDWHD GH D GLIHUHQLD SULQ


&RPSRUWDPHQWH IXPDWDOFRROHWF  VHFLXQL D[LDOH GH JURVLPH UHJODELO HVXWXUL FX GHQVLWL GLIHULWH

situate n contact unele cu altele.


MedicatLHGHIRQG x $X IRVW FRGLILFDWH vQ  GH QXDQH GH JUL FkWH XQD

SHQWUX ILHFDUH XQLWDWH FRQYHQLRQDO GH GHQVLWDWH vQWUH 1000 UH

,VWRULFXOEROLL 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
Analize efectuate:
6DQJH JUVLPHDSHULUHQDOvQWUH-L-60 UH.
x 3ULQLQWHUPHGLXO&7VHHOXFLGHD]ULQLFKLXOQHIXQFLRQDO

8ULQD OD 8,9 VH FHUFHWHD] SDFLHQWXO XUHPLF FDQFHUXO UHQDO WHVWLFXOXO
 ectopic, pacientul politraumatizat sau traumatismul renal solitar.

&7IUVXEVWDQGH contrast: leziuni calcificate renale,


8URFXOWXUD
(FKRJUDILH 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*,( XII. CAIETUL STAGIULUI DE UROLOGIE

IXQFLRQDOH DOWXUL GH FHOH PRUIRORJLFH $YDQWDMXO PDUH HVWH F VH 5HQDODVLPSO
poate face prin CT o stadializare corect TNM n cazul tumorilor 8URJUDILH

retroperitoneale (extinderea tumorii? ganglioni invadati? metastaze
la distanta?)$VWD]L VH UHDOL]HD] manevre minim invazive sub &7501

FRQWURO WRPRJUDILF SXQFLD FKLVWXULORU UHQDOH SDQFUHDWLFH SXQFLH
7UDWDPHQWPHGLFDPHQWRV
biRSVLHJDQJOLRQDUVDXWXPRUDO
7. 5(=21$1$0$*1(7,&18&/($5 

/DED]DDFHVWHLLQYHVWLJDLLVWDXSURSULHWLOHQXFOHLORUGH
7UDWDPHQWXURORJLF
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 3DUWLFXODULWLDOHFD]XOXL

VWUL IL]LFH FKLPLFHPRGLILFUL FHOXODUH VDX vQFUFWXU OLFKLGLDQ 
FDUDFWHULVWLFLOH HVXWXOXL Q XURORJLH DSOLFDLLOH FOLQLFH VH UHIHU OD 

PDOIRUPDLL FRQJHQLWDOH SDWRORJLH YDVFXODU VWDGLHUHD
&RFOX]LLFRPHQWDULL
neoplasmului FkQG HYDOXDUHD &7 QX HVWH FRQFOXGHQW 6LQJXUD
VXEVWDQ GH FRQWUDVW XWLOL]DW HVWH DFLG *G-DTPA (gandolinium

dietilen triamono-penacetil). 

Dezavantajele
Avantajele RMN RMN &RQWUDLQGLFDLLOH501

Imagine n orice 9LWH]PLFGH 3DFLHQLFXDQHYULVP
plan (transvers,
sagital, coronal) GHVIXUDUH intracranian
Claritatea imaginii
Cmp larg de este, uneori, Clipurile metalice puse
vedere LQIHULRDUFHOHL intraoperator

RELQXWHSULQ&7

Contrast tisular Fragmente metalice

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

 
XII. CAIETUL STAGIULUI DE UROLOGIE ,,,(;3/25$5($,0$*,67,&1852/2*,(

Caietul stagiului de urologie ,QGHSHQGHQ Sarcina este o


IDGHRSHUDWRU FRQWUDLQGLFDLHUHODWLY
1XPHVLSUHQXPH)2
Vrsta DQL 6H[ 8. ,19(67,*$,,/($1*,2*5$),&(1852/2*,(
0RWLYHOHLQWHUQULL
n scop diagnostic: HTA reno-YDVFXODU PDV UHQDO
GLDJQRVWLFGLIHUHQLDOvQWUHQHRSODVPLWXPRUEHQLJQULQLFKLPXW
$+&
XURJUDILF KHPDWXULH GH HWLRORJLH QHSUHFL]DW GRQDWRU SHQWUX

WUDQVSODQWUHQDOULQLFKLJUHIDWQHIXQFLRQDO
$3) n scop LQWHUYHQLRQDO angioplastii endoluminale de

$33 DUWHU UHQDO HPEROL]DUH VHOHFWLY vQ VFRS KHPRVWDWLF D UDPXULL


 DUWHULDOH vQ KHPDWXULL VSROLDQWH WXPRUDOH WHUDSLD FLWRVWDWLF

&RQGLLLGHYLDLPXQF LQWUDDUWHULDO
SHVWXGLD]WUHLID]HGLVWLQFWH

, )D]D DUWHULDO SXQH vQ HYLGHQ trunchiul arterial,


&RPSRUWDPHQWH IXPDWDOFRROHWF 
marile ramuri arteriale, apoi a arteriolelor mici interlobare. n caz de
blocaj arterial cirFXODLHFRODWHUDOH[WUDUHQDO
MedicatLHGHIRQG
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8ULQD x LQLLDO GRX WLSXUL GH H[DPLQDUH PRUIRORJLF VWDWLF 

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Echografie: 
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x SHQWUXFXUEDUHQRJUDILFVHGLVFXWVHJPHQWH
1. primul segment este cel vascular, care &7501

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radioactiv; 

3. al treilea segment este cel excretor FX R SDQW 
GHVFHQGHQW FDUH FRUHVSXQGH LHLULL WUDVRUXOXL SULQ VLVWHPXO
3DUWLFXODULWLDOHFD]XOXL
colectoUvQXUHWHULYH]LF

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pielocaliceal
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,VWRULFXOEROLL




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8ULQD


8URFXOWXUD
(FKRJUDILH


 
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5HQDODVLPSO
8URJUDILH


&7501

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Tratament urologic: 




3DUWLFXODULWLDOHFD]XOXL



Fig.III.4 - RRS, calcul coraliform stng, calcul vezical gigant 
&RFOX]LLFRPHQWDULL














Fig.III.5 - RRS, calcul coraliform stng, tip A


 
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0HGLFDLHGHIRQG

,VWRULFXOEROLL




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SanJH


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5HQDODVLPSO: ..
Urografie: ...


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Tratament medicamentos: 

.

Tratament urologic: 




Particulariti ale cazului 

Fig. III 8 Ecografie calcul ureteral cu UHN suprajDFHQW 


Cocluzii/comentarii: 



















 
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0HGLFDie dHIRQG

Istoricul bolii: 




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6DQJH


8ULQD..


Urocultura:
Echografie: 

Fig.III. 9,10 - RRS+UIV, calcul n ureterocel drept, IUUVXQHW


suprajacent nalt



 
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stang..
..
&7501......


Tratament medicamentos:



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tumorii vezicaOH 


3DUWLFXODULWi ale cazului:.. WUDWDPHQWLQFRUHFWDSOLFDWGHFtre medicul
de familie, FDUH QX D HYDOXDW FRUHFW VL QLFL QX D vQGUXPDW FWUH
VSHFLDOLVW R SDFLHQW FX IDFWRUL IDYRUL]DQL SHQWUX DSDULLD XQHL
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$PORGLSLQ 5 mg , 1 cp/zi
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de familie a urmat tratament cu ciprofloxacin si vitamin K, se
interneaza pentru reaparitia hematuriei
Analize efectuate:
SQJHGA-6200/mmc; Hb-11,4 g/dl; Ht- 26%; glicemie 156 mg/dl;
uree 36 mg/dl; creatinina 0,92 mg/dl
8ULQpH-6; Leucocite +, Eritrocite ++++, Nitriti-neg;Sediment:
rare leucocite; rare epitelii plate; foarte frecvente
KHPDWLL.......
8URFXOWXUDQHJDWLY
(FKRJUDILHRD- normal echografic;
RS- UHN gr.I, transonicitate normala; VU- formatiune
echogena de aprox. 3 cm pe peretele lateral
stang Fig.III.14 - Ecografie, rinichi polichistic
5HQDODVLPSOfara OIC pe ariile reno-urotero-vezicale
Fig.III.15 &7D[LDOFXVXEVWDQ de contrast, hidronefroz SULQOLWLD] ED]LQHWDO
8URJUDILHHOLPLQDUH SUH]HQW ELODWHUDO 5'-sistem pielocaliceal fara
distensie, ureter suplu, RS- HOLPLQDUH WDUGLY FX DVSHFW GH 8+1 JU,
 
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XUHWUDOLGHHYROXLDSRVWRSHUDWRULHGXS-]LOHGHODLQWHUYHQLH
se va HIHFWXD R FLVWRJUDILH UHWURJUDG 'DF QX H[LVW H[WUDYD]DUH D
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sfincterian.
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Fig.III.16 &7WXPRU UHQDO
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FRQGLLLOHXQHLLQWHUYHQLLHILFLHQWHGLQSXQFWGHYHGHUHRQFRORJLF36$-
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prostatectomia radical


 
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GHVXWXU
Se impune suprimarea sondei ureterale JJ la aproximativ 6
VSWPkQLSRVWWUDQVSODQWGHDVHPHQHDvQ FRQGLLLVWULFWHGHVWHULOLWDWH
ODVDODGHRSHUDLL
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Antibioticoterapia este obligatorie timp de 10 zile postoperator, ideal
fiind ca bolnavul (la externare) VDLERXURFXOWXUQHJDWLY
X. INGRIJIREA PACIENTILOR CU PROSTATECTOMIE
RADICALA Fig.III.17 - 83*UHWURJUDGWXPRU GHXURWHOLXvQDOW SLHORFDOLFHDO

Imediat GXS vQFKHLHUHD LQWHUYHQLHL FKLUXUJLFDOH SDFLHQWXO


HVWH GHWXEDW L WUDQVIHUDW vQ 6HFLD GH 7HUDSLH ,QWHQVLY XQGH HVWH
VXSUDYHJKHDW DWHQW SHQWUX PHQLQHUHD VWDELOLWLL IXQFLLORU YLWDOH
DVLJXUDUHD DQDOJH]LHL PRQLWRUL]DUHD GLXUH]HL RUDUH L D GUHQDMXlui pe
tuburile plasate lateral de anastomoza vezico-XUHWUDO 'UHQDMXO
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ILVWXOHXULQDUHSULQOLSVDGHHWDQHLWDWHDDQDVWRPR]HLYH]LFR-uretrale,
OLPIRUDJLHL GDF V-D SUDFWLFDW L OLPIDGHQHFWRPLH SHOYLQ VDX
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LQWHQV SRDWH LPSXQH ODYDM YH]LFDO SH VRQGD XUHWUDO )ROH\ FX WULSOX
FXUHQW 0XOL SDFLHQL SUH]LQW HGHP SHQR-scrotal, ce se remite Fig.III.18 - &7WXPRU XURWHOLDO vQDOW
spontan n cteva zile.


 
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nefrectomia sau pieloplastia. n rest, suprimarea sondei uretro-
vezicale n primele 24 ore (exceptnd interveniile la nivelul vezicii
XULQDUH  L D WXEXOXL GH GUHQ vQ SULPHOH -3 zile (n cazul n care
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XUPH]SULQFLSLLOHFKLUXUJLHLFODVLFH,QXQHOHFD]XULSRDWHILQHFHVDUD
repetarea investigatiilor de laborator la 24 de ore de la interventie.
IX. SUPRAVEGHEREA POSTOPERATORIE A PACIENTULUI
TRANSPLANTAT
n perioada SRVWRSHUWDWRULH LPHGLDW urmarirea pacientului
include mVXULOH GHUHDQLPDUHVSHFLILFHRULFUHL LQWHUYHLLFKLUXUJLFDOH
Fig.III.19 ,50WXPRU UHQDO stg. GHVFKLVH PDMRUH WUHEXLH IDFXW GH FDWUH medicul anestezist-
reaminator LVHUHIHUODPHQLQHUHDLUHHFKLOLEUDUHDKHPRGLQDPLF,
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monitorizare a diurezei orare.
n primele zile postoperaWRU WUHEXLH PHQLQXWH Psurile
suportive hemodinamice, PRQLWRUL]DUHD GLXUH]HL L FRPSHQVDUHD
poliuriei, pacientul transplantat putQGXQHRULDYHDR GLXUH]FDUHV
GHSDHaVF Oh. Deasemenea este importaQW XUPrirea
drenajului pe tuburile plasate in spaLXO UHWURSHULWRQHDO L
prevezical, pansamentul zilniF vQ FRQGLLL VWULFWH GH VWHULOLWDWH GDWRULW
ULVFXOXL PDMRU GH LQIHFLH DYkQG vQ YHGHUH VWatusul imunologic,
HFKRJUDILL 'RSSOHU SHQWUX DSUHFLHUHD YDVFXODUL]DLHL UHQDOH L D
HYHQWXDOHORUFROHFLL
Fig.III.20 - 8,9SURFHVvQORFXLWRUGHVSDLXpolar superior stg, cu ScurtaUHD L, ulterior, suprimarea tuburilor de dren la 4-5 zile
DPSUHQWLGLODWDLHFDOLFHDOVXSHULRDU
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L IRUPD VWRPHL SHQWUX D SURWHMD WHJXPHQWXO GLQ MXUXO DFHVWHLD L D
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SHULVWRPDO SRDWH UHGXFH DGHUHQD GLVSR]LWLYXOXL FROHFWRU VDX SRDWH
determina dureri la desprinderea foliei, motiv pentru care majoritatea
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Fig.III.21 - (FRJUDILHWXPRU YH]LFDO VWkQJ cu UHN suprajDFHQW
$YvQG vQ YHGHUH IDSWXO F vQ XULQD GUHQDW SULQ XURVWRPLH VH
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DVLPSWRPDWLFLFKLDUGDFSUH]LQWXURFXOWXULSR]LWLYH
$SRUWXODGHFYDWGHOLFKLGHHVWHHVHQLDOSHQWUXDUHGXFHULVFXO
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SDFLHQLLFXXURVWRPLH
VIII. ,17(59(1II LAPAROSCOPICE
In cazul SDFLHLORU OD FDUH XUPHD] LQWHUYHQLL ODSDURVFRSLFH
nainte de DFHVWHDWUHEXLH HYDOXDWFX DWHQie status-ul cardiovascular
SUHFXP i prezena unor anomalii ale oaselor sau a coloanei
vertebrale. Antecedentele de intervenii chirugicale sunt foarte
importante n evaluarea preoperatorie a acestor pacieni. In cazul
SDFLHQilor cu feocromocitom plasarea preoperatorie a unui cateter
Fig.III.22 - 8,9DFHODLFD]LPDJLQHODFXQDU FHRFXS hemivezica
arterial e oblLJDWRULH 3URILOD[LD DQWLELRWLF e recoPDQGDW chiar i n VWkQJULQLFKLVWkQJ DEVHQDHOLPLQULL

cazurile n care pacientul nu are o infecie documentat.


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supravegherii cardiovasculare.
VIII.             - iar sistemul de
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Fig.III.23 6HFYHQ D[LDO &7SRVWFRQWUDVW DFHODLFD] 
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 DVSHFWXO HGHPDWRV LQLLDO YD GLVSDUH vQ XUPWRDUHOH -6 luni, iar n
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schimbarea sistemului colector. nainte de GHFODQDUHD DFHVWHL
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-VSODUHDWHJXPHQWXOXLSHULVWRPDO
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asigura HWDQHLWDWHDDFHVWXLD
Q WLPSXO QRSLL VH SRDWH FRQHFWD R SXQJ FROHFWRDUH OD
sistemul de urostomie pentru a asigura drenajul permanent al
acestuia.
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GHHUYHHOHXPHGHVSHFLDOFRQFHSXWHSHQWUXFXUDUHDWHJXPHQWXOXL

 
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fi foarte utile n acest caz.
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&UHDUHD XQHL XURVWRPLL GHILQLWLYH DUH XQ LPSDFW PDMRU IL]LF L
Fig.III.25 - 8,97%&UHQDOULQLFKLPDVWLFGUHSW8+1VWkQJ HUR]LXQLGLODWDLL
SVLKLFDVXSUDSDFLHQLORUVFKLPEkQGPXOWHDVSHFWHDOHYLHLLFRWLGLHQH XUHWHUFXFDOLEUXLQHJDODEXDUHYH]LFDOvQYkUIGHFUHLRQYH]LFPLF

Consilierea preoperatorie UHDOL]DW GH SHUVRQalul specializat


VWRPD QXUVH  DGXFH EHQHILFLL PDMRUH vQ SODQXO HYROXLHL
SRVWRSHUDWRULL L SH WHUPHQ OXQJ D SDFLHQWXOXL FX XURVWRPLH
LQFRQWLQHQW &RQVLOLHUHD VH SRWH H[WLQGH FX HIHFWH EHQHILFH SHQWUX
SDFLHQWLDVXSUDPHPEULORUDSURSLDLDLIDPLOLHLDFHVtuia.
,QIRUPDLLOH WUHEXLH V LQFOXG HOHPHQWH OHJDWH GH LQWHUYHQLD
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.
Fig.III. 26 - 8,9ULQLFKLvQSRWFRDY+1UDPGUHSW
ngrijirea postoperatorie
,PHGLDW GXS LQWHUYHQLD FKLUXUJLFDO VWRPD WUHEXLH V ILH
$
 
,,,(;3/25$5($,0$*,67,&1852/2*,( XI NGRIJIREA PACIENTULUI UROLOGIC

$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 una-
doua 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


GDWRUDWH FDOFXOXOXL FDOFXOLORU PRQWDUHD XQHL VRQGH -- OD VIkULWXO
XUHWHUDOFRPSOHW 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 


 
XI NGRIJIREA PACIENTULUI UROLOGIC IV. INSTRUMENTARUL N UROLOGIE


6XSULPDUHDILUHORUGHVXWXUD-a zi constituie unul din gesturile IV. INSTRUMENTARUL N UROLOGIE
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
Fig.IV.6 Cateter ureteral standard
VXSULPDUHDQHIURVWRPLHLLDVRQGHLYH]LFDOHXUHWHUDOH


 
IV. INSTRUMENTARUL N UROLOGIE XI NGRIJIREA PACIENTULUI UROLOGIC

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
SRVLELO GXS FH SDFLHQWXO L-a reluat tranzitul intestinal pentru
Fig.IV.9 sonda Foley pentru nefrostomie
materii fecale si gaze.
!
  
XI NGRIJIREA PACIENTULUI UROLOGIC IV. INSTRUMENTARUL N UROLOGIE

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! Fig.IV.13 Rezectoscop
IV. NEFRECTOMIA
DXS LQWHUYHQLD HIHFWXDW VXE DQHVWH]LH JHQHUDO SDFLHQWXO
SUVHWHVDODGHRSHUDLHvQGUHSWkQGX-se spre VHFLDGHUHDQLPDUH,
DYkQGDOWXULGH:
- perfuzia i.v.,
- VRQGD)ROH\VLPSO
Fig.IV.14 Litotritor mecanic
- SXQJ FROHFWRDUH FXSODW OD WXEXO GH GUHQ GLQ UHJLXQHD
 
! 
IV. INSTRUMENTARUL N UROLOGIE XI NGRIJIREA PACIENTULUI UROLOGIC

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 WULSOXFXUHQW WUDFLRQDWj 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,
WHPSHUDWXU FkWLVSHFLILFLDVSHFWXOOLFKLGXOXLGHODYDMPRQLWRUL]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
minimalizat.
Fig.IV.18 ureteroscop flexibil
QGHSUWDUHDWUDFLXQLLjOD6DOYDULV GXSSULPHOH 20 ore


 
XI NGRIJIREA PACIENTULUI UROLOGIC IV. INSTRUMENTARUL N UROLOGIE

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-
YH]LFDO SkQD OD XUHWHURVFRSLD UHWURJUDG VDX ODSDURVFRSLH
voluminoase.
8URORJXO HVWH FXQRVFXW FD RPXO FX VRQGD $FHVWH LQVWUXPHQWH
/D VIkULWXO LQWHUYHQLHL VH LQVWDOHD] R VRQG )ROH\ FX
devenite banale n ziuDGHDVW]LSULQXWLOL]DUHVXEGLIHULWHYDULDQWH
triplu curent, FX EDORQD PLF -PO L GHVLJXU ODYDM YH]LFDO 9RP
UHXHVFVDOLQHVXIHULQD FkWGHGXUHURDVHVWHUHWHQLDDFXWGH
DYHDDFHOHDLSUHRFXSULOHJDWHGHIXQFLRQDUHDVLVWHPOXLGHODYDMFD
XULQ  L V VDOYH]H YLDD DQXULD REVWUXFWLY UHWHQLD GH XULQ
LvQFD]XO785-3DWkWvQWLPSXOWUDQVSRUWXOXLVSUHVDORQLLQVWDOULLvQ
LQIHFWDWvQFLOHXULQDUHVXSHULRDUH 
pat.
Sondele VXQWQLWHWXEXULGLQplastic de diferite dimensiuni
Monitorizarea lavajului vezical GH RELFHL vQ SLFWXU OHQW
L IRUPH FH UHDOL]HD] FRPXQLFDUHD XQXL VHJPHQW al aparatului
VDXPHGLH DUHDFHHDLPRWLYDLHFDLOD785-P i anume prevenirea
H[FUHWRUFXPHGLXOH[WHUQvQFLUFXLWvQFKLV VRQGXUHWUR-YH]LFDO
FROPDWULLVRQGHLYH]LFDOHFXFKHDJXULvQFD]XODSDULLHLQHDWHSWDWHD QHIURVWRP  VDX FX DOW VHJPHQW OHJWXUD VLVWHP SLHORFDOLFHDO-
XQHL VkQJHUUL GLQ SHUHWHOH YH]LFDO GH OD ORFXO de UH]HFLH YH]LFD XULQDU SULQ VRQG DXWRVWDWLF XUHWHUDO WLS --  &DOLEUXO
,QUHJLVWUDUHD FXUHQW D SDUDPHQWULORU IXQFLRQDOL 7$ SXOV VRQGHORUVHDSUHFLD]GXSVFDUD&KDULHUUH &K RXQLWDWHILLQG
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]DHVWHVXEFRQWURO GHLvQUDUHFD]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
preferat la femei (fig.IV.1);
DOLPHQWDLHLFDLvQFD]XOUH]HFLLORUWXPRULORUSURVWDWLFH
- Sonda Tiemann FX YkUI FXGDW L HILODW FH SHUPLWH DQJDMDUHD
6XSULPDUHD VRQGHL YH]LFDOH VH IDFH GRDU OD LQGLFDLD
prin curbura uretrei bulbare (fig.IV.2);
operatorului L HVWH OHJDW vQ SULQFLSDO GH SURIXQ]LPHD UH]HFLHL
De]DYDQWDMXO DFHVWRU VRQGH HVWH F HOH QX SRVHG XQ VLVWHP GH
HYHQWXDOH LQFLGHQWH FD GH H[HPSOX SHUIRUDLD DFFLGHQWDO D YH]LFLL 
IL[DUHLQWHUQILLQGQHFHVDUIL[DUHDH[WHUQFXOHXFRSODVW LQVWDELO 
GDU vQ FHOH PDL PXOWH FD]XUL VH IDFH GXS -5 zile. ,GHQWLILFDUHD L

 
IV. INSTRUMENTARUL N UROLOGIE XI NGRIJIREA PACIENTULUI UROLOGIC

VDXOLJDWXUDODSUHSX GXUHURDV  HVWHVWHULO 


7RWXLGDFUHXLPVLQWURGXFHPFXJUHXWDWHRVRQGGH $OLPHQWDLDYDUHVSHFWDUHJXOLOHLQWHUYHQLLORUVXEUDKLDQHVWH]LH
DFHVW WLS HVWH GH SUHIHUDW V R PHQLQHP SkQD FDOLEUP XUHWUD 7RWXURORJXOYDGHFLGHGDFHVWHFD]XOVPDLHYDFXH]HGLQEDORQDXO
GHFkWVILPDPELLRL LVvQFHUFPVRvQORFXLP
sondei Foley 5-10-PO OLFKLG vQ IXQFLH GH FRQGLLLOH VSHFLILFH
- Sonda Foley sau sonda cu EDORQD FDUH SH OkQJ FLUFXLWXO
LQWUDRSHUDWRULL 8Q SURFHQW UHODWLY PLF GH SDFLHQL WROHUHD] PDL JUHX
QRUPDOGHHYDFXDUHDXULQLLPDLSUH]LQWXQFLUFXLWIRUPDWGLQWU-un
VRQGD YH]LFDO IDSW PDQLIHVWDW SULQ WHQHVPH YH]LFDOH GXUHUL
canal n grosimea peretelui sondei prin care se introduce ser printr-
hipogastrice. ExplickQG FX EOkQGHH SDFLHQWXOXL SUREOHPD L
RUDPLILFDLHH[WHUQFXVXSDS$VWIHOVHXPIOEDORQDXO aflat la
DGPLQLVWUkQG PHGLFDLD 1R-Spa 2fX3/zi, Piafen 1fX3/zi, Arcoxia
FDSWXOLQWHUQvQvQYHOLXOSHUHWHOXL ILJ,9 $FHVWEDORQDIL[HD]
PJ]L vOSXWHPDMXWDVGHSHDVFDFHVWLQFRQYHQLHQW
VRQGDLQXSHUPLWHLHLUHDHL'LPHQVLXQLOHORUYDULD]GHOD&K-
Q IRDUWH UDUH FD]XUL UHDSDULLD XULQLORU GH DVSHFW KHPDWLF
ODFRSLLSvQOD&K-ODSDFLHQLLRSHUDLHQGRVFRSLF
impune reinstalarea, vQ FRQGLLL GH DVHSVLH L DQWLVHSVLH PQXL
2 YDULDQW VSHFLDO GH VRQG )ROH\ HVWH FHD cu dublu
curent, SHQWUXVSODUHDFRQWLQXDYkQGUDPLILFDLLH[WHUQHXQD
VWHULOHEDGLMRQDUHFX%HWDGLQ  lavajului vezical pentru cteva ore, o

GHGUHQDMXULQDUXQDSHQWUXXPIODUHDEDORQDXOXLLXQDSULQFDUH ]LFKLDUODXQIOX[FDUHVvPSLHGLFH colmatarea sondei.

VHLQWURGXFHVHUVDXDSVWHULOvQYH]LFSHQWUXVSODUH QFRQGLLLOHREQXLWHGHHYROXLHn ziua a 3-DVHVXSULP sonda


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
pansamentul care va fi schimbat zilnic.
SLHOH VDX R VRQG )ROH\ VXELUH ILJ,9  FH YD IL FXSODW la o
II. TUR-V
SXQJFROHFWRDUHvQFLUFXLWvQFKLV
5H]HFLD HQGRVFRSLF a tumorilor vezicale papilare de mici
!
 $
XI NGRIJIREA PACIENTULUI UROLOGIC IV. INSTRUMENTARUL N UROLOGIE

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
RULFXP XUPHD] R LQWHUYHQLH HQGRVFRSLF VH SRW IROosi sondele
VHPQDOHD] R VkQJHUDUH LPSRUWDQW (care poate impune, n rare
uretro-vezicale. De asemenea, tot pentru menajarea uretrei, se
cazuri, UHLQWHUYHQLD pentru realizarea hemostazei, la vedere,
SUHIHU GUHQDMXO VXSUDSXELDQ vQ FD] GH UHWHQLL DFXWH GH XULQ GH
endoscopic 'DFHYROXLDHVWHVLPSOIUFRPSOLFDLLVHGHFLGH
cauze non-urologice. n cazul UHWHQLHL FURQLFH FRPSOHWH GH XULQ,
VXSULPDUHD WUDFLXQLL 6DOYDULV ILH vQ FXUVXO VHULL ILH OD PD[LP 
FRPSOLFDLH ILUHDVF D REVWUXFLHL VXEYH]LFDOH VH LQVWDOHD] OD
GHRUHGHODLQWHUYHQLH
nceput, de SUHIHUDWRVRQGXUHWUR-YH]LFDO
Avnd n vedere lavajul vezical, DVLVWHQWD YD DYHD JULM V
Sonde sau catetere ureterale VXQWVXELULOXQJLLIOH[LELOH
noteze prHFLVvQIRDLDGHREVHUYDLHcantitatea de lichide perfuzate,
cel mai frecvent de calibru 5-&KFXPDQGUHQPHWDOLFGHvQWULUH
YROXPXO GH OLFKLG IRORVLW SHQWUX ODYDM 9/  L FDQWLWDWHD GH OLFKLG
Ele pot fi folosite n:
HOLPLQDW vQ SXQJD FROHFWRDUH 9(  8ULQD HOLPLQDW 8(  YD IL - scop terapeutic cateterism ureteral n anurie
FDOFXODW SULQ IRUPXOD UE = VE-VL L YD IL WUHFXW vQ IRDLD GH REVWUXFWLYGHH[HPSOX ILJ,9 
REVHUYDLH - 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 prLQGHSDLUHDREVWDFROXOXL GHFHOHPDLPXOWHRULOLWLD]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-VHDVWIHODGRXDEXFO FHHDFHH[SOLFDQXPHOH).
De oELFHL HOH VH PHQLQ FkWHYD VSWPkQL GDr uneori se pot
eliminarea micilor cheaguri.
PHQLQH L OXQL de zile, iar anumite sonde zise ORQJ OLIH pot fi
Din ziua 1 postoperator SDFLHQWXO YD IL vQFXUDMDW V VH
PHQLQXWH FKLDU SkQD OD  DQ FRPSR]LLD ORU vPSLHGLFkQG LQ
PRELOL]H]HPDLvQWkLODPDUJLQHDSDWXOXLLDSRLSULQVDORQ GDF
majoritatea cazurilor, vQ FRQGLLLOH XQXL IOX[ XULQDU QRUPDO
VWDUHD JHQHUDO R SHUPLWH  FX VSHFLILFDUHD SUHFLV Ge a nu ridica
GHSXQHUHD VUXULORU FDUH IDF FD VRQGHOH -- RELQXLWH V QX ILH
SXQJD FROHFWRDUH OD QLYHOXO YH]LFLL XULQDUH XULQD GLQ SXQJ QX
!
 
IV. INSTRUMENTARUL N UROLOGIE XI NGRIJIREA PACIENTULUI UROLOGIC

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
FHIDOLF n cazul anesteziei generale);
OD VIkULWXO LQWHUYHQLHi este obligatorie.Cnd nu se poate monta o
-VRQGD XULQDU GUHQXULOH VH DGDSWHD] OD SXQJL VWHULOH L VH
VRQGXUHWHUDOLVLWXDLDLPSXQHXQGUHQDMDOFDYLWLORUUHQDOHVH
DHD] OD XQ QLYHO LQIHULRU IU FXGXUL, cu posibilitatea de
HIHFWXHD] VLPLODU FD OD YH]LFD XULQDU XQ GUHQDM H[WHUQ DO
supraveghere peUPDQHQW pentru a descoperi la timp ntreruperea
ULQLFKLXOXLDGLFRQHIURVWRPLHSHUFXWDQ.
VFXUJHULLGHOLFKLGFDUHSRDWHILFDX]DWGHREVWUXDUHDGHSODVDUHDVDX
Vom utiliza o WUXVGHQHIURVWRPLH FDUHFRQLQHXQDFFX
cudarea sondei sau drenurilor.
PDQGUHQ FX FDUH VH SXQFLRQHD] VLVWHPXO SLHOR-caliceal sub
-pentru combaterea eventualelor frisoane bolnavul este nvelit
ghidaj ecografic si sonda propriu-]LV 'XSD VFRDWHUHD
maQGUHQXOXL L H[WHULRUL]DUHD XULQLL vQ VWD] VH LQMHFWHD] FXGRXSWXULVHDGDXJWHUPRIRDUH HYHQWXDOVHDGDXJDPHGLFDLD

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] I. ,1*5,-,5($63(&,),&3(17583$&,(1,,&8TUR-P
la piele sau o sond )ROH\ &K - FX EDORQD PLF - 3 ml 5H]HFLD HQGRVFRSLF D WXPRULORU SURVWDWLFH EHQLJQH VDX
(fig.IV.9). PDOLJQH GXUHD]DSUR[LPDWLYRU /DVIkULWXOSURFHGXULLSDFLHQWXO
&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
pentru a asiguUD R FRPSUHVLH KHPRVWDWLFD D FROXOXL  $VLVWHQWD YD
REVWUXFWLYH DFXWH GDU GHILQLWLY vQ DFHOHDL QHRSOD]LL
VXSUDYHJKHDSHGXUDWDWUDQVSRUWXOXLGHODVDOODVDORQVRQGDODYDMXO
JHQLWDOHQHRSODVPH FH LQYDGHD] WULJRQXO YH]LFDO VDX XUHWHUHOH
L FXSODUHD SXQJLL FROHFWRDUH LDU OD LQVWDODUHD SDFLHQWXOXL vQ SDW YD
XUPkQG D IL VFKLPEDW periodic, sub ghidaj radiologic, n sala de
XUPULFDPRQWDMXOUHDOL]DWvQVDOVQXVXIHUHGHFXSOULWractionari.
RSHUDLH 
0RQLWRUL]DUHD VWULFW D SDFLHQWXOXL 7$ SXOV  L D ODYDMXOXL
INSTRUMENTARUL ENDOSCOPIC
vezical n primele 4- RUH SRVWRSHUDWRU HVWH HVHQLDO vQ SUHYHQLUHD
3ULPLLHQGRVFRSLWLDXIRVWXURORJLLSHQWUXFHLDXIRVWFHL
IRUPULLFKHDJXULORU FDUHSRWREVWUXDVRQGDYH]LFDOGHRDUHFHRGDW
!
 
XI NGRIJIREA PACIENTULUI UROLOGIC IV. INSTRUMENTARUL N UROLOGIE

3HULRDGDSRVWRSHUDWRULHHVWHGLYL]DWvQLPHGLDWLWDUGLY dinti care au privit in interiorul vezicii urinare cu ajutorul unui

n postoperatorul imediat, pacientul va fi transportat fie n cistoscop.

salonul de supraveghere postoperatorie, fie n salonul de terapie CISTOSCOPUL EXPLORATOR are urmatoarele
componente:
LQWHQVLY vQ IXQFLH GH VWDUHD FOLQLF L GH WLSXO LQWHUYHQLHL GH
- teaca de lucru, OD FDUH VH DWDHD] VXUVD GH DSD VWHULOVHU
FRPSOLFDLLOH LQWHUYHQLWH vQ WLPSXO DFWXOXL FKLUXUJLFDO GH EROLOH FURQLFH
fiziologic.
asociate. Aici pacientul va fi monitorizat continuu i va beneficia de
- telescopul un sistem de prisme pentru transmiterea imaginii, la
vQJULMLULVSHFLDOHFHOSXLQSHQWUXGHRUHVDXPDLPXOWGXSFD]
FDUH VH DWDHD] FDEOXO GH OXPLQ GH OD R VXUV H[WHUQ 1X SRL
ngrijirile acordate pacientului pe timpul transportului de la
YL]XDOL]D FRQLQXWXO YH]LFDO GDF QX DL OXPLQ L lichid.
VDOLLQVWDODUHDDFHVWXLDODSDW
7HOHVFRDSHOHSHUPLWRYHGHUHGHODODvQIXQFLHGHVLWXDLD
-OD DQXQDUHD YHQLULL EROQDYXOXL vQ VHFLH PHGLFXO KRWUWH
SDFLHQWXOXL QHOHJHP DFXP GH FH OD SDFLHQLL FX FLVWLW DFXW
VDORQXOLSDWXOvQFDUHXUPHD]DILDGXV vQIXQFLHGHGLDJQRVWLFGH
XQGH GLVWHQVLD YH]LFDO HVWH SUDFWLF LPSRVLELO FLVWRVFRSLD HVWH
VWDUHD GH JUDYLWDWH VH[  L GDF HVWH QHFHVDU SUHJWLUHD GH contraindicata!
PDWHULDOHVDXDSDUDWXUvQPRGVSHFLDO 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:


- teaca de lucru (18-20 Ch) cu canal de lucru de 5 Ch pentru
de aneVWH]LH GHQDWXUD LQWHUYHQLHLGHFRPSOLFDLLOHFDUHDXVXUYHQLW
introducerea unui ghid;
vQ WLPSXO RSHUDLHL VDX DU SXWHD V DSDU GXS L VWDUHD JHQHUDO D
- telescopul FXRSWLFGH
bolnavului, la preluarea pacientului, DVLVWHQWD VH LQWHUHVHD] GH
- elementul de lucru SDUWHDPHFDQLF FRPSXVGLQWU-un mner ce
WRDWHDFHVWHGDWHSHQWUXDSXWHDDFLRQDvQFRQFRUGDQ cu starea
WUDQVPLWHRPLFDUHvQDLQWH-vQDSRLXQHLODPHDIODWHODFDSWXOLQWHUQ
EROQDYXOXL SHQWUX UHVWDELOLUHD IXQFLLORU RUJDQLVPXOXL prevenirea
DO GLVSR]LWLYXOXL ILJ,9  6H IRORVHWH SHQWUX uretrotomia
FRPSOLFDLLORU L HIHFWXDUHD PDQHYUHORU FRUHVSXQ]WRDUH SHQWUX R
LQWHUQ RSWLF D XQHL VWULFWXUL GH XUHWU GXSD FH DQWHULRU SULQ
YLQGHFDUHFRUHFWLFRPSOHWvQWLPSRSWLP
zona stricturDW D IRVW WUHFXW XQ ILU JKLG ,QFL]LD ]RQHL VWULFWXUDWH
-vQ WLPSXO WUDQVSRUWXOXL VH VXSUDYHJKHD] SXOVXO UHVSLUDLD
HVWH XQLF RUD   VDX PXOWLSO RUD      /D VIkULWXO
aparLLDFLDQR]HLVWDUHDGHFRQWLHQSHUIX]LDGUHQXULOH LQWHUYHQLHLVHLQVWDOHD]RVRQGXUHWUR-YH]LFDO)ROH\VDX

!$
 
IV. INSTRUMENTARUL N UROLOGIE XI NGRIJIREA PACIENTULUI UROLOGIC

&KFHVHPHQLQH-]LOHFDVGLODWH]RQDVWULFWXUDW V-LJROHDVFYH]LFD
REZECTOSCOPUL DUHvQFRPSRQHQ -se vor face XOWLPHOH YHULILFUL DOH VWULL GH FXUHQLH D
- teaca de lucru (24-&K ODFDUHVHDWDHD]WXEXOGHLQWUDUHL pacientului insistndu-VH SH UHJLXQHD RPELOLFDO L a organelor
LHLUHDOLFKLGXOXL GXEOXFXUHQW 
genitale externe;
- telescopul GH RELFHL GH  OD FDUH VH DWDHD] FDEOXO GH
-vQIXQFLHGHVWDUHDVDJHQHUDOSDFLHQWXOYDILWUDQVSRUWDWOD
OXPLQ
VDODGHRSHUDLHFXWDUJDVDXFXXQFUXFLRULYDILvQVRLWGHDVLVWHQWD
- elementul de lucru, FH WUDQVPLWH PLFDUHD vQDLQte-napoi unei
GH VDORQ FDUH vO YD SUHGD vPSUHXQ FX GRFXPHQWHOH PHGLFDOH IRDLD
DQVHGHUH]HFLHFDUHODFDSWXOLQWHUQDUHREXFO6HXWLOL]HD]
GHREVHUYDLHUDGLRJUafii, CT), echipei operatorii;
SH SULQFLSLXO  XQ FXUHQW HOHFWULF GH OD R VXUV H[WHUQ FH VH
-n blocul operator pacientul va fi preluat de asistentele de
DWDHD] la sistemul de lucru, trecnd prin bucla ansei va
DQHVWH]LHLGHODVDODGHRSHUDLHFDUHYRUIDFHSUHJWLULOHvQYHGHUHD
GHWHUPLQD WLHUHD VDX FRDJXODUHD HVXWXOXL vQ IXQFLH GH
LQWHUYHQLHL PRQWDUHD SHUIX]LLORU YHQRDVH SUHJWLUHD FkPSXOXL
intensitatea curentului folosit (fig.IV.13). Operatorul realizea]
DFHVWH GH]LGHUDWH DFLRQkQG vQ WLPSXO LQWHUYHQLHL SHGDOD GH
RSHUDWRUSUHJWLUHDSHQWUXDQHVWH]LHHWF 

VHFLXQHVDXGHFRDOJXODUHLQIXQFLHGHHWDS 3UHJWLUHDvQYHGHUHD(6:/

Nu trebuie fFXW FRQIX]LD vQWUH FXUHQWXO HOHFWULF IRORVLW L - VH YD IDFH GLQ ]LXD SUHFHGHQW vQ SULPXO UkQG FX XQ UHJLP

laser! (vezi capitolul dedicat acestui subiect). DOLPHQWDUFDUHVH[FOXGDFHOHDOLPHQWHFDUH, fermentndSURYRDF


$FHDVWD SURFHGXU VH QXPHWH vQ OLPED HQJOH] balonare GXOFLXULOH L IUXFWHOH GH RULFH IHO EXWXUL GXOFL VDX
7UDQVXUHWKUDO 5HVHFWLRQ RI WKH 3URVWDWH GH XQGH SUHVFXUWDUHD FDUERJD]RDVHSkLQHDIDVROHDFDUWRILLYDU]DvQJKHDWDHWF
IUHFYHQWXWLOL]DWvQFOLQLFGH785-P. -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
1*5,-,5,/(%2/1$9,/25'83,17(59(1,,
5H]HFLD WUDQVXUHWUDO VH IRORVHWH DVW]L SH VFDUD ODUJ
CHIRURGICALE PE APARATUL URINAR
SHQWUXDWUDWDWXPRULOHYH]LFDOHKLSHUSOD]LDEHQLJQGHSURVWDWGH
QJULMLULOH SRVWRSHUDWRULL vQFHS LPHGLDW GXS LQWHUYHQLD
voluPPHGLXVDXGHEORFDUHDGHFROYH]LFDODSDUXWODSDFLHQLLFX
FKLUXUJLFDO L GXUHD] SkQ OD YLQGHFDUHD FRPSOHW D EROQDYXOXL
!
 

XI NGRIJIREA PACIENTULUI UROLOGIC IV. INSTRUMENTARUL N UROLOGIE

VXSUDID FkW PDL ODUJ vQ IXQFLH GH UHJLXQH VH YD IRORVL ORFDO R FDQFHUGHSURVWDW

VROXLHDQWLVHSWLF %HWDGLQ  LITOTRITORUL MECANIC DUHvQFRPSRQHQ:

3HQWUX SDFLHQLL FDUH QX VH SRW GHSODVD WRDWH DFHVWH - teaca de lucru JURDV &K  FX WXE GH LQWUDUH L LHLUH D
lichidului;
SUHJWLUL VH YRU HIHFWXD OD SDW DWkW FOLVPD HYDFXDWRULH FkW L
- telescopul, de obicei de 0, cuplat la FDEOXOGHOXPLQ
toaleta pe regiuni).
- elementul de lucru FH WUDQVPLWH PLFDUHD GH VWUkQJHUH GLQ
Q VLWXDLLOH GH XUJHQ SUHJWLULOH SHQWUX RSHUDLH VH YRU
H[WHULRU FX DMXWRUXO XQXL PkQHU D XQRU JKHDUH FD XQ FOHWH OD
efectua ntr-XQ WLPS VFXUW GDU DYkQG JULM V VH UHVSHFWH WRDWH
FDSWXO LQWHUQ FDUH DWXQFL FkQG PULPHD FDOFXOXOXL R SHUPLWH vO
HWDSHOH FX H[FHSLD FOLVPHL HYDFXDWRULL FDUH VH YD IDFH GRDU OD
FXSULQGHVWUkQJHLVSDUJH ILJ,9 
recomandarea medicului.
Desigur, calculii de inIHFLH FH DX UHSXWDLD GH D IL IULDELOL
3UHJWLULOHGLQGLPLQHDDLQWHUYHQLHL
GDULDFHLPDLGXULGDUSXLQPDLYROXPLQRLSRWILWULWXUDLDVWIHOQ
-pacientul nu mai aUHYRLHVFRQVXPHOLFKLGH VIXPH]H
FD]XOFDOFXOLORUYH]LFDOLYROXPLQRLFDUHQXSRWILSULQLvQFOHWH
-vLYDHIHFWXDWRDOHWDRELQXLWGHGLPLQHD;
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
DSUXWHvQFXUVXOQRSLL IHEU 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; FDOFXOXOXL IU D UH]ROYD L SUREOHPD REVWDFROXOXL VXEYH]LFDO GH
-SDFLHQWXO vL YD VFKLPED OHQMHULD GH FRUS vPEUFkQG o H[HPSOX KLSHUSOD]LD EHQLJQ GH SURVWDW  WUHEXLH V QH DWHSWP
FPDGHVSLWDOFXUDWODUJ ODUHFLGLYDOLWLD]LFvQWUXFkWVWD]DYH]LFDOFDIDFWRUHWLRORJLFSULPDU
-ODSDFLHQLLFURUDOLV-DPRQWDWVRQGXULQDUODLQWHUQDUHvQ DOOLWLD]HLSHUVLVW

FRQWH[WXOUHWHQLHLGHXULQ H[DGHQRPGHSURVWDW OLVHYDsuprima 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
SHUPLW HIHFWXDUHD SURFHGXULORU HQGRXURORJLFH L DVXSUD DSDUDWXOXL
-PHGLFDLD SUHRSHUDWRULH UHFRPDQGDW GH PHGLFXO DQHVWH]LVW
urinar superior.
YDILDGPLQLVWUDWvQWLPSXWLO H[VHGDWLYHDQWLKLSHUWHQVLYHDQWLELRWLFH 
Iata principalele instrumente folosite:
pentru a se instala efectul SkQODPRPHQWXOLQWHUYHQLHL
NEFROSCOPUL, (fig.IV.15): instrumentul care permite
-vQDLQWHGHDILWUDQVSRUWDWODVDODGHRSHUDLHSDFLHQWXOWUHEXLH
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IV. INSTRUMENTARUL N UROLOGIE XI NGRIJIREA PACIENTULUI UROLOGIC

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
utiliznd cel mai frecvent   ./0 1 0 0 123
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41 1501 0 /000.0 02."
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66 78/00,000 0.0( /0
introduce sonotrodul FX FDUH VH IUDJPHQWHD]FDOFXOLL  VDX pense

de extragere D FDOFXOLORU vQWUHJL VDX IUDJPHQWDL 3URFHGXUD FH
666 78/00,000 02.0
LPSOLFXWLOL]DUHDORUVHQXPHWHQHIUROLWRWULLHSHUFXWDQDW(NLP).   -0(..000  
3XWHPXWLOL]DQHIURVFRSXOLSHQWUXDUHDOL]DRDOWLQWHUYHQLH 69 78/00,000 -0 00
VSHFWDFXORDV L DQXPH endopielotomia LQWURGXFkQG XQ FXLW /00 
9 : 0,-0/00 /0030
VSHFLDO SHQWUX VHFLRQDUHD MRQFLXQLL SLHOR-ureterale, n cazul
0-0 00(..0 /0 ' .
VWHQR]HL &DOLEUDUHD XUHWHUXOXL YD IL UHDOL]DW XOWHULRU SULn
LQWURGXFHUHD DQWHURJUDG D XQHL VRQGH DXWRVWDWLFH XUHWHUDOH WLS
x GXS FH SDFLHQWXO LD FXQRWLQ GHVSUH QHFHVLWDWHD
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URETEROSCOPUL HVWH LQVWUXPHQWXO FDUH DOWXUL GH
vQIRDLDGHREVHUYDLH FHVWHGHDFRUGFXRSHUDLDLvLDVXP
OLWRWULWRUXOH[WUDFRUSRUHDODSURGXVVFKLPEDUHDSURIXQGD
riscurile care decurg de aici; n anumite cazuri vor fi invitai i
VWUDWHJLLORU WHUDSHXWLFH vQ OLWLD]D XUHWHUDO L QX QXPDL
aparintorii pacientului s semneze.
Pentru o mDLXRDUvQHOHJHUHXUHWHURVFRSXOWUHEXLHSULYLW
-VHDUD VH YD HIHFWXD R FOLVP HYDFXDWRULH D WXEXOXL
FDXQQHIURVFRSDYkQGSUDFWLFDFHOHDLFRPSRQHQWHvQV
digestiv;
un calibru mult mai mic, adaptat pentru dimensiunile
-pacientul va face un GX FX R VXEVWDQ DQWLVHSWLF n
ureterului (Ch 6-8-10). (fig.IV.16).
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permit introducerea unor pense foarte fine pentru extragerea de genitale externe;

FDOFXOL VDX IUDJPHQWH GH FDOFXOL UH]XOWDWH LQ XUPD OLWRWULLHL -SUHJWLUHD FkPSXOXL RSHUDWRU VH YD IDFH SULQ epilarea zonei
intracorporeale (realizate prin contact direct, la vedere, ntre calcul GHLQWHUYHQLHvQGLPLQHDDLQWHUYHQLHL folosind un aparat de ras,
L VRQRWURGXO VXELUHILEUD ODVHU  8UHWHURVFRSLD ILH F este GHXQLFIRORVLQGHFWUHRSHUVRDQVSHFLDOL]DWSHQWUXDSUHYHQL
UHWURJUDG FHOPDLIUHFYHQWDVW]L ILHDQWHURJUDGGLQVSUHULQLFKL OH]LXQLOH FXWDQDWH (VWH GH SUHIHUDW V QX VH XWLOL]H]H FUHPH
VSUH YH]LF  SRDWH IL XWLOL]DW vQ VFRS WHUDSHXWLF DD FXP DP GHSLODWRDUH GHRDUHFHSRW SURYRFDDOHUJLL 'XSGHSLODUHD ]RQHLSHR

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OH]LXQLORU VDX PRGLILFULORU WHJXPHQWDUH LQIODPDLL DOHUJLL), iar zone considerate suspecte la nivelul ureterului.

PRGLILFULOHDSUXWHYRUILUDSRUWDWHLPHGLDWPHGLFXOXLGHVDORQ. Pentru extragerea de fragmente n timpul ureteroscopiei


SXWHP XWLOL]D L XQ LQVWUXPHQW VSHFLDO QXPLW  sonda Dormia
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GLILFLO SHQWUX QXPHURL SDFLHQL L GH DFHHD PHGLFXO DOWXUL GH XUHWHURVFRS DXIRVWIDEULFDWHvQYDULDQWDULJLGDVHPLULJLGDGDULvQ
asistenta de salon, WUHEXLH V WLH V FRPXQLFH IRDUWH ELQH FX YDULDQWD IOH[LELO DFHDVWD GLQ XUP UHVSHFWkQG SULQFLSLXO
pacientul pentru a-L FkWLJD vQFUHGHUHD V WLH V UVSXQG ILEURVFRDSHORU ILJ,9  (VWH HYLGHQW F XQ cistoscop flexibil
vQWUHEULORUSHFDUHDFHVWDOHDUHV-LDOXQJHWHPHULOHLV-ODMXWHV SRDWH V H[SORUH]H PXOW PDL OHMHU WRDW VXSUDIDD PXFRDVHL
WUHDFFXFkWPDLSXLQHHPRLLSHVWHDFHVWPRment. vezicale, inclusiv zonele mai greu accesibile cistoscopului rigid,

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6H YRUEHWH DVW]L GHVSUH UHWURJUDGH LQWUDUHQDO VXUJHU\
GLVSR]LLH L GH WLSXO LQWHUYHQLHL SUHJWLULOH YRU vQFHSH cu unele
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H[FHSLL H[ FLVWHFWRPLH WRWDO QHFHVLW R SUHJWLUH VSHFLDO D
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WXEXOXLGLJHVWLY vQSUH]LXDLQWHUYHQLHLLYRU consta n:
FDSDELOVDMXQJvQFHOHPDLDVFXQVHFDOLFHVH[WUDJGHDFROR
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fr zahUFXRUHvQDLQWHGHLQWHUYHQLH sensibileFHHDFHIDFHFDXWLOL]DUHDORUVILHUHODWLYOLPLWDW
Medicul anestezist va face consultul preanestezic, care va consta 5HFRPDQGP OHFWXUD DFHVWXL FDSLWRO vPSUHXQ FX FHD D
vQ H[DPLQDUHD SDFLHQWXOXL YHULILFDUHD GRFXPHQWHORU H[LVWHQWH L YD capitolului dediFDW LQWHUYHQLLORU HQGRXURORJLFH SHQWUX R PDL EXQ
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DVHPHQHDDQHVWH]LVWXOYDUHFRPDQGDRPHGLFDLe anxiolitico-VHGDWLY Endourologia este un capitol fascinant al practicii urologice iar

FDUHYDILDGPLQLVWUDWGXSRUDUXOLQGLFDW$QWLELRWHUDSLDSUHRSHUDWRULH SURJUHVHOH WHKQRORJLFH IFXWH vQ XOWLPLL DQL DWUDJ GLQ FH vQ FH PDL

HVWH IRDUWH XWLO vQ SUHYHQLUHD H[WLQGHULL XQXL SURFHV LQIHFLRV PXOL WLQHULDEVROYHQLFWUHDFHDVWVSHFLDOLWDWH

(cunoscut sau latent).


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V. LASERUL N UROLOGIE
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/DVHUXO HVWH XQ GLVSR]LWLY RSWLF FH JHQHUHD] XQ IDVFLFRO
luminos (fascicul laser), ce are un spectru foarte ngust de lungimi PDL DOHV GDF L VH H[SOLF vQ FH FRQVW SURFHGXUD Q FOLQLF

GH XQG VSUH GHRVHELUH GH OXPLQD RELQXLW  HVWH IRFDOL]DW SH R SUHJWLUHDSDFLHQWXOXLDUHvQYHGHUH
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Generarea fasciculului laser se poate face continuu sau n dLPLQHDDFkQGVHYDHIHFWXDSXQFLD
LPSXOVXUL 'XS GHVFRSHULUHD VD vQ DQLL  V-au descoperit -SURILOD[LD XQHL HYHQWXDOH LQIHFLL PDQHYUD HVWH WRWXL
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YDSRUL]D'HDVHPHQHDODVHUXOSRDWHIUDJPHQWDFDOFXOL OLWRWULLH  DGPLQLVWUPFDPHGLFDLHDQWDOJLFITramadol (100mg i.m).
$SOLFDLL L-DX JVLW ODVHULL vQ GHUPDWRORJLH L FKLUXUJLH VHFLXQHD Se verific faptul c pacientul care era pe tratament cronic cu
HVXWXULORUFXODVHUFXDUJRQ  medicaie care poate modifica coagularea (PLAVIX, TROMBEX,
Tipuri de lasere folosite in urologie :
ASPENTER, ASPIRINA CARDIO, etc) i-a ntrerupt-o cu cel putin 7-
1. Holmium (Ho): Yag (Ytrium aluminium garnet) laser;
10 zile nainte de puncie!!!
2. .73 SRWDVLX WLWDQ\O IRVIDW .7$ 1G <DJ  L /%2
Tehnica: 'XS EDGLMRQDUHD UHJLXQLL SHULQHDOH FX %HWDGLQ
(lithium borat, LBO:Nd:Yag) laser;
PHGLFXO YD HIHFWXD SXQFLD SURSULX-]LV VXE UHSHUDM ecografic cu un
3. Thulium (Tm): Yag laser;
transductor special, sau prin ghidaj digital, palpatoriu. Se vor recolta
4. /DVHUHWLSGLRG
cte 5-6-12 fragmente din fiecare lob prostatic, care vor fi puse n
/D RUD DFWXDO FHOH PDL IUHFYHQWH DSOLFDLL VXQW vQ chirurgia
UHFLSLHQWHFXIRUPROLvQVRLWHGHEXOHWLQXODQDWRPR-patologic care va
HQGRXURORJLF$FHVWHDVXQW
cuprinde datele pacientului vor fi transportate la laborator.
1. n endourologia aparatului urinar inferior:
'XS HIHFWXDUHD ELRSVLHL VH YD DSOLFD XQ pansament local,
x (QXFOHHUHD VDX YDSRUL]DUHD WUDQVXUHWUDO D
DGHQRPXOXLGHSURVWDW LDU SDFLHQWXO YD IL FRQGXV OD VDORQ L VXSUDYHJKHDW vQ FRQWLQXDUH

x 5H]HFLD VDX YDSRUL]DUHD WUDQVXUHWUDO D WXPRULORU pentru a depista o HYHQWXDOVkQJHUDUHSRVWSURFHGXU, apariia febrei,

vezicale; etc.

x 6HFLXQHDHQGRVFRSLFDVWULFWXULORUuretrale; 3H WRW SDUFXUVXO LQWHUQULL EROQDYXOXL VH YRU PVXUD L

x Incizia colului vezical; vQUHJLVWUD ]LOQLF vQ IRLD GH REVHUYDLH DQXPLL SDUDPHWUL 7$ SXOV
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XI NGRIJIREA PACIENTULUI UROLOGIC V. LASERUL N UROLOGIE

GDFSDFLHQWXOHVWHDJLWDW'LD]HSDP-10mg, administrat lent i.v. x /LWURWULLDFDOFXOLORUYH]LFDOL

5HDFLLDOHUJLFHFXWDQDWH 2. n endoscopia aparatului superior:

- Simptome: URHD ORFDO ODORFXOLQMHFLHL urticarie, cu sau x 6HFLXQHD HQGRVFRSLF D MRQFLXQLL SLHORXUHWHUDOH

IUSUXULWUDVKFXWDQDW stenozate (endopielotomie);

Tratament: vQ IXQFLH GH VHYHULWDWH DQWLKLVWDPLQLFH 7DYHJ\O x /LWRWULLD HQGRVFRSLF D FDOFXOLORU XUHWUDOL vQ FXUVXO
XUHWHURVFRSLHL L D calculilor pielocaliceali n cursul nefrolitotomiei
i.vIPO PJ VDXGHULYDLFRUWL]RQLFL 6ROX-Decortin 100-250mg sau
percutanate sau a ureteroscopiei retrograde flexibile.
Hemisuccinat de hidrocortizon 100mg).
Cele mai multe studii au avut drept obiectiv chirurgia
5HDFLLJHQHUDOHVHYHUH
HQGRVFRSLFDSURVWDWHLLOLWRWULLDvQWLPSXOXUHWHURVFRSLHL
- Simptome generale: URHDDIHHL LWUXQFKLXOXL VHQ]DLHGH
6H FXQRDWH F JROG VWDQGDUG-ul chirurgical n hiperplazia
DQ[LHWDWH DJLWDLH XUWLFDULH JHQHUDOL]DW FX SUXULW GXUeri de spate,
EHQLJQDGHGHSURVWDW (denumita inca adenom de prostata) este
YUVWXUL SDOLGLWDWH WUDQVSLUDLL UHFL SLHUGHUHD FXQRWLQHL stare
HOHFWURUH]HFLD WUDQVXUHWUDO 785-3  7RWXL DFHDVWD SUH]int un
OLSRWLPLFsimptome respiratorii: tahipnee, dispnee expiratorie, tuse
JUDGUHODWLYLPSRUWDQWGHFRPSOLFDLLFXPDUILVkQJHUULSHUIRUDLL
VSDVWLF DWDF GH DVWP EURQKRVSDVP simptome cardiovasculare: VWHQR]H L SRDWH FHO PDL important, timpul lung al curbei de
WDKLFDUGLHVFGHUHWHQVLRQDO RF vQYDUH SHQWUX FKLUXUJ /DVHUHOH DX IRVW VWXGLDWH WRFPDL vQ LGHHD
 Tratament: YD IL DQXQDW GH XUJHQ PHGLFXO GH DQHVWH]LH L UHGXFHULL DFHVWRU FRPSOLFDLL L D VFXUWULL FXUEHL GH vQYDUH
WHUDSLH LQWHQVLY $GUHQDOLQ LY PO PJ  GLOXDW  FX /DVHUXOSRDWHYDSRUL]DHVXWXOSURVWDWLFVDXvOSRDWHVHFLRQDIU
VHU IL]LRORJLF vQ WLPS FH PRQLWRUL]P DFWLYLWDWHD FDUGLDF VVHSURGXFVkQJHUULLPSRUWDQWHGHDVHPHQHDSHQHWUDUHDVD
DWHQLH OD DULWPLH  VH UHSHW GXS  PLQXWH GDF HVWH n HVXWHVWHSkQODRDGkQFLPHGHPPGHFLXQDYDQWDMIDGH

QHFHVDU DFHHDL GR] FRUWLFRL]L LY 6ROX-Decortin 50-1500 curentul electric folosit la TUR-P, ce poate produce leziuni

mg sau Valon A solubil, 100-300mg; oxigenoterapie SURIXQGH 'XS R SHULRDG GH HQWX]LDVP FkQG VH FUHGHD F

VXSUDYHJKHDW laserul va nlocui TUR-P, studiile nu au putut dovedi un avantaj


FHUW DO DFHVWXLD vQ SULYLQD UH]XOWDWHORU SRVWRSHUDWRULL GH
GDF HVWH QHFHVDU UHVSLUDLH DUWLILFLDO PDVF GH R[LJHQ
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LQWXEDLH RUR-WUDKHDO EURQKRVSDVPROLWLFH (XILOLQ -0,48g i.v., SUHXO FUHVFXW DO ILEUHORU FH WUDQVPLW ODVHUXO L FDUH VXQW GH XQLF
20mg/min; UHVWDELOLUHDYROXPXOXLFLUFXODQWULGLFDUHDSLFLRDUHORUVROXLL IRORVLQ &X VLJXUDQ F VWXGLLOH XOWHrioare efectuate pe termen
HOHFWUROLWLFHLYHYHQWXDOVXEVWLWXHQLGHSODVP lungQHYRUGDXQUVSXQVODvQWUHEDUHDFDUHWHKQRORJLHHVWHPDL
ODQHYRLHPDQHYUHGHUHVXVFLWDUHFDUGLRYDVFXODU EXQ 7RWXL GXS SHVWH  DQL GH IRORVLUH ODVHULL vQ WHUDSLD
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!

 
V. LASERUL N UROLOGIE XI NGRIJIREA PACIENTULUI UROLOGIC

multe centrH GLQ OXPH ILLQG SDFLHQL unei vene antecubitale, folosind un cateter venos periferic de 14 sau
FDUH SUHIHU DFHDVW PHWRG Q  * FDUH VH YD PHQLQH SH WRW WLPSXO H[DPLQULL SHQWUX D SVWUD R
FKLUXUJLDSURVWDWHLVHIRORVHVFXUPWRULL 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
SHROXQJLPHGHPPLHVWHSXLQ
PHWDOLFLGHFOGXUGLIX]LQWHQVGDUHIHPHUSHFDUHRYDVLPLvQ
DEVRUELW GH DS L KHPRJORELQ
FkWHYD VHFXQGH QFHSXWXO LQMHFWULL WUHEXLH QRWDW FX H[DFWLWDWH L
SURGXFkQG R FRDJXODUH WHUPLF OD
FRQVWLWXLH PRPHQWXO ]HUR DO H[DPLQULL SHQWUX Woate expunerile din
VXSUDIDDHVXWXOXLLLPHGLDWVXELDFHQW
timpul urografiei.
HVXWXO FRDJXODW GHYLQH DOE L QX
5HFRPDQGULOHJDWH GHXWLOL]DUHDVXEVWDQHORUGHcontrast:
VkQJHUHD] HOH HOLPLQkQGX-se ulterior
- VXEWDQHOH GH FRQWUDVW WUHEXLH SVWUDWH vQWU-un loc
vQ VSWPkQLOH XUPWRDUH 3ULQ
;< o
FUHWHUHD LQWHQVLWLL ODVHUXOXL VH SRDWH ntunecos, la 15-25 C, GDU QX vQ YHFLQWDWHD HFKLSDPHQWHORU
SURGXFHYDSRUL]DUHDHVXWXOXL UDGLRORJLFHSHQWUXROXQJSHULRDGGHtimp;
2. Laserul KTP (potasiu titanyl fosfat) emite pe o lungime - DPEDODMXO ILROHL IODFRQXOXL  VH vQGHSUWHD] GRDU FX FkWHYD
GH XQG GH  PP HPLWH FXORDUHD momente nainte de utilizare, examinndu-VHFXDWHQLHVROXLDVQX
verde) provocnd un nivel mediu de ILHWXOEXUHVDXVSUH]LQWHVHGLPHQW
FRDJXODUH L YDSRUL]DUH MXPWDWH GLQ - WUHEXLHDYXWJULMFDILROHOHFXVXEVWDQGHFRQWUDVWV nu fie
nivelul de penetrare al laserului OVDWH GHVFKise mai mult de 4 ore de la prima utilizare, riscul
Neodium YAG). De asemenea, poate fi
FRQWDPLQULLEDFWHULHQHILLQGGHORFQHJOLMDELO
IRORVLW OD VHFLXQHD Hsutului prostatic
(VWH XWLO GH WLXW PDL DOHV SHQWUX WHKQLFLHQLL UDGLRORJL L
UH]HFLDODVHU 
DVLVWHQWHOHPHGLFDOHFDUHLQMHFWHD]VXEVWDQDGHFRQWUDVWFDUHVXQW
3. Laserul Holmium: YAG
UHDFLLOHDGYHUVHFHSRW VDSDUODLQMHFWDUHLUHFRPDQGULOHvQFD]XO
HPLWH SH R OXQJLPH GH XQG GH
DSDULLHLDFHVWRUD
2000mm, pulsat, spre deosebire de
5HDFLLDOHUJLFHPRGHUDWH
primele 2 lasere care sunt emise
-Simptome: JUHXUL FOGXUL VWUQXW ]JRPRWH vQ urechi,
continuu.
=)&+ gdilituri n gt.
Efectul hemostatic este mai redus, ca al
- Tratament: OLQLWLUHD SDFLHQWXOXL DGPLQLVWUDUHD GH R[LJHQ


 
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XI NGRIJIREA PACIENTULUI UROLOGIC V. LASERUL N UROLOGIE

ureteropielografie retro- VDXDQWHURJUDGFLVWRJUDILHXUHWURJUDILH&7 SULPHORU GRX (VWH IRORVLW SHQWUX HQXFOHHUHD WUDQVXUHWUDO D

RMN. DGHQRPXOXLWHKQLFDQXPLW+ROHS

- examene endoscopice: cistoscopie; Dispozitivele moderne de


generare a laserului cu un volum
- H[SORUDUHUDGLRL]RWRSLF
relativ redus, sunt deplasabile n sala
- SXQFLHELRSVLHUHQDO
GH RSHUDLH GDU vQ WLPSXO IRORVLULL ORU
- SXQFLHELRSVLHSURVWDWLF
QHFHVLW SXUWDUHD GH RFKHODUL GH
3UHJWLUHD SDFLHQWXOXL SHQWUX H[DPHQH VSHFLDOH
SURWHFLH contra fasciculului luminos.
1.PrHJWLUHDSDFLHQWXOXLSHQWUXXURJUDILH
La dispozitivul de producere se
8URJUDILD SUHVXSXQH LQMHFWDUHD LQWUDYHQRDV GH VXEVWDQH
DGDSWHD] ILEUH FH WUDQVPLW OXPLQD
speciale QXPLWHVXEVWDQHGHFRQWUDVW care ajungnd n rinichi se
laser, care se introduc pe canalele de
HOLPLQRSDFiILLQGDVWIHOSHUDGLRJUDILLOHHIHFWXDWHVHFYHQLDOVLVWHPXO
lucru ale endoscoapelor, ajungnd n
pielo-caliceal, XUHWHUXO L PDL WkU]LX YH]LFD Q YHGHUHD XQHL EXQH FRQWDFWFXHVXWXO ='*><
SUHJWLUL SHQWUX XURJUDILH D SDFLHQWXOXL DVLVWHQWD YD DYHD JULM FD 4. /DVHUXO WLS GLRG &HO PDL
acesta VUHVSHFWHXUPWRDUHOHUHJXOL: cunoscut este laserul Indigo, utilizat mai ales n Statele Unite
- restrngerea consumului de lichide cu 12 ore nainte de SHQWUX YDSRUL]DUHD VDX FRJXODUHD LQWHUVWLLDO D DGHQRPXOXL GH
explorare; SURVWDW
- FRQVXPXO GH DOLPHQWH IU UH]LGXXUL FDUH QX SURYRDF 3HQWUX OLWRWULLD FDOFXOLORU XULQDUL FHO PDL ODUJ XWLOL]DW HVWH
EDORQDUH FDUQHILDUWSkLQHXVFDWRXWDULEUkQ]GHYDFL laserul Holmium:Yag. Se folosesc fibre cu diametru redus. De
- evitarea FRQVXPXOXL GH OLFKLGH GXOFL VPkQWkQ vQJKHDW DVHPHQHD XQGD GH RF FUHDW OD VSDUJHUHD FDOFXOXOXL HVWH PDL
compoturi, fructe, dulciuri), PLFGHFkWODOLWRWULLDEDOLVWLFVF]kQGULVFXOPLJUULLFDOFXOXOXLGLQ
- evitarea fumatului ; ureter n sistemul pielocaliceal. Din cauza acestor avantaje laserul

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 fragmente restante post-SURFHGXU  HVWH GH SHVWH  PRWLY
SHQWUX FDUH vQ XQHOH UL GH]YROWDWH D GHYHQLW PHWRGD GH OLWRWULLH
SDFLHQLL DOHUJLFL OD  VXEVWDQD GH FRQWUDVW OD FHL FX KHSDWRSDWLL VDX
FHDPDLIUHFYHQWIRORVLW JROGVWDQGDUG 6LQJXUXOGH]DYDQWDMHVWH
QHIURSDWLL JUDYH KLSHUWLURLGLH 7%& SXOPRQDU HYROXWLY DQHPLH
FRVWXOULGLFDWGHDFKL]LLHDODSDUDWXOXLLDOFRQVXPDELOHORU Iibrele
KHPROLWLF VWUL IHEULOH Kipersensibilitate la iod, cardiopatii grave,
laser).
pacienii diabetici aflai sub tratament cu metformin.
,QMHFWDUHD VXEVWDQHL GH FRQWUDVW VH IDFH SULQ SXQFLRQDUHD


 
9,(;3255,/((1'2852/2*,&(,0,1,0,19$=,9( XI NGRIJIREA PACIENTULUI UROLOGIC

9,,17(59(1,,/((1'2852/2*,&(,0,1,0INVAZIVE performan Karnofsky pe care l redm n tabelul de mai jos.

8URORJLD HVWH XQD GLQWUH VSHFLDOLWLOH SULYHOHJLDWH OD FDUH  ; 0(..0 008.0 200,.
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00,.
FHOH PDL YHFKL WLPSXUL DYkQG vQ YHGHUH H[LVWHQD XQHL FL

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! 10  0  2.0 0 @-    ?@ 
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@ 
GLDJQRVWLF LQWHUYHQLLOH HQGRXURORJLFH V-au dezvoltat permanent,
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materialelor moderne, siliconate, a instrumentelor flexibile, $ A2,0 . 00 02-030 00

perfectarea sistemelor optice, VXUVHORU GH OXPLQL de redare a
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imaginii.
  
 #, 07 /0.00 
I. CATETERISMUL URETRO-VEZICAL  C 
5HWHQLD FRPSOHW GH XULQ HVWH VLWXDLD vQ FDUH YH]LFD
XULQDUWUHEXLHGUHQDWGHXUJHQ'HFHOHPDLPXOWHRULVRQGDMXO x Examen paraclinic care va cuprinde:
HYDFXDWRU HVWH HIHFWXDW GH PHGLFXO XURORJ GDU H[LVW L VLWXDLL vQ a. analize de laborator uzuale FDUHVHUHFROWHD] pentru orice
care medicul de familie VDX GH DOW VSHFLDOLWDWH FKLUXUJ LQWHUQLVW WLSGHLQWHUYHQLH 767&JUXSVDQJXLQ5KKHPROHXFRJUDP96+
VDX QHXURORJ  WUHEXLH V IDF DFHDVW LQWHUYHQLH 1H FRQIUXQWP XUHH FUHDWLQLQ LRQRJUDP VDQJXLQ JOLFHPLH SUREH KHSDWLFH
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XQHLVRQGHGHFWUHSHUVRQDOPHGLFDOQHSUHJWLWFRUHVSXQ]WRULDU LRQRJUDP XULQDU XURFXOWXUL SHQWUX LGHQWLILFDUea bacilului Koch n
rezultatul a fost crearea unei leziuni uretrale, ceea ce numim n urina, etc.), radiografie toracic, ecografie abdominal, ECG,
limbaj curent FDOHIDOVXUHWUDO H[DPHQGHPHGLFLQLQWHUQ
(VWHELQHGHWLXWFkWHYDOXFUXUL b. examene speciale, vQ IXQFLH GH RUJDQXO SH FDUH VH
x RULFH PDQHYU XURORJLF FDWHWHULVP FLVWRVFRSLH HWF 
intervine:
HVWHSRWHQLDOWUDXPDWL]DQWLLQIHFWDQWPRWLYSHQWUX
- H[DPHQHLPDJLVWLFHUHQDOVLPSOXURJUDILHLYSLHORJUDILH
care trebuie efectuate respectnd normele de asepsie

 

XI NGRIJIREA PACIENTULUI UROLOGIC 9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(

,QWHUYHQLLOHFKLUXUJLFDOHODUkQGXOORUSRWILJUXSDWHvQXUJHQH LDQWLVHSVLH;

L LQWHUYHQLL SURJUDPDWH 8UJHQHOH VXQW FRQVLGHUDWH VLWXDLLOH cnd x VRQGHOH FD L FHOHODOWH LQVWUXPHQWH DX GLIHULWH FDOLEUH

VXQW SHULFOLWDWH DQXPLWH IXQFLL ale organismului, care pot pune n exprimate n Charriere: 1Ch=1/3mm diametrul extern

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de 6mm);
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x VRQGHOH FX EDORQD VXQW DXWRVWDWLFH DGLF GXS
FKLUXUJLFDO ORPERWRPLH SHQWUX R UXSWXU UHQDO HWF  n astfel de
LQWURGXFHUHD ORU vQ YH]LF JRQIODUHD EDORQDXOXL FX VHU
cazuri, recoltarea anDOL]HORU VH GHVIDRDU DSURDSH vQ SDUDOHO FX
vPSLHGLFLHLUHDVRQGHL
SULPHOHPVXULGHUHVXVFLWDUHLWUDWDPHQW (instalarea unei perfuzii
x VRQGHOHGHSODVWLFFXFLRF 7LHPDQQ VDXFDOLEUXXQLIRUP
venoase, oxigenoterapie, introducerea unei sonde vezicale, etc),
FLOLQGULF 1HODWRQ  WUHEXLH PRQWDWH FX JULM L GRDU GH
FRRUGRQDUHDJHVWXULORUILLQGHVHQLDODWLQJHULLVFRSXOXLSURSXV
medicul VSHFLDOLVWXURORJ YH]LLFDSLWROXOInstrumentarul
Avnd ca UHSHU WHPSRUDO HVHQLDO PRPHQWXO LQWHUYHQHL
XURORJLF);
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x GDFVRQGDDOHDVQXGHSHWHREVWDFROXOQXVHIRUHD]
vQvQJULMLULSUHRSHUDWRULLLvQJULMLULSRVWRSHUDWRULL
LQWURGXFHUHD HL 5LVFXO GH D SURGXFH R FDOH IDOV HVWH
3UHJWLUHD SUHRSHUDWRULH FRQVW ntr-o serie de ngrijiri
foarte mare!
generale care se DFRUG ILHFUXL SDFLHQW LQWHUQDW H[DPHQ FOLQLF
Etapele cateterismului uretro-vezical:
SDUDFOLQLF vQJULMLUL LJLHQLFH XUPULUHD IXQFLLORU YLWDOH L YHJHWDWLYH
&XQRVFXW L VXE GHQXPLUHa de sondaj vezical DFHDVW
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VSHFLDOvQIXQFLHGHWLSXOLQWHUYHQLHL  YH]LFSULQFDUHVHHYDFXHD]XULQDDFXPXODW0HGLFXOYDDYHD
ngrijiri generale: PQXL VWHULOH L GXS GH]LQIHFLD PHDWXOXL XULQDU L D UHJLXQLL
x Examen clinic general FRQVW n evaluarea pacientului SHULQHDOH YD LQWURGXFH FX PXOW JULM VRQGD XUHWUDO VWHULO
prin observarea aspectului general (a faciesului, a mersului, OXEULILDW FX JHO DQHVWH]LF ILJ9,  2 VROXLH DQWLVHSWLF OD
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FDUHYDILHIHFWXDWGHFWUHPHGLFXOVSHFLDOLVWUH]LGHQW 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
$

 
9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9( XI NGRIJIREA PACIENTULUI UROLOGIC

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
'DF VH vQWkOQHWH YUHXQ REVWDFRO QX VH IRUHD] trziu n practica clinic importante beneficii pacientului .
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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 s 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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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
$VW]LSHEXQGUHSWDWH, nu mai este normal i nici posibil s
GHODvQFHSXWRVRQG)ROH\FXWULSOXFXUHQWGHFDOLEUXPDUHSULQ
se interneze pacieni cu o stare general bun doar pentru a fi
FDUH VXE XQ ODYDM YH]LFDO DEXQGHQW V SRDW IL HYDFXDWH
investigai. Toate investigaiile, de la cele mai simple (analize de
eventualele cheaguri.
snge i urin, etc.) pn la cele mai complexe (CT sau RMN) trebuie
'XS LQVWDODUHD VRQGHL L D SXQJLL FROHFWRDUH YRP DWUDJH
desfaurate la aceast categorie de pacieni n condiii de ambulator,
ateQLD SDFLHQWXOXL F HVWH LQWHU]LV ULGLFDUHa pungii colectoare la
i, cnd strategia terapeutic s-a conturat, pacientul accept
QLYHOXO ED]LQXOXL GHRDUHFH XULQD GLQ SXQJ FDUH QX PDL HVWH
intervenia i riscurile ei iar comorbiditile sunt bine controlate, se
VWHULO  VH SRDWH vQWRDUFH vQ YH]LF IDYRUL]kQG LQIHFLD XULQDU
(conform principiului vaselor comunicante).
GHFLGHLQWHUQDUHDLct mai rapid, gestul terapeutic.


  
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II. Acetazolamida n cazul sondelor Tiemann sau Nelaton care nu sunt


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IV. Tiazide DLEHQ]LGHOHXFRSODVWGHSHQLV
V. Triamteren 6H UHFRPDQG XQ WUDWDPHQW FX DQWLVHSWLFH XULQDUH SHU RV
13. Hipouricemiante %LVHSWRO 1RUIOR[DFLQ 2IOR[DFLQ HWF  SHQWUX D SUHYHQL DSDULLD
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 /DSDFLHQLLSXUWWRULGHVRQGYH]LFDOYRPUHFRPDQGD
14. Altele - consumul abundent de lichide pentru a mpiedica pe ct posibil
I. 6UXULGH$8 colmatarea sondei;
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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
XUHWUHL HVWH SUDFWLF LPSRVLELO VWULFWXUL XUHWUDOH UXSWXU GH XUHWU
FDOH IDOV FUHDW SULQ PDQHYUDUH LQWHPSHVWLY, etc.) iar pacientul
HVWH vQ UHWHQLH FRPSOHW GH XULQ VDX FkQG UHWHQLD FRPSOHW GH
XULQ D DSUXW vQ FRQWH[WXO XQHL SURVWDWLWH DFXWH LDU FDWHWHULVPXO
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antisepsie fiind obligatorii!
3UHJWLUHDSDFLHQWXOXL



 
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666 B,2
deasupra simfizei pubiene, perpendicular pe planual abdominal.
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6. Anestezice generale
I. Metoxifluran
7. Anticoagulante
I. Dicumarol
II. Fenindiona
8. Anticonvulsivante
I. Oxazolidindione
9. Antidiabetice orale
I. Clorpropamida
Fig. VI.2 3XQFLDVXSUDSXELDQ
II. Tolbutamida
10. Antihipertensive
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4. HYLWDUHDDGPLQLVWUULLGHGLXUHWLFHvQVSHFLDO DDQXPLWDSUREDVRQGHL vLYDUHOXDPLFLXQLOH
uricozurice;
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persoanele cu risc crescut la care examinarea nu poate fi urinare cu un endoscop rigid sau flexibil.
HYLWDW Vizualizarea lumenului uretral, a mucoasei vezicale, a
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1. Antibiotice Chimioterapice SULQDFHVWHRULILFLLVXQWUHSHUHHVHQLDOHvQVWDELOLrea diagnosticului
a. Aminoglicozide L LPSOLFLW a conduitei terapeutice n multe DIHFLXQL XURORJLFH vQ
I. toate
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IV. Chimioterapice antibacilare
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A. Rifampicina
V. $OWHDQWLELRWLFHLFKLPLRWHUDSLFH permite pasajul direct al instrumentului, alternativa recomandat
A. Demeclociclina ILLQG UHSUH]HQWDW GH DYDQVDUHD LQVWUXPHQWXOXL VXE FRQWURO YL]XDO
96 +8
direct (uretro-cistoscopie). Unghiul lentilei permite endoscopistului
966 (
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0 fXUQL]HD]RLPDJLQHSHGLUHFLDWHOHVFRSXOXLILLQGRSWLPHSHQWUX
explorarea uretrei, cele de 30 permit vizualizarea peretilor laterali
L SRVWHULRU YH]LFDOL vQ WLPS FH OHQWLOHOH GH  VXQW XWLOH SHQWUX
HYDOXDUHDFRUHFWDGRPXOXLYH]LFDOVLD]RQHLDQWHUioare a colului
vezical.
&RQWUDLQGLFDLLOH uretrocistoscopiei sunt reprezentate de -
LQIHFLD XULQDU LPSRVLELOLWDWHD DYDQVULL LQVWUXPHQWDUXOXL GDWRULW


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unor stricturi uretrale, OLSVD XQHL FRODERUUL DGHFYDWH GLQ SDUWHD doze mari, discontinue, la repetarea tratamentului cu
pacientului. 5LIDPSLFLQ 3UH]HQD GH DQWLFRUSL L FRPSOH[H LPXQH DWHVW
,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

DGPLQLVWUDUHD RUDO GH IOXRURFKLQRORQH VDX 7ULPHWRSULP- QXPDL SHQWUX FD]XUL ELQH VHOHFWDWH FkQG QX H[LVW R DOW
DOWHUQDWLY 9D IL XUPULW FRUHFW GLXUH]D SHQWUX D VXUSULQGH
6XOIDPHWR[D]ROSHQWUXRGXUDWGHPD[LPGHRUH
PRPHQWXO LQVWDOULL SROLXUHL FD VHPQ DO LQVWDOULL GLVIXQFLHL
Pacientul va fi pus pe masa de cistoscopiH vQ SR]LLH
UHQDOHvQVRLWGHGHWHUPLQDUHDSHULRGLFDGHQVLWLLXULQDUHL
JLQHFRORJLF'XSEDGLMRQDUHDFXVROXLHDQWLVHSWLF %HWDGLQ D
monitorizarea clerence-XOXL FUHDWLQLQHL 'DF VH FRQVWDW
RUJDQHORU JHQLWDOH L D UHJLXQLL SHULQHDOH VH LQWURGXFH SH XUHWU
GHWHULRUDUHD IXQFLHL UHQDOH VH RSUHWH DGPLQLVWUDUHD L VH
jelly-DQHVWH]LFRVXEVWDQXOHLRDVFXUROOXEUHILDQW, antiseptic L ncepe tratamentul adecvat al IRA.
anestezic; pensarea penisului pentru 3-5 minute va facilita 6H YD HYLWD XWLOL]DUHD vQ GR]H PDUL FXUH SUHOXQJLWH L
contactul cu mucoasa, instalndu-VHDQHVWH]LDORFDO 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
acesteia sunt:
cisWRVFRSXO L VH SURJUHVHD] OD YHGHUH VSUH XUHWUD SURVWDWLF
1. LQVXILFLHQDUHQDOSUHH[LVWHQW
evalundu-se aspectul mucoasei uretrale, eventuale stricturi, 2. QHIURSDWLDGLDEHWLFFXSURWHLXQXULHPDLPDUHGH
tumori, calculi migraL. 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:
 1. OLPLWDUHD H[DPHQHORU FX VXEVWDQ GH FRQWUDVW OD
Fig.VI.3. 3R]LLDEROQDYXOXLSHPDVDGHFLVWRVFRSLH
persoanele cu risc crescut;


  
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VHSRWUHJVLWRDWHDFHVWH PDQLIHVWULHVWHGHQHIURSDWLLWR[LFH $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[FHSLDFHIDORULGLQHL HULWURPLcina, cotrimoxazolul, lincomicina, GHVFKLV ODSURVWDW
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

  
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Avantajele principale ale cistoscopiei flexibile sunt : $FLXQHWHUDSHXWLF: analog de hormon antidiuretic.
,QGLFDLL HQXUHVLVQLFWXULHGLDEHWLQVLSLGFROLFDUHQDO "
- tolerabilitatea superioDU
Mod de administrare: VHDGPLQLVWUHD]GHSUHIHUDWODDFHHDL
- SRVLELOLWDWHDHIHFWXULLvQGHFXELWGRUVDO RU vQDLQWH GH PHVH FRPSULPDWXO QX VH LQJKLWH FL VH WRSHWH
sub limb.
- XXULQDDYDQVULLLQVWUXPHQWXOXLvQFRQGLLLOHXQXLFROYH]LFDOvQDOW
Contraindicatii: $OHUJLH VSHFLILF cardiopatia LVFKHPLF
- capacitatea de flectare a vrfului endoscopului fapt care permite epilepsia IHPHL JUDYLGH KLSRQDWUHPLH DOWH DIHFLXQL FH
QHFHVLWWUDWDPHQWGLXUHWLFSROLGLSVLDKDELWXDOVDXSVLKRJHQ
YL]XDOL]DUHDvQWUHJLLYH]LFLXULQDUHLLQVSHFLDFROXOXLYH]ical.
LQVXILFLHQDUHQDOVHYHUERDODYRQ:LOOHEUDQG,LE
Video-uretrocistoscopia permite imaginilor att din 5HDFLL DGYHUVH IULWDLD mucoasei nazale, cefalee,
HQGRVFRSLD ULJLG FkW L GLQ FHD IOH[LELO V ILH SURLHFWDWH SH XQ 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
Nefrotoxicitatea pentru a evita instalarea sau
III. ELECTRORE=(&,$75$1685(75$/ SUHFLSLWDUHDXQHLGLVIXQFLLUHQDOH
5H]HFLDWXPRULLYH]LFDOH sau TUR-9UHSUH]LQWRLQWHUYHQLH 1HFHVLWDWHD DGDSWULL SRVRORJLHL vQ IXQFLH GH
FKLUXUJLFDOHQGRVFRSLFHVWHR continuare a cistoscopiei (pe care YDORDUHDILOWUDWXOXLJORPHUXODU JUDGXOLQVXILFHQHLUHQDOH 
R HIHFWXP vQ UDKLDQHVWH]LH  L FDUH FRQILUP H[LVWHQD XQHL Arsenalul farmacoterapeutic urologic cuprinde n
IRUPDLXQL WXPRUDOH (D HVWH UHFRPDQGDW SHQWUX VWDGLLOH 7 a, T1 VSHFLDOJUXSHGHPHGLFDPHQWHDFURULPSDFWDVXSUDIXQFLHL

XQGH VH FRQVLGHU F HVWH WUDWDPHQW FX YL] radical. Se UHQDOHHVWHLPSRUWDQWVILHFXQRVFXW(VWHYRUEDGHVSUH


antibiotice;
HIHFWXHD]LvQVWadii mai avansate, T2vQVSHUDQDFSHQHWUDLD
antiinflamatorii nesteroidiene (AINS);
vQVWUDWXOPXVFXODUQXHVWHSUHDSURIXQGLSXWHPUH]HFDSkQvQ
VXEVWDQHGHFRQWUDVW
HVXWXO PXVFXODU OLEHU Q 7 L 7 VH SUDFWLF QXPDL vQ VFRS
EfecWXO QHIURWR[LF GHWHUPLQ OH]LXQL LQWHUVWLLDOH VDX
GLDJQRVWLF VDX SDOHDWLY KHPRVWD] VDX PULUHD FDSDFLWLL
JORPHUXODUH H[SULPDWHFOLQLFSULQLQVXILFLHQUHQDODFXWVDX
vezicale, cnd nu se pRDWHHIHFWXDFLWHFWRPLDWRWDO
FURQLFSHULQLFKLQRUPDOLDQWHULRUXWLOL]ULLPHGLFDPHQWHORU'H
5H]HFLD vQFHSH GLQVSUH ]RQD OLEHU D WXPRULL VSUH ED]D HL,
PHQLRQDW F DFHODL DJHQW WR[LF PHGLFDPHQWRV SRDWH
DGLFVSUHSHUHWHOHYH]LFDO ILJ9, 6HWDLHIUDJPHQWHWXPRUDOH
GHWHUPLQD OH]LXQL L PDQLIHVWUL FOLQLFH PXOWLSOH L UHFLSURF
FX EXFOD DQVHL FDUH DSRL YRU IL H[WUDVH FX R VHULQJ VSHFLDO
DFHODL WDEORX FOLQLF SRDWH IL GHWHUPLQDW GH R PXOWLWXGLQH GH
*X\RQ FX FDSDFLWDWH PDUH L FDUH VH DWDHD] OD WHDFD

 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 UH]HFWRVFRSXOXL &KLDU GDF ED]D WXPRULL HVWH vQJXVW OD FHOH
$FLXQHWHUDSHXWLFchimioterapic antineoplazic. papLODUH QX QH OFRPLP V R WLHP GH OD vQFHSXW ILLQF WXPRUD
,QGLFDLL WXPRUL YH]LFDOH GXS UH]HFLD HQGRVFRSLF a
acestora. HOLEHUDW QX YD SXWHD IL H[WUDV 1X VH IDFH KHPRVWD] GXS
Mod de administrare: LQVWLODLLLQWUDYH]LFDOH cu 50 mg n 50 ml ILHFDUHIUDJPHQWWLDWFLQXPDLFkQGVHvQWkOQHWHXQYDVPDLDFWLY
VHURLQVWLODLHVSWPkQVSWPkQLGXS785-V.
5HDFLL DGYHUVH locale: polakiurie, hematurie (fenomene de SH PVXU FH QH DSURSLHP GH ED] /D SHUHWHOH YH]LFDO
FLVWLW FKLPLF  JHQHUDOH DPHHOL JUHD IHEU KLSRWHQVLXQH hemostaza sHIDFHULJXURVODYHGHUHSHWRDWVXSUDIDDUH]HFDW
Asocieri medicamentoase: 'R[RUXELFLQ  KLGURSURSLOFHOXOR]
XQ DGH]LY OD PXFRDVD YH]LFDO  ! FUHWH FRQFHQWUDLD 'XS UH]HFLH VH LQVWDOHD] R VRQG )ROH\ SHQWUX  zile, pentru
FKLPLRWHUDSLFODQLYHOXOPXFRDVHLYH]LFDOH'R[RUXELFLQ limpezirea urinii.
7KLRWHSDVDX0LWRPLFLQ&- efect sinergic.

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 Fig.VI.4. 5H]HFLDWXPRULLYH]LFDOH
timp posibil. 6H SRW vQWkPSOD XQHOH LQFLGHQWH vQ WLPSXO UH]HFLHL &nd
5HDFLL DGYHUVH FLVWLW FKLPLF KHPDWXULH IHEU GXUHUL UH]HFPSUHDFXUDMRVSXWHPperfora peretele vezical:
HSLJDVWULFHUHDFLLFXWDQDWH VXEIRUPGHHF]HPGHFRQWDFW
UDVKSDOPDUGHVFXDPDLL - FkQGDFHDVWSHUIRUDLH VHSHWUHFHvQ]RQDIL[DYH]LFLL
Asocieri medicamentoase: 'R[RUXELFLQ  0LWRPLFLQ C DGLF WULJRQ VDX SHUHL ODWHUDOL QX HVWH QHYRLH GH DOWH JHVWXUL
HIHFW VLQHUJLF 0LWRPLFLQ &  hipertermie - XQ SRWHQLDO
adjuvant important. WHUDSHXWLFHFLSXULVLPSOXVHPHQLQHVRQGDXUHWUR-YH]LFDOPDL
XVI. TRATAMENTUL NOCTURIEI SI ENUREZISULUI multe zile.
1.Minirin Melt (desmopresina) - FkQG SHUIRUDLDHVWHvQVSHFDORWHDYDILvQFDYLWDWHD
3UH]HQWDUH IDUPDFHXWLF trochisti de contin 60 respectiv 120 SHULWRQHDO ILLQG QHFHVDU LQWHUYHQLD FKLUXUJLFDO vQ YHGHUHD
PLFURJUDPHVXEVWDQDFWLY


  
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VXWXUULLYH]LFLLXULQDUH FLVWRUDILH LDGUHQULLFDYLWLLSHULWRQHDOH. Prezentare farmaceutica: comprimate cu 250 mg abiraterona


acetat.
2DOWVLWXDLHcare poate determina DSDULLDXQHLSHUIRUDLL
Actiune terapeutica: inhibitor puternic al citocromului steroidal
VHvQWkPSOFkQGWXPRUDVHDIOSHSHUHWHOHODWHUDO LODUH]HFLH 3 &<3 LQKLEkQGDVWIHOHQ]LPDFDUHGHWHUPLQVLQWH]D
WHVWRVWHURQXOXLDWkWvQJODQGHOHVXSUDUHQDOFkWLvQWHVWLFXO
VDUH REWXUDWRUXO 'DF DFHVW OXFUX HVWH FXQRVFXW vQDLQWH GH
,QGLFDLL WUDWDPHQWXO FDQFHUXOXL GH SURVWDW PHWDVWDWLF
RSHUDLHVDXUHFXQRVFXWvQFXUVXOFLVRVFRSLHLSRDWHILSUHYHQLWSULQ rezistent la castrare n asociere cu analogi de LH-RH.
Mod de administrareGR]DUHFRPDQGDWHGHPJ FS 
modificarea formei de anestezie, excitarea obturatorului putnd
FD GR] XQLF ]LOQLF 7UHEXLH DGPLQLVWUDW FX GR]H PLFL GH
ILSUHYHQLWSULQDQHVWH]LHJHQHUDOFXLQWXEDLHRUR-traheaO prednisol sau prednisolol ( 10 mg/zi).
&RQWUDLQGLFDLL KLSHUVHQVLELOLWDWH OD VXEVWDQD DFWLY
5H]HFLDDGHQRPXOXLGHSURVWDW sau TUR-P. iQVXILFLHQDKHSDWLFVHYHU FODVD&&KLOG-Pugh)
Se SUDFWLFvQJHQHUDOSHQWUXDGHQRDPHGHSkQOD-60 5HDFLL DGYHUVH DQHPLH GLVIXQFLH VH[XDO KLSHUWHQVLXQH
DUWHULDOKLSRSRWDVHPLHUHWHQLHGHOLFKLGHHGHPHSHULIHULFH
FPF VH HFKLYDOHD]  FPF FX  J HVXW SURVWDWLF  (QGRVFRSLWLL
H[SHULPHQWDL SRWUH]HFD VLDGHQRDPHPDLPDUL5H]HFLDFRQVW ;9,,167,/$,,,175$9(=,&$/(
GLQ WLHUHD GH HVXW SURVWDWLF FX EXFOD DQVHL GLQVSUH LQWHULRUXO
1.BCG:
prostatei SkQODFDSVXODVDIUDJPHQWHOHILLQGXOWHULRUndeprtate. 3UH]HQWDUH IDUPDFHXWLF suspensie de bacilli Calmette
ILJ9, 3UDFWLFXUHWUDSURVWDWLFVHGHVILLQHD]WUDQIRUPkQGX-se *XHULQ YLL 0\FREDFWHULXP ERYLV  OLRILOL]DW 7 mg
imunostimulent BCG liofilizat; solvent (lichid de suspensionare
ntr-o cavitate. )UDJPHQWHOH GH HVXW UH]HFDW VH vQGHSUWHD] FX Sautan diluat 3 ml).
DFHHDLVHULQJ*X\RQ'DFUPkQIUDJPHQWHGHHVXWvQYH]LF $FLXQHWHUDSHXWLFimunomodulator.
,QGLFDLL LPXQRVWLPXOHQW GXS LQWHUYHQLL FKLUXUJLFDOH SHQWUX
ele pot dHWHUPLQDFRPSOLFDLLUHWHQLHGHXULQODVFRDWHUHDVRQGHL WXPRUL PDOLJQH GH YH]LFL XULQDUH GH VkQ GLJHVWLYH EURQLFH
LQIHFLLSHUVLVWHQWHIRUPDUHGHFDOFXOL 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
Fig.VI.5 5H]HFLD HVXWXOXLSURVWDWLF
LPXQRVXSUHVRDUH LQIOXHQHD] UVSXQVXO OD LPXQRVWLPXOHQW
BCG - ULVFLQIHFLL%&*JHQHUDOL]DWHWUDWDPHQWFRQFRPLWHQWVDX
n antecendente cu un imunomodelator poate avea efecte
negative asupra imunostimulului BCG.


  
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Indicatii: WUDWDUHD SDFLHQLORU FX FDQFHU GH SURVWDWD vQ VWDGLX $YDQWDMXOUH]HFLHLIDGHLQWHUYHQLDGHVFKLVHVWHF
avansat.
SRL IDFH KHPRVWD]D la YHGHUH coagulnd direct artera sau
Mod de administrare: 'R]DLQLLDOGHPJDGPLQLVWUDWFD
GRX LQMHFLL XOWHULRU OXQDU FkWH R LQMHFLH VXEFXWDQDW Este YHQD L DLFL KHPRVWD]D QX VH IDFH GXS ILHFDUH WLHUH ILLQGF
LQWHU]LVinjectarea LQWUDYHQRDV VDXLQWUDPXVFXODU
DFHODL YDV GH VkQJH vO UHJVHWL GH PDL PXOWH RUL PHUJkQG vQ
&RQWUDLQGLFDLL KLSHUVHQVLELOLWDWH OD VXEVWDQD DFWLY VDX la
oricare GLQWUHH[FLSLHQL SURIXQ]LPH VSUH FDSVXO $MXQL OD FDSVXO WUHEXLH V IDFHP R
5HDFLL DGYHUVH DQHPLH FUHWHUH vQ JUHXWDWH LQVRPQLH
DPHHDO FHIDOHH GLDUHH JUHD FUHWHUHD WUDQVDPLQD]HORU FRDJXODUH HILFLHQW &HD PDL PDUH JULM WUHEXLH V R DFRUGP
hepatice. VkQJHUULL DUWHULDOH ILLQGF HD QX SRDWH IL FRQWURODW SULQ
IV. Antiandrogeni
FRPSUHVLXQH FX EDORQDXO VRQGHL )ROH\ FD FHD YHQRDV 'H
1. CASODEX (Bicalutamida)
3UH]HQWDUH IDUPDFHXWLF comprimate filmate de 50, 150 mg DVHPHQHD KHPRVWD]D OD QLYHOXO FROXOXL YH]LFDO WUHEXLH V ILH PDL
$FLXQH WHUDSHXWLF $QWDJRQLWL KRUPRQDOL FDUH EORFKHD] DWHQWIDGHDOWH]RQHILLQGFODDFHVW QLYHOQXH[LVWRVXILFLHQW
receptorii pentru androgeni ai celulelor prostatice.
,QGLFDLLFDQFHUGHSURVWDW metastazat n asociere cu analogi FRPSUHVLXQH D EDORQDXOXL VRQGHL )ROH\ /D ILQDOXO UH]HFLHL VH
LH-5+VDXRUKLHFWRPLDELODWHUDO LQVWDOHD] R VRQG )ROH\ HYHQWXDO FX GXEOX FXUHQW FDUH VH
Mod de de administrare: oral, 1 tb de 50 mg pe zi.
5HDFLL DGYHUVH EXIHXUL SUXULW JLQHFRPDVWLH WXOEXUUL PHQLQH-3 zile.
GLJHVWLYH JUHD YUVWXUL  DIHFWDUH KHSDWLF WUDQ]LWRULH 6H SRWvQWkPSODXQHOHLQFLGHQWHLvQ WLPSXODFHVWXLWLSGH
VFGHUHDOLELGRXOXLDVWHQLH
&RQWUDLQGLFDLL femei L FRSLL KLSHUVHQVLELOLWDWH OD UH]HFLH2ULFDUHHQGRVFopist poate deschide un sinus venos cnd
bicalutamida. taie prea profund, cu sngerare masiv. n acest caz se
$VRFLHUHXWLO: analogi LH-RH.
HIHFWXHD] R FRDJXODUH LQVLVWHQW L FkQG QX HVWH VXILFLHQW VH
2. EULEXIN )OXWDPLG  XPIOEDORQDXOVRQGHLPDLPXOWLDFHDVWDVHPHQLQHWUDFLRQDW
3UH]HQWDUHIDUPDFHXWLFcps 250 mg.
$FLXQH WHUDSHXWLF DQWLDQGURJHQ SHULIHULF EORFKHD] prin &RQWLQXDUHDUH]HFLHLFXVLQXVGHVFKLVSRDWH GXFH ODSWUXQGHUHD
FRPSHWLLHUHFHSWRULLSHQWUXdihidrotestosteron). FUHVFXWGHDSvQFLUFXLWXOVDQJXLQFXULVFXOLQVWDOULLLQWR[LFULLFX
Mod de administrare: oral, 1 cp x 3/zi.
&RQWUDLQGLFDLLKLSHUVHQVLELOLWDWHODIOXWDPLG VDXODH[FLSLHQL DSLLQVWDODUHDXQXLsindrom TUR.
SUXGHQ DIHFLXQL KHSDWLFH vQ DVRFLHUL FX DQWLFRDJXODQWH 2 DOW FDSFDQ R FRQVWLWXLH GRULQD GH D UH]HFD FkW PDL
5HDFLL DGYHUVH JLQHFRPDVWLH JUHD YUVWXUL PRGLILFUL
WUDQ]LWRULL D IXQFLHL KHSDWLFH VFGHUHD OLELGRXOXL DQRUH[LH PXOW vQ ]RQD YHUXPPRQWDQXP OLPLWD GLVWDO D XUHWUei prostatice),
edeme, echimoze, prurit, sdr. lupus-like, cefalee, vertij, anemie dar care este foarte aproape de sfincterul striat, voluntar al uretrei.
KHPROLWLF LFWHU FROHVWDWLF VGU GH VXSUHQVLH DQGURJHQLF la
SDFLHQLL FDUH QX PDL UVSXQG OD EORFDGD DQGURJHQLF /H]DUHDDFHVWXLDGXFHODRSHQLELOFRPSOLFDLHSHQWUXSDFLHQWGDU
PD[LPDO WUDWDPHQW LQWHUPLWHQW FX )OXWDPLGD VWDELOL]HD] L SHQWUX PHGLF L DQXPH LQFRQWLQHQD XULQDU. De aceea este
HYROXLDSHQWUXXQWLPS
Asocieri medicamentoase: analogi LH-RH. PDL ELQH V evaluezi bine situatia cnd rezeci un adenom. Dect
un sindrom TUR, mai bine un RE-TUR. Sau dect un incontinent
V. Inhibitori ai sintezei de androgeni
XULQDU PDL ELQH UH]HFL GH GRX RUL $GLF HVWH GH SUHIHUDW R
1. ABIRATERONE (Zytiga)

$
  
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UHLQWHUYHQLHGHFkWVULWLRFRPSOLFDLH ILHFDUH OXQ  PJ  VDX OD ILHFDUH  VSWPkQL  PJ 
,QGLFDLL FDQFHU GH SURVWDW PHWDVWD]DW FDQFHU GH SURVWDW
Deblocarea de col vezical sau TUR-$'. FRQVW n
ORFDO DYDQVDW FD R DOWHUQDWLY OD RUKLHFWRPLD ELODWHUDO
UH]HFLD DGHQRFDUFLQRPXOXL GH SURVWDW 'HVLJXU, tratamentul de Tratamentul adjuvaQW DO SURVWDWHFWRPLHL UDGLFDOH HIHFWXDW vQ
stadiul local avansat.
HOHFLH SHQWUX QHRSODVPXO SURVWDWLF HVWH SURVWDWHFWRPLD UDGLFDO
5HDFLL DGYHUVH EXIHXUL VFGHUHD OLELGRXOXL VFGHUHD
&RQGLLDHVWHVVXUSULQ]LDIHFLXQHDvQVWDGLLOHLQLLDOHVLWXDLHFDUH WROHUDQHLODJOXFR]UDUJLQHFRPDVWLH
$VRFLDLLXWLOHantiandrogeni (Casodex).
GLQSFDWHVHvQWkPSOPXOWSUHDUDU
0DMRULWDWHD SDFLHQLORU FX DGHQRFDUFLQRP GH SURVWDW VH
2.ELIGARD /HXSURUHOLQ 
SUH]LQW OD PHGLF FX UHWHQLH FRPSOHW GH XULQ FkQG VWDGLXO 3UH]HQWDUH IDUPDFHXWLF - liofilizat L VROYHQW SHQWUX VROXLH
LQMHFWDELOPJPJPJ
LQWHUYHQLHL UDGLFDOH HVWH GHSLW ILLQG QHFHVDU LQWHUYHQLD
,QGLFDLL SHQWUX WUDWDPHQWXO FDQFHUXOXL GH SURVWDW
SDOLDWLYGHEORFDUHHQGRVFRSLFGHFROYH]LFDOKRUPRQRWHUDSLH hormonodependent, n stadiu avansat.
Mod de administrare: (OLJDUGVHDGPLQLVWUHD] sub forma unei
5H]HFLD HVWH DVHPQWRDUH FX FHD a adenomului de
sinJXUH LQMHFLL VXEFXWDQDWH 6ROXLD LQMHFWDW IRUPHD] XQ
SURVWDW GDU HVWH PDL SXWLQ VkQJHUkQG VL IU SUHWHQLH GH D GHSR]LW VROLG FX HOLEHUDUH SUHOXQJLW FDUH YD HOLEHUD FRQWLQXX
DFHWDWGHOHXSURUHOLQ
DMXQJHODFDSVXO6HLQVWDOHD]RVRQG)ROH\HYHQWXDOFXGXEOX &RQWUDLQGLFDLL +LSHUVHQVLELOLWDWH OD DFHWDW GH OHXSURUHOLQ OD
FXUHQWFDUHVHPHQLQH]LOH DOLDJRQLWLDL*Q5+VDXODRULFDUHGLQWUHH[FLSLHQL/DSDFLHQLL
FDUH DX IRVW RUKLHFWRPL]DL vQ SUHDODELO FD L OD DOL DJRQLWL DL
,QFL]LD WUDQVXUHWUDO GH SURVWDW (ITUP) sau incizia GnRH, Eligard nu scade valorile plasmatice de testosteron mai
colului vezical LPSOLF VHFLRQDUHD SULQ SURVWDWD REVWUXFWLY FX XQ PXOW GHFkW vQ FD]XULOH GH FDVWUDUH FKLUXUJLFDO  (OLJDUG HVWH
FRQWUDLQGLFDWODIHPHLLFRSLL
FXUHQWHOHFWULFGHvQDOWIUHFYHQIRORVLQGRDQV special. 5HDFLL DGYHUVH EXIHXUL VWDUH GH UX RERVHDO L WUDQ]LWRU
$FHDVWWHKQLFHVWHDGHFYDWGRDUSURVWDWHORUPLFLFXXQ LULWDLH ORFDO OD ORFXO LQMHFWULL /D DSUR[LPDWLY  GLQWUH
SDFLHQLDSDUEXIHXULLPSRWHQVFGHUHDOLELGRXOXL DPEHOHFD
col vezical nalt L IU ORE PHGLDQ 2 LQFL]LH HVWH HIHFWXDW GLQ R FRQVHFLQ D VFGHULL FRQFHQWUDLHL SODVPDWLFH D
]RQD VLWXDW VXE RULILFLXO XUHWHUDO XQL VDX ELODWHUDO L H[WLQV SULQ testosteronului  HGHPH SHULIHULFH HPEROLH SXOPRQDU
SDOSLWDLL PLDOJLL KLSRWRQLH PXVFXODU IULVRDQH GLVSQHH YHUWLM
FROXO YH]LFDO SkQ OD  FP SUR[LPDO GH YHUXPRQWDQXP (VWH HUXS LL FXWDQDWH DPQH]LH WXOEXUUL GH YHGHUH L VHQVLELOLWDWHD
SRVLELO R VkJHUDUH SRVWRSHUDWRULH YDULDELO FD LQWHQVLWDWH PRWLY pielii.
,,,$QWDJRQLti LH-RH
SHQWUX FDUH LQWHUYHQLD HVWH XUPDW GH LQVHULD XQXL FDWHWHU
uretrovezical dotat cu sLVWHPGHLULJDLHYH]LFDOSHQWUXRSHULRDG 1. Degarelix
Prezentare farmaceutica: )ODFRQFHFRQLQHPJGHJDUHOL[
de 24-48 de ore. VXEIRUPde acetat 'XSUHFRQVWLWXLUHILHFDUHPOGHVROXLH
5H]XOWDWHOH VXQW H[FHOHQWH FX R LQFLGHQ IRDUWH PLF D FRQLQHPJGHJDUHOL[
$FLXQH WHUDSHXWLF antagonist al hormonului eliberator de
FRPSOLFDLLORU HMDFXODUHD UHWURJUDG ILLQG vQUHJLVWUDW OD PDL SXLQ JRQDGRWURILQ *Q5+  LQGLFDW SHQWUX WUDWDPHQWXO SDFLHQLORU
GHGLQSDFLHQLLQFRQWLQHQXULQDUvQLPSRWHQvQ- DGXOL GH VH[ PDVFXOLQ FX FDQFHU GH SURVWDW KRUPRQR-
dependent n stadiu avansat. Degarelix reduce cantitatea de
15%. testosteron din organism si ncetineste dezvoltarea celulelor

 canceroase.
 !
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Mod de administrare: 'R]D X]XDO LQFOXVLY SHQWUX batrni) IV. 1()52/,7,75,,$3(5&87$1$7 1/3
este de 5 mg de 2-3 ori pe zi
1HIUROLWRWRPLDSHUFXWDQDWHVWHRLQWHUYHQLHFKLUXUJLFDOPLQLP
&RQWUDLQGLFDLL JODXFRP GLVXULH GDWRUDW XQXL VLQGURP
REVWUXFWLY KLSHUWURILH EHQLJQ GH SURVWDW VDX DOW FDX]  LQYD]LYSULQFDUHVHSDWUXQGHFXQHIURVFRSXOSHUFXWDQDWSkQOD
PLDVWHQLHVHYHUGLILFXOWDLGHIRUPDUHDMHWXOXLXULQDUGDWRUDWH
QLYHOXO VLVWHPXOXL SLORFDOLFHDO XQGH VH UHSHUHD] L GLVWXJH SULQ
DGHQRPXOXL GH SURVWDW, boli intestinale (inclusiv REVWUXFLL
intestinale si colite), tiroide hiperactive, sarcina, perioada de diferite metode (ultUDVRQLF EDOOLVWLF ODVHU  FDOFXOL VLWXDL OD DFHVW
ODFWDLHLSHULRDGDGHSUHFRQFHSLHFRSLLVXEYkUVWDGHDQL
nivel.
5HDFLL DGYHUVH: XVFFLXQHD JXULL FRQVWLSDLH YHGHUH
vQFHRDWVHQ]DLHGHUXGXUHULVDXDUVXULJDVWULFHvQURLUHD ,QGLFDLLOH1/3
IHHL vQVSHFLDOODFRSLL VLGLILFXOWLGHPLFLXQH
x Calcul bazinetal voluminos (peste 2-3cm) VDX OLWLD]
4. Mirabegron ( Betmiga) PXOWLSOORFDOL]DWvQED]LQHW
3UH]HQWDUH IDUPDFHXWLF FRPSULPDWH FX HOLEHUDUH SUHOXQJLW
FHFRQLQUHVSHFWLYPJPLUDbegron. x Calcul coraliform (NLP singur sau NLP + ESWL);
$FLXQH WHUDSHXWLF Atunci cnd urina se acumuleaza n x &DOFXODQFODYDWvQMRQFLXQHDSLHOR-XUHWHUDOFXULQLFKLPXW
YH]LFD XULQDU SUHGRPLQ VWLPXODUHD QHUYRDV VLPSDWLF FX
activarea receptorilor beta-DGUHQHUJLFL GLQ PXVFXODWXUD QHWHG urografic;
0LUDEHJURQ DFLRQHD] FD XQ DJRQLVW SRWHQW L VHOHFWLY DO x /LWLD] UHQDO XQLF VDX PXOWLSO VHFXQGDU VWHQR]HL
receptorilor beta 3-adrenergici determinnd relaxarea
musculaturii netede la nivelul vezicii urinare. FRQJHQLWDOHVDXFkWLJDWHDMRQFLXQLLSLHOR-uretrale.
,QGLFDLL WUDWDPHQWXOVLPSWRPDWLFDOLPSHULR]LWLLPLFLRQDOHDO &RQWUDLQGLFDLLOH1/3
IUHFYHQHL PLFLRQDOH FUHVFXWH LVDX DO LQFRWLQHQHL SULQ
LPSHULR]LWDWHPLFLRQDO a) Absolute: WXOEXUULGHFRDJXODUHFHSUHGLVSXQODVkQJHUUL
Mod de administrare: 'R]D UHFRPDQGDW HVWH GH  PJ R JUDYH FRQWUROXOSHUDPHWULORUFRDJXOULLHVWHREOLJDWRULXFD
GDWSH]LFXVDXIUDOLPHQWH
&RQWUDLQGLFDLL KLSHUVHQVLELOLWDWHODVXEVWDQDDFWLY LSHQWUX(6:/856VDXWUDWDPHQWFKLUXUJLFDO 
5HDFLL DGYHUVH LQIHFLL GH WUDFW XULQDU WDKLFDUGLH GLVSHSVLH SDFLHQWHOHFXVDUFLQ PDLDOHVvQSULPHOHOXQL SHQWUXF
urticarie.
H[LVWXQULVFFUHVFXWGHPDOIRUPDLLvn contextul expunerii
XV. MEDI&$,$11(23/$608/'(35267$7 ODUDGLLLOH;SDFLHQLLQHFRRSHUDQLvQFRP
I. Analogi LH-RH b) Relative: GLDEHWXO ]DKDUDW GHFRPSHQVDW DIHFLXQL FDUGLR-
UHVSLUDWRULL GHFRPSHQVDWH XOFHU GXRGHQDO vQ ID]D DFWLY
1. ZOLADEX *RVHUHOLQ 
3UH]HQWDUH IDUPDFHXWLF implant ntr-R VHULQJ SUHXPSOXW ,QIHFLLOH XULQDUH QHVSHFLILFH QHWUDWDWH VDX QHFXQRVFXWH
ntr-un ambalaj protector (3,6 mg; 10,8 mg); anterior inteUQULL QHFHVLW XQ WUDWDPHQW LQWHQVLY FX
$FLXQH WHUDSHXWLF prin administrarea de doze repetate
LQKLE VHFUHLD KLSRIL]DU GH /+ GHWHUPLQkQG VFGHUHD DQWLELRWLFH FRQIRUP DQWLELRJUDPHL vQDLQWH GH SURFHGXU
FRQFHQWUDLHLSODVPDWLFHDWHVWRVWHURQXOXLODEUEDL'XS ([LVWHQD XQXL SURFHV EDFLODU DFWLY VH VXSXQH DFHORUDL
GH ]LOH GH OD DGPLQLVWUDUHD SULPHL GR]H FRQFHQWUDLLOH
plasmatice ale testosteronului ating valori similare cu cele UHJXOL DIHFLXQLOH FDUGLR-vasculare aflate sub tratament cu
LQGXVHGHFDVWUDUHDFKLUXUJLFDO anticoagulante (Trombostop), pot beneficia de tratament
Administrare: LQMHFWDUH VXEFXWDQDW n peretele abdominal la


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SULQ 1/3 GXS RSULUHD DQWLFRDJXODQWHORU FX  ]LOH L Mod de administrare: 'R]DUHFRPDQGDWHGHPJRGDWSH
]L OD QHYRLH SRDWH IL PDULW OD PJ R GDWD SH ]L QX HVWH
YHULILFDUHDULJXURDVDQRUPDOL]ULLSDUDPHWULORUFRDJXOULL
QHFHVDU DMXVWDUHD GR]HL OD SDFLHQLL FX LQVXILFLHQ UHQDO
$7(17,(DQRPDOLLOHGHIRUPLSR]LLHDULQLFKLORUVHSRW XRDUSkQODPRGHUDW FOHDUDQFHFUHDWLQLQD!POPLQ 
&RQWUDLQGLFDLL 5HWHQLH GH XULQ PHJDFRORQ PLDVWHQLH
vQVRL GH DQRPDOLL GH YDVFXODUL]DLH GH H[ ULQLFKLXO vQ
JODXFRP LQVXILFLHQ KHSDWLF VHYHU LQVXILFLHQ UHQDO
potcoDY  VHYHUEROQDYLVXEKHPRGLDOL]
5HDFLL DGYHUVH XVFFLXQHD JXULL GLVSHSVLH FRQVWLSDLH
,DWprincipalele etape ale procedurii:
WXOEXUULRFXODUH
 DH]DUHDSDFLHQWXOXL vQSR]LLHJLQHFRORJLF
2. Tolterodina
 uretrocistoscopia care va vizualiza orificiul ureteral de Prezentare farmaceutica: comprimate filmate de 1 respectiv 2
SDUWHD FDOFXOXOXL GDU VH YRU XUPUL L DOWH SRVLELOH OH]LXQL mg tolterodina
$FWLXQH WHUDSHXWLF antagonist specific competitiv al
asociate - ex: tumori vezicale); UHFHSWRULORUPXVFDULQLFLFHDFWLRQHD]VHOHFWLYDYkQGLQYLYRR
 instalarea unei sonde ureterale simple (5-&K  SkQ vQ DILQLWDWH FUHVFXW SHQWUX UHFHSWRULL GH OD QLYHOXO YH]LFLL XULQDUH
IDGHFHLGHODQLYHOXOJODQGHORUVDOLYDUH
ED]LQHWLLQMHFWDUHDVXEVWDQHLGHFRQWUDVW DPHVWHFDWFX ,QGLFDLL tratamentul vezicii urinare hiperactive cu simptome de
DOEDVWUX GH PHWLOHQ  SHQWUX YL]XDOL]DUHD L GHVWLQGHUHD polakiurie si PLFLXQL LPSHULRDVHLQVRLWHGHLQFRQWLQHQ
Mod de administrare: 'R]D UHFRPDQGDW HVWH GH  PJ GH 
sistemului pielo-caliceal; RUL SH ]L FX H[FHSLD SDFLHQLORU FX GLVIXQFLL KHSatice, la care
 UHSR]LLRQDUHD SDFLHQWXOXL SH PDVD GH RSHUDLH 'LQ GR]DUHFRPDQGDWHVWHGHPJGHRULSH]L
&RQWUDLQGLFDLL 7ROWHURGLQDHVWHFRQWUDLQGLFDWODSDFLHQLLFX
SR]LLDLQLLDOSDFLHQWXOHVWHDH]DWvQSR]LLHGHSURFXELW UHWHQLHXULQDU; forme necontrolate de glaucom cu unghi nchis;
FX SDUWHD SH FDUH VH DIO FDOFXOXO VSUH RSHUDWRU 6H miastenia gravis; antecedente de hipersensibilitate la
WROWHURGLQ VDX H[FLSLHQL IRUPH JUDYH GH FROLW XOFHUDWLY;
foloseste si pozitia de decubit dorsal in anumite situatii. megacolon toxic.
'H]LQIHFLDSLHOLLFXEHWDGLQLDH]DUHDFkPSXULORUVWHULOH 5HDFii adverse: XVFFLXQHD JXULL GLVSHSVLH  VFGHUHD
ODFULPDLHLGLVSHSVLHFRQVWLSDLHGXUHULDEGRPLQDOHIODWXOHQ
peste pacient sunt urPWRULLSDL YUVWXUL
 SXQFLD FDOLFHDO (VWH SXQFLRQDW GH RELFHL XQ FDOLFH
3. Oxibutinina
LQIHULRUGDUGDFVLWXDLDRLPSXQHLGDFHVWHSRVLELO H[ 3UH]HQWDUH IDUPDFHXWLF FRPSULPDWH FH FRQLQ  PJ
DERUGXO MRQFLXQLL SLHOR-XUHWHUDOH FDOFXOL LQFODYDL vQ R[LEXWLQLQFORUKLGUDW
$FLXQH WHUDSHXWLF EORFKHD] DQXPLL UHFHSWRUL GLQ
MRQFLXQHD SLHOR-XUHWHUDO  VH SRDWH DERUGD L FDOLFHOH RUJDQLVP QXPLL UHFHSWRULL PXVFDULQLFL 0 VL 0 /D QLYHOXO
mijlociu. 3XQFLD VH IDFH VXE FRQWURO IOXRURVFRSLF LVDX YH]LFLL XULQDUH HIHFWXO HVWH GH UHOD[DUH D PXFKLORU FDUH
FRQWUROHD]PLFLXQHD$FHDVWDGHWHUPLQFUHWHUHDFDQWLWLL
HFRJUDILF /D SWUXQGHUHD vQ FDOLFH VH VFXUJH OLFKLGXO GLQ GHXULQFDUHSRDWHILUHLQXWGHYH]LFDXULQDUVLPRGLILFDULDOH
sistemul pielo-FDOLFHDO VROXLD GH FRQWUDVW  DOEDVWUX GH PRGXOXLGHFRQWUDFWDUHDPXFKLORUYH]LFLLXULQDUHSHPDVXUFH
aceasta se umple.
PHWLOHQ  &RQVLGHU F HFRJUDILD RIHU R RULHQWDUH VSDLDO ,QGLFDLL LPSHULR]LWDWHXULQDUODfemeiFXVDXIUSLHUGHULGH
PDLEXQSULQHYLGHQLHUHDFDOLFHOXLSRVWHULRUSHUPLkQGR XULQ, n cazurile de YH]LF LQVWDELO FX H[FHSLD LQFRQWLQHQHL
urinare de efort - YH]LFDQHXURORJLF VSDVWLF

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DULWPLLQHFRQWURODWHKLSRWHQVLXQHDUWHULDO PP+J VDX SXQFLHPDLVLJXU


FXKLSHUWHQVLXQHDUWHULDOQHFRQWURODWSDFLHQLLFDUHXWLOL]HD]
 LQWURGXFHUHDILUXOXLJKLGSULQDFXOGHSXQFLH. Firul ghid
RULFHIRUPGHQLWUDWRUJDQLF
Reactii adverse: cele mai frecvente sunt cefaleea si dispepsia. HVWH R VkUP VSHFLDO FX XQ FDSW PRDOH QHDJUHVLY L
2. Avanafil
FHOODOW FDSW ULJLG 6H LQWURGXFH SULQ OXPHQXO DFXOXL LDU
Prezentare farmaceutica: coprimate cu 50 mg substanta
activa SDUWHD PRDOH VH YD vQFROFL vQ ED]LQHW LVDX FDOLFH VH
Actiune terapeutica: inhibitor selectiv, reversibil al
LQFL]HD] WHJXPHQWXO SH OkQJ DF DSUR[ FP GDU L vQ
fosfodiesterazei tip 5 (PDE5) cu specificitate pentru guanozin
monofosfatul ciclic (cGMP). SURIXQ]LPHGDFHVWHSRVLELOSkQODDSRQHYUR]
Indicatii: WUDWPHQWXOGLVIXQFLHLHUHFWLOHODEDUEDW
Mod de administrare: GR]D UHFRPDQGDW H GH  PJFX   dilatarea traiectului de nefrostomie cu ajutorul unor
GH PLQXWH vQDLQWH GH DFWLYLWDWHD VH[XDO vQ IXQFLH GH dilatatoare coaxiale (primul dilatator este introdus pe firul
HILFDFLWDWHLWROHUDELOLWDWHGR]DSRDWHILFUHVFXWODPJVDX
VFD]XWODPJ ghid!). Ultimul dilatator este practic teaca nefroscopului
&RQWUDLQGLFDLL SDFLHQL FDUH XWLOL]HD] RULFH IRUP GH QLWUDW (26-28Ch).
RUJDQLFSDFLHQLFXDQJLQSHFWRUDOLQVWDELOSDFLHQLFDUHDX
avut infarct miocardic sau accident vascular cerebral n ultimele  nefroscopia, FDUH YL]XDOL]HD] vQ FRQGLLL EXQH FDOFXOXO
6 lXQLSDFLHQLFXLQVXILFLHQUHQDOVDXKHSDWLFVHYHU MRQFLXQHD SLHOR-XUHWHUDO VRQGD XUHWHUDO &KLDU GDF QH
Reactii adverse: FHIDOHH KLSHUHPLH IDFLDO FRQJHVWLH QD]DO
SDOSLWDLLLQWROHUDQGLJHVWLY SHUPLWH R YL]LELOLWDWH PDL EXQ KLSHUSUHVLXQHD SUHOXQJLW
SRDWH GXFH OD DEVRUELH FUHVFXW GH DS vQ FLUFXODLD
3. Dapoxetina
3UH]HQWDUHIDUPDFHXWLF comprimate filmate de 30 si 60 mg. VDQJXLQFXHIHFWHDVHPQWRDUHFDODHQGRVFRSLDMRDV
$FLXQHWHUDSHXWLF inhiELWRULVHOHFWLYLDLUHFDSWULLVHURWRQLQHL  liWRWULLD SURSULX-]LV SRDWH IL H[HFXWDW XOWUDVRQLF
Indicatii: VH XWLOL]HD]D vQ WUDWDPHQWXO HMDFXOULL SUHFRFH OD
EDUEDLLFXYkUVWFXSULQVvQWUHLGHDQL HOHFWURKLGUDXOLF VDX EDOLVWLF OLWRWULLD LQWUD-FRUSRUHDO  'H
&RQWUDLQGLFDLL LQVXILFLHQDFDUGLDFDULWPLLFDUGLDFHSDFLHQLL UXWLQVHXWLOL]HD]VRQRWURGXOFDUHDUHPXOWLSOHDYDQWDMH
cu manie sau depresii severe, pDFLHQL VXE WUDWDPHQW FX
inhibitori ai monoaminooxidazei ( IMAO), linezolid, litiu, IUDJPHQWHD] ELQH DUH VLVWHP GH DVSLUDLH FRQWLQX D
tramadol. IUDJPHQWHORULULVFUHGXVGHOH]DUHDSHUHWHOXLFLLXULQDUH
5HDFLL DGYHUVH FRQYXOVLL KLSRWHQVLXQH DUWHULDO OLSRWLPLH
vertij, cefalee. (fig.VI.6).
'LVWUXJHUHD FDOFXOXOXL HVWH XUPDW GH DVSLUDUHD
XIV. 0(',&$,$19(=,&$+,3(5$&7,9$
PLFURIUDJPHQWHORUVDXGHH[WUDFLDORUFXRSHQVULJLGFXJKHDUH
1. Vesicare ( Solifenacin) GDF GLPHQVLXQLOH SHUPLW H[WUDJHUHD SH WHDFD QHIURVFRSXOXL 

Prezentare IDUPDFHXWLF Comprimate filmate 5 mg, 10 mg; /LWRWULLD VH RSUHWH FkQG Falculul a fost distrus/extras complet,
cutie 3 blist. 10 comprimate GDF DSDUH XQ LQFLGHQW QHSUHY]XW VkQJHUDUH  VDX GDF QX PDL
Actiune terapeutica: Solifenacinul este un antagonist
competitiv, specific, al receptorilor colinergici. pot fi extrase celelalte fragmente restante prin acest traiect.
Indicatii: Tratamentul simptomatic al LQFRQWLQHQHL XULQDUH,
PLFLXQLIUHFYHQWHODSDFLHQLLFXYH]LFDKLSHUDFWLY


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FRQLQkQGHWDPVLODWJ FXWLLFXEXF 
$FLXQHWHUDSHXWLF$QWLKHPRUDJLFSULQPHQLQHUHDLQWHJULWLL
FDSLODUHORU UHGXFH WLPSXO GH VkQJHUDUH IU V DIHFWH]H
coagularea.
,QGLFDLL Profilaxia si tratamentul hemoragiilor prin ruptura de
vase mici vQSkQ]D vQFXUVXOLQWHUYHQLLORUFKLUXUJLFDOHVDX 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
Fig.VI.6 /LWRWULLDLQWUDFRUSRUHDO cu ajutorul sonotrodului
FKLUXUJLFDOHHYHQWXDOvQF-ILROHvQWLPSXOVDXGXSRSHUDLH
2ULFH 1/3 VH WHUPLQ SULQ instalarea unei sonde de vQ XUJHQH  ILROH DSRL FkWH o fiola la 4-6 ore; doza de
vQWUHLQHUHRELVQXLWHVWHRILRODGHRUL]L
nefrostomie prin teaca nefroscopului. Rolul nefrostomiei este de 5HDFLL DGYHUVH 5DUHRUL KLSRWHQVLXQH WUHFWRDUH FHIDOHH
D DVLJXUD HYDFXDUHD PLFLORU IUDJPHQWH UHVWDQWH L D FKHDJXULORU HUXSLLFXWDQDWH
&RQWUDLQGLFDLL 3UXGHQ VDX VH HYLW OD EROQDYLL FX DIHFLXQL
GXS LQWHUYHQLH 6H SRW IRORVL vQ DFHVW VFRS L VRQGH DXWRVWDWLFH WURPERHPEROLFHILEULODLHDWULDOLDQJLQSHFWRUDO
cu balonet (care este umflat n bazinet). Nefrostomia are rol de
XIII. 0(',&$,$1',6)81&7,$(5(&7,/I EJACULARE
KHPRVWD] FRPSULPkQG WUDLHFWXO GH QHIURVWRPLH DYDQWDM SHQWUX PRECOCE
VRQGHOH FX EDORQHW FDUH GLQ PRWLY GH KHPRVWD] SRDWH IL
1. Cialis ( Tadalafil)
WUDFLRQDWXRUSHQWUXDH[HUFLWDRFRPSUHVLXQHLPDLEXQ  Prezentare farmaceutica: GLVSRQLELOVXEIRUPGHFRPSULPDWH
NLP supine : filmate de 2,5 PJPJPJLPJ
Actiune terapeutica: inhibitor selectiv, reversibil al
n YDULDQWD FODVLF SHQWUX SUDFWLFDUHD 1/3 SDFLHQWXO HVWH fosfodiesterazei tip 5 (PDE5) cu specificitate pentru guanozin
plasat n decubit ventral. monofosfatul ciclic (cGMP).
Indicatii: 7UDWDPHQWXO GLVIXQFLHL HUHFWLOH OD EUEDLL DGXOL
Q XOWLPLL DQL D FkWLJDW WHUHQ YDULDQWD GH DERUGDUH Pentru ca tadalafil V ILH HILFDFH HVWH QHFHVDU SUH]HQD
SHUFXWDQDW D ULQLFKLXOXL OD SDFLHQWXO SODVDW vQ GHFXELW GRUVDO VWLPXOULLVH[XDOH
Mod de administrare: IQ JHQHUDO GR]D UHFRPDQGDW HVWH GH
(tehnica Valdivia), ce s-a dovedit a fi la fel de siguULHILFLHQWFD PJDGPLQLVWUDWvQDLQWHGHDFWLYLWDWHDVH[XDODQWLFLSDWL
YDULDQWDFODVLF LQGLIHUHQW GH LQJHVWLD GH DOLPHQWH /D SDFLHQLL OD FDUH WDGDODILO
10 mg nu produce un efect adecvat, se poate ncerca
$YDQWDMHOH SR]LLHL GH GHFXELW GRUVDO VXQW WLPSXO RSHUDWRU administrarea a 20 mg. Medicamentul se poate administra cu
PDL VFXUW SRVLELOLWDWHD HIHFWXULL VLPXOWDQH D XUHWHURVFRSLHL FHOSXLQPLQXWHvQDLQWHGHDFWLYLWDWHDVH[XDO
Contraindicatii: $OHUJLH OD WDGDODILO SDFLHQLL FX LQIDUFW
UHWURJUDGH VDX D XQHL LQWHUYHQLL ODSDURVFRSLFH L FRQIRUWXO VSRULW miocardic in ultimile 90 de zile, SDFLHQLL FXDQJLQLQVWDELOVDX
SHQWUXSDFLHQWRSHUDWRULanestezist. 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


 !
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L FURQLF WHODQJLHFWD]LD IDPLOLDO HSLVWD[LV VLQGURDPHOH 3UDFWLFDUHD 1/3 vQ YDULDQWD 9DOGLYLD QHFHVLW vQV
caSLODUH WR[LFH vQ LQWR[LFDWLL FX DUVHQ L EHQ]RO - hemoragii HFKLSDPHQWUDGLRORJLFLPDVGHRSHUDLHSHUIRUPDQWHLDUSR]LLD
FDSLODUH DOH DSDUDWXOXL UHVSLUDWRU L GLJHVWLY FLUR]H KHSDWLWH
UHVSHFWLY RIHU XQ FkPS OLPLWDW SHQWUX SXQFLH H[SXQH SDFLHQWXO
hematemeze, hemoptizie, hemoragii retiniene, uterine.
'R]D SHQWUX DGXOL este de 1,5 mg de 1-3 ori/zi. XQXL ULVF GH OH]LXQH D RUJDQHORU LQWUDSHULWRQHDOH L OLPLWHD]
&RQWUDLQGLFDLL: Hemoragii masive prin ruptura de vase mari PDQHYUDELOLWDWHDLQWUDUHQDO
(este ineficace).
,QWHUDFLXQLPHGLFDPHQWRDVH: Se poate asocia in perfuzie cu &RPSOLFDLLLQWUD- LSRVWLQWHUYHQLH
analeptice, simpatomimetice, curarizante, barbiturice. Este ,QFLGHQWH LQWUDRSHUDWRULL SHUIRUDLD ED]LQHWXOXL
incompatibil cu vitamina C. (incident rar, datorat introducerii neadecvate a acului de
2. FITOMENADION SXQFLHDILUXOXLJKLGVDXDGLODWDWRUXOXL 3OJLOHMRQFLXQLL
3UH]HQWDUHIDUPDFHXWLF)LROHDPOVROXLHDSRDV FRORLGDO
pielo-ureterale (VH UH]ROY prin montarea unui stent
LQMHFWDELO FRQLQkQG ILWRPHQDGLRQ  PJ FXWLH FX  EXF 
$FLXQH WHUDSHXWLF 9LWDPLQD . QDWXUDO DFLRQHD] ureteral pentru 3-VSWPkQLQHIURVWRPLDPHQLQkQGX-se
antihemoragic prin perfectarea sintezei hepatice a protrombinei
3-4 zile).
L D DOWRU IDFWRUL DL FRDJXOULL 9,, ,; L ;  HIHFWXO HVWH UHODWLY
rapid - VHLQVWDOHD]vQ-4 ore - LQWHQVLSUHOXQJLW Pierderea traiectului de nefrostomie SHUFXWDQ
,QGLFDLL ,QWR[LFDLH DFXW cu anticoagulante cumarinice;
intraoperator.
SURILODFWLFVDXFXUDWLYvQDOWHVkQJHUULSULQKLSRSURWURPELQHPLH
sau hipovitamino] . vQ ERDOD KHPRUDJLF OD QRX-QVFXW vQ Pneumotorax/hidrotorax. Acest incident apare la
FXUVXO WUDWDPHQWXOXL FX VDOLFLODL vQ LFWHUXO REVWUXFWLY vQ EROLOH
aproape un sfert din paciHQL GDF SXQFLD ULQLFKLXOXL V-a
KHSDWLFH HILFDFLWDWHD HVWH VODE  VDX LQWHVWLQDOH vQ FD]XO
folosirii ndelungate de antibiotice administrate oral, etc. efectuat deasupra coastei a XII-a. Leziuni ale organelor
Mod de administrare: /D DGXOL RELQXLW LQWUDPXVFXODU -40
adiacente rinichiului: FRORQILFDWVSOLQGXRGHQSHGLFXO
PJRGDWSH]L vQIXQFLHGHJUDYLWDWH vQXUJHQHLQWUDYHQRV
foarte lent, 2-PJ]L vQLQWR[LFDLDDFXWFXFXPDULQLFHVHSRW renal.
LQMHFWD SkQ OD  PJ]L  OD QRX-QVFXL L VXJDUL FXUDWLY
+HPRUDJLD LQWUDRSHUDWRULH L SRVWRSHUDWRULH sub1%
intramuscular 1-2 mg/zi; profilactic, intramuscular 0,5-2 mg, oral
1-PJ vQERDODKHPRUDJLF 'R]DUHDSRDWHILFRQWURODWSULQ din cazuri), GDF KHPRUDJLD HVWH PDVLY poate avea risc
timpul Quick sau prin trombotest.
vital.
5HDFLLDGYHUVH,QMHFWDUHDLQWUDYHQRDV UDSLG poate provoca
FRQJHVWLD IHHL VXGRUDLH VHQ]DLH GH FRQVWULFLH WRUDFLF Hematuria poate apare LGXS 1-]LOHGHHYROXLH VLPSO
GLVSQHH FLDQR] WDKLFDUGLH FRODSV FKLDU DFFLGHQWH OHWDOH
IRDUWH UDU LQWROHUDQ FX IHQRPHQH GH RF OD QRX-QVFXL IULQFLGHQWH
ILWRPHQDGLRQD SRDWH IL FDX] GH KLSHUELOLUXELQHPLH UDUHRUL 
&RQWUDLQGLFDLL ,QWROHUDQ OD ILWRPHQDGLRQ DWHQLH OD
VLPSWRPHOH GH RF  SUXGHQ OD QRX-QVFXL L OD VXJDUL V. 1()526720,$3(5&87$1$7
6ROXLD LQMHFWDELO GH ILWRPHQDGLRQ QX WUHEXLH DPHVWHFDW FX 'HILQLLH 1HIURVWRPLD SHUFXWDQDW 163  UHSUH]LQW GHULYDLD
DOWHVROXLLSHQWUXLQMHFWDUHVDXSHUIX]LH
XULQDU H[WHUQ UHDOL]DW OD QLYHOXO ULQLFKLXOXL SH FDOH SHUFXWDQDW
3. ETAMSILAT
3UH]HQWDUH IDUPDFHXWLF )LROH D  PO VROXLH LQMHFWDELO


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ORPEDU 3RDWH DYHD FDUDFWHU WHPSRUDU VDX GHILQLWLY L vQ $FLXQHWHUDSHXWLFLQKLEDUHPDUFDW a factorului X ; DFLXQHD
GHLQKLEDUHDWURPELQHLHVWHVODEVDXQXO; efect inhibitor mai
majoritatea cazurilor se H[HFXWvQFRQGLLLGHXUJHQ.
VODEDVXSUDDFWLYULLLDJUHJULLSODFKHWHORU
,QGLFDLL. ,QGLFDLL profilaxia trombozelor venoase L D HPEROLLORU GH
FDX] PHGLFDO VDX FKLUXUJLFDO WUDWDPHQWXO WURPER]HL
163WHPSRUDU VHLQGLFvQXUPWRDUHOHVLWXDLLSDWRORJLFH
YHQRDVH SURIXQGH DFXWH L D HPEROLHL SXOPRQDUH SUHYHQLUHD
- n LQVXILFLHQD UHQDO DFXW REVWUXFWLY atunci cnd FRDJXOULL n circuitul extracorporeal n timpul hemodializei n
LQVXILFLHQD UHQDO DFXW VDX FURQLF DQJLQD LQVWDELO L
cateterismul ureteral nu este posibil;
infarctul miocardic non Q.
- n FROLFD UHQDO KLSHUDOJLF UHIUDFWDU OD WUDWDPHQWXO Mod de administrare: GR] SURILODFWLF VH DGPLQLVWUHD]
medical la care cateterismul ureteral este imposibil; VXEFXWDQDW  GR] VHULQJ SUHvQFUFDW  GLQ RULFH SUHSDUDW
timp de 7-10 zile); GR]DFXUDWLY GR]ODRUH
- n XUHWHURKLGURQHIUR]D LQIHFWDW atunci cnd &RQWUDLQGLFDLLhipersensibilitate, ulcer peptic acut, hemoragie
cateterismul ureteral nu este posibil; FHUHEUDO FRDJXORSDWLL JUDYH OH]LXQL L LQWHUYHQLL FKLUXUJLFDOH
SH61&RFKLXUHFKLDQWHFHGHQWHGHWURPERFLWRSHQLHPHGLDW
- n leziunile ureterale iatrogene precoce sau tardive, cel imunoloJLFLQGXVGHKHSDULQ
PDLIUHFYHQWGXSLQWHUYHQLLJLQHFRORJLFH 5HDFLL DGYHUVH UDU KHPRUDJLH WURPERFLWRSHQLH UHDFLL
DOHUJLFH UDUHRUL KLSHUNDOLHPLH IRDUWH UDU QHFUR] FXWDQDW OD
- n LQWHUYHQLLOH UHFRQVWUXFWLYH DOH MRQFLXQLL SLHOR- ORFXO LQMHFLHL L UHDFLL DQDILODFWLFH SUHFDXLL - n anestezia
XUHWHUDOH XUHWHUXOXL VDX MRQFLXQLL XUHWHUR-vezicale pentru HSLGXUDO UDKLGLDQ WURPERFLWRSHQLH ,+ I.R., hipertensiune
DUWHULDOQHFRQWURODWUHWLQRSDWLHKLSHUWHQVLYVDXGLDEHWLF. n
SURWHFLD ]RQHL RSHUDWH FDUH UPkQH XVFDW L SHUPLWH LQVXILFLHQD UHQDO supraveghere tratament cu heparine
cicatrizarea mai UDSLG IUDFLRQDWHSULQPVXUDUHDDFWLYLWLLDQWLIDFWRUXOXL; WHQGLQDOD
acumulare).
- de HYDOXDUHDIXQFLHLUHQDOHVHSDUDW
- ca prim timp al nefrolitotomiei percutanate. XII. HEMOSTATICE

NSP GHILQLWLY VH LQGLF vQ LQVXILFLHQD UHQDO FURQLF 1. ADRENOSTAZIN


REVWUXFWLY VHFXQGDU SDWRORJLHL WXPRUDOH SHOYLQH vezico- 3UH]HQWDUHIDUPDFHXWLF POVROXLHDSRDV FRQLQHPJ
carbazocrom.
prostatice, utero-ovariene, recto-sigmoidiene) atunci cnd $FLXQHWHUDSHXWLF: Carbazocrom este un produs de oxidare
FUHDWLQLQD GHSHWH PJ VDX H[LVW GH]HFKLOLEUH HOHFWUROLWLFH al adrenalinei. Este un hemostatic, produce diminuarea
permeabilitatii si cresterea rezistentei capilarelor. Administrat la
LPSRUWDQWH KLSHUSRWDVHPLHDFLGR]PHWDEROLF  om reduce timpul de sangerare de la 200 secunde la 120-110
&RQWUDLQGLFDLL0DQHYUDQXSRDWHILSUDFWLFDWvQXUPWRDUHOH VHFXQGH 1RUPDOL]HD] WLPSXO GH VkQJHUDUH SUHOXQJLW vQ PRG
patologic. Adrenostazinul nu intervine n procesul de coagulare;
VLWXDLL diferite teste de coagulare (timpul de coagulare, timpul de
- SDFLHQLFXWXOEXUULQHFRUHFWDELOHDOHFRDJXOULL SURWURPELQD HWF  DX IRVW JVLWH QHPRGLILFDWH GXS
administrarea adrenostazinului.
- paciHQLFXLQVXILFLHQUHVSLUDWRULHVHYHU ,QGLFDLL prevenirea L WUDWDPHQWXO KHPRUDJLLORU FKLUXUJLFDOH
- SDFLHQLQHFRRSHUDQL SURILODFWLF vQ LQWHUYHQLL FKLUXUJLFDOH FDUH H[SXQ OD KHPRUDJLL
Tehnica operatorie. FDSLODUH RUO XURORJLH FKLUXUJLH RVRDV L WRUDFR-SXOPRQDU  -
SUHYHQLUHDLWUDWDPHQWXOKHPRUDJLLORUPHGLFDOHSXUSXUDDFXW

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GHvQMXPWLUHHVWHGHRUH (VWH DEVROXW QHFHVDU H[LVWHQD XQHL VOL GH RSHUDLL


$FLXQH WHUDSHXWLF la SDFLHQLL FX IXQFLH UHQDO QRUPDO
HQGRXURORJLFH SUHY]XW FX PDV RSHUDWRULH UDGLRORJLF DSDUDW
FRQFHQWUDLLOH FHOH PDL PDUL UHDOL]kQGX-VH vQ VkQJH ILFDW L
rinichi. UDGLRORJLF PRELO FX EUD vQ & HFRJUDI RSHUDWRU L instrumentar
,QGLFDLL urografii, computer tomografie cu suEVWDQ de
specific.
FRQWUDVW DQJLRJUDILL FX VXEVWDQH GLJLWDO IOHERJUDILL
KLVWHURVDOSLQJRJUDILL ILVWXORJUDILL DUWHULRJUDILL L vQ VSHFLDO 3DFLHQWXO vQ DQHVWH]LH UHJLRQDO UDKLGLDQ SHULGXUDO  VDX
angiocardiografii.
JHQHUDO HVWH SR]LLRQDW vQ GHFXELW YHQWUDO SH PDVD GH RSHUDLH
Mod de administrare: - GR]D QHFHVDU pentru urografii este
de: 1,3 ml/kgc Ultravist 240; 1 ml/kgc Ultravist 300; 0,8 H[FHSLHIDFJUDYLGHOHFDUHVHYRUSR]LLRQDvQGHFXELWODWHUDO 
ml/kgc Ultravist 370.
Timpii operatori. n cazul unei nefrostomii temporare se
&RQWUDLQGLFDLL hipertiroidism.
5HDFLL DGYHUVH JUHD YUVWXUL HULWHP VHQ]DLH JHQHUDO SUHIHU PRQWDUHD XQHL QHIURVWRPLL D PLQLPD GH 8 Ch respectnd
GH FOGXU 8OWUDYLVWXO HVWH vQ JHQHUDO ELQH WROHUDW FKLDU L OD
XUPWRULLSDL
SDFLHQLL FDUH DX SUH]HQWDW vQ DQWHFHGHQWH UHDFLL alergice la
VXEVWDQHGHFRQWUDVW - SXQFLDHFRJKLGDWDVLVWHPXOXLSLHORFDOLFHDOFXXQDFILQ
* PP  L H[WUDJHUHD GH XULQ GLQ VLVWHP FRQILUP SXQFLD
4. Visipaque ( Iodoxanol)
3UH]HQWDUHIDUPDFHXWLF IODFRDQHFXVROXLHLQMHFWDELOSHQWUX FRUHFW 
administrare LQWUDYHQRDV VL LQWUDDUWHULDO GH    L - VH LQWURGXFH VXE FRQWURO UDGLRORJLF R VROXLH VHU IL]LRORJLF-
 PO FX FRQFHQWUDLL GH  PJ ,PO  PJ ,POVL  PJ
I/ml. colorant-VXEVWDQGHFRQWUDVWvQVLVWHPXOSLHORFDOFHDO
,QGLFDLL compus organic, iodat, utilizat pentru urografii i.v., - FX XQ DF  * PP  L VXE FRQWURO IOXRURVFRSLF VH
DQJLRFDUGLRJUDILLDRUWRJUDILLDUWHULRJUDILHFHUHEUDO
Mod de administrare: 'R]D DGPLQLVWUDW HVWH LQ IXQFLH GH SXQFLRQHD]JUXSXOFDOLFHDOLQIHULRUSRVWHULRU
WLSXO GH H[DPLQDUH YkUVW JUHXWDWH GHELWXO FDUGLDF L VWDUHD - GXSVFRDWHUHDPDQGUHQXOXLDFXOXLVHH[WHULRUL]HD]XULQDFX
JHQHUDO D SDFLHQWXOXL FkW L GH WHKQLFD XWLOL]DW DVWIHO SHQWUX
urografie 270/320 mgI/ml 40-80 ml, flebografie 270 mgI/ml 50- FRORUDQW GHFLDYHPRSXQFLHFRUHFW LVHLQVHUSHDFXQILUJKLG
150 ml/mb. inf., CT corp 270/320 mgI/ml 75-150 ml . Doza de SkQvQVLVWHPXOSLHORFDOLFHDOVDXXUHWHU
270 mg I/ml este recomandata in cele mai multe cazuri.
&RQWUDLQGLFDLL 7LUHRWR[LFR] PDQLIHVW LQVXILFLHQ FDUGLDF - VXE FRQWURO IOXRURVFRSLF L SH ILUXO JKLG VH SUDFWLF GLODWDLD
GHFRPSHQVDW traiectului cu dilatatoare flexibile de teflon 5-7-9-11 Ch;
5HDFLL DGYHUVH VHQ]DLH GH FDOGXU GH UHFH VDX GXUHUH OD
ORFXO LQMHFWULL WXOEXUUL GH YHGHUH FHIDOHH JUHDD YUVWXUL L - VH LQVHU VRQGD GH QHIURVWRPLH  &K vQ VLVWHPXO
WXOEXUUL GH JXVW 3RW DSUHD GH DVHPHQHD UHDFLL FXWDQDWH pielocaliceal, se extrage firul ghid;
prurit, parosmie, angioedem si simptome respiratorii.
- H[WHULRUL]DUHD GH XULQ-contrast-FRORUDQW SH VRQG  L
XI. ANTICOAGULANTE HYLGHQLHUHD IOXRURVFRSLF D EXFOHL VRQGHL vQ VLVWHP FRQILUP
1. HEPARINE FXPDVPROHFXODUPLF SR]LLRQDUHDFRUHFWDQHIURVWRPLHL
3UH]HQWDUH IDUPDFHXWLF VHULQJL SUHvQFUFDWH FX R GR] de - IL[DUHDVRQGHLFXILUHGHDODSLHOH
DQWLFRDJXODQW(12;,3$5,1 PO PJ )5$;,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.

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QFD]XOSR]LLRQULLXQHLQHIURVWRPLLGHILQLWLYHVHXWLOL]HD]FD ;68%67$1('(&2175$67
VRQG XQ FDWHWHU )ROH\  &K 7HKQLFD RSHUDWRULH HVWH DFHLDL
1.OMNIPAQUE (Iohexolum):
ILLQG vQV QHFHVDU GLODWDLD VXSOLPHQWDU D WUDLHFWXOXL GH 3UH]HQWDUHIDUPDFHXWLFOmnipaque 180 flac 10 ml sau 15
PO VRO LQM FRQLQH  PJ,PO; Omnipaque 240 fl. a 15, 50,
nefrostomie cu dilaWDWRU D[LDO EXWRQDW $ONHQ SH FDUH VH LQVHU
POVROLQMFDUHFRQLQHPJ,PO; Omnipaque 300
succesiv tecile dilatatoare 9-12-15-18-21- &K L vQ ILQDO IO D     PO VRO ,QM FRQLQkQG  PJ,PO;
semiteaca Hutschenreiter (26 Ch) pe care se introduce sonda Omnipaque 350 fl. a 20, 50, 100, 200 ml VRO ,QM FRQLQkQG
350 mgI/ml.
Foley. $FLXQHWHUDSHXWLFLLQGLFDLLcompus organic, iodat, utilizat
&RPSOLFDLL. Pot fi multiple dar din fericire sunt rare, invers pentru urografii i.v., angiocardiografii, aortografii, arteriografie
FHUHEUDO
SURSRULRQDOH FX H[SHULHQD vQ FKLUXUJLD SHUFXWDQDW 0HULW D IL Mod de administrare: pentru urografii se poate folosi
PHQLRQDWHFHOHPDLIUHFYHQWH Omnipaque 350 IO  PO LY VDX FRQIRUP UHFRPDQGULL
radiologului.
- hemoragia intra- VLH[WUDUHQDO 5HDFLL DGYHUVH FRQJHVWLD SLHOLL VHQ]DLH GH FDOG JUHD
- SHUIRUDLDED]LQHWXOXL UHDFLLDQDILODFWLFHSkQODVWDUHGHRF

- le]LXQLOH RUJDQHORU GH YHFLQWDWH: peritoneul parietal 2. IOPAMIRO: (Iopamidol)


posterior, colonul, ficatul, splina, etc.; 3UH]HQWDUHIDUPDFHXWLF: ILROHDPOVROLQMFRQLQkQG
,RSDPLGROFRUHVSXQ]WRUDPJ,POILROH IODFRDQH 
- GHSR]LLRQDUHDQHIURVWRmiei. DPOPOPOVDXPOVROLQMFRLQkQG
ngrijirea nefrostomiei6XSUDYHJKHUHDLPHGLDWDSDFLHQWXOXL FRUHVSXQ]kQGDPJ,POILROH IODFRDQH  10 ml, 30
POPOVDXPOVROLQMFRQLQknd 75,5 % corespunznd la
FX QHIURVWRPLH LPSOLF  PVXUL JHQHUDOH FOLQLFH FXUE WHUPLF 370 mgI/ml.
SXOV WHQVLXQH DUWHULDO HWF  L VSHFLILFH GH ODERUDWRU $FLXQH WHUDSHXWLF L LQGLFDLL produs organic de contrast
WULLRGDW L KLGURVROXELO XWLOL]DW vQ FDUGLRORJLH LQWHUYHQLRQDO
KHPROHXFRJUDP FUHDWLQLQ LRQRJUDP VDQJXLQ HWF 2GDWD XURORJLHLODPLHORJUDILH
drenajul urinar constituit ne asteptam la o tendinta de normalizare 0RG GH DFLXQH SHQWUX XURJUDILL VH SRW IRORVL ILROH  L
-100 ml, maxim 200 ml pentru adult administrat i.v.
a functiei renale. 5HDFLL DGYHUVH FHIDOHH JUHD YUVWXUL GLVSQHH
6HLPSXQLFkWHYDPVXULGHPRQLWRUL]DUHORFDO KLSRWHQVLXQH RUWRVWDWLF VHQ]DLH GH FDOG UHDFLL DOHUJLFH
&RQWUDLQGLFDLL SUXGHQ VDX HYLWDUHD XWLOL]ULL OD SDFLHQLL FX
- FRQWUROXO SOJLL RSHUDWRULL D DQFRUDMXOXL VRQGHL L D UHDFLL QHGRUite la iod n antecendente, la alergici, astmatici; la
pansamentului, existind posibilitatea infiltrarii pansamentului cu SDFLHQLL FX LQVXILFLHQ KHSDWR-UHQDO JUDY SUXGHQ vQ
LQVXILFLHQ KHSDWLF VHYHU LQVXILFLHQ UHQDO PRGHUDW
urina in cazul depozitionarii/infundarii sondei.
VHYHU LQVXILFLHQ FDUGLDF EROL VLVWHPLFH GLDEHW PLHORP
- FRQWUROXODVSHFWXOXLXULQLL GHRELFHLVHOLPSH]HWHvQ- multiplu; dezechilibrele hidroelectolitice trebuie corectate;
RUHGXSPDQHYU  LQWHUIHUFXWHVWXOFXLRGUDGLRDFWLY-3 luni.

- FRQWUROXOGLXUH]HLSHVRQGH[LVWLQGULVFXOXQHLHYHQWXDOH 3. ULTRAVIST:
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FRQLQkQG ,RSUDPLG  JPO 8OWUDYLVW  ; Iopramid 0,623
 g/ml (Ultravist 300); Iopramid 0,769 g/ml (Ultravist 370); timpul
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Mod de administrare: oral 1 cpx3-]L LQM  ILRO x 2-3 / zi la
tractul urinar este permeabil. n cazul nefrostomiei definitive sonda
nevoie
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GH VDUFLQ WUDYDOLX DOptare; SUHFDXLL DVWP EURQLF
antecendente de ulcere gastroduodenale, Boala Crohn, VI. URETEROSCOPIA
KLSHUWHQVLXQH DUWHULDO GLVFUD]LL VDQJXLQH GLDEHW ]DKDUDW
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VkQJHUULGLJHVWLYHHUXSLLFXWDQDWHGHUPDWLWH[IROLDWLY SUHVXSXQHLQVSHFWDUHDXUHWHUXOXLFXDMXWRUXOXUHWHURVFRSXOXLGDUL
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,QWHUDFLXQL PHGLFDPHQWRDVH asocierea cu alte AINS sau stenoze) situate la acest nivel.
glucocorticoizi ULVF GH VkQJHUDUH GLJHVWLY  DVRFLHUHD FX
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DVRFLHUHD FX ,(&$ ULVF GH LQVXILFLHQ UHQDO DFXW FUHWH $ ,QGLFDLL GLDJQRVWLFH evaluarea unui "defect de
FRQFHQWUDLDSODVPDWLFDGLJR[LQHLLULVFXOHIHFWHORUWR[LF
XPSOHUH LPDJLQH ODFXQDU vQFRQMXUDW GH VXEVWDQ GH FRQWUDVW 
3.DICLOFENAC: OD QLYHOXO XUHWHUXOXL SH XURJUDILHXUHWHURSLHORJUDILH UHWURJUDG
3UH]HQWDUHIDUPDFHXWLFdrajeuri 50 mg; sup 100 mg.
$FLXQH WHUDSHXWLF antiinflamator, antalgic L DQWLSLUHWLF GLQ evaluarea unei hematurii macroscopice unilaterale; identificarea
clasa AINS nesteroidiene. XQHLWXPRULXURWHOLDOHvQFD]GHFLWRORJLHXULQDUVHOHFWLYSR]LWLY
,QGLFDLL SROLDUWULWD UHXPDWRLG VSRQGLODUWULWD DQFKLORSRHWLF
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dureroase vQVIHUDSHOYLQ
Mod de administrare: oral 1 drajeux3/zi la nevoie, ulterior 1-2 HOHFWURUH]HFLH  D XQHL WXPRUL XUHWHUDOH VDX GXS RSHUDLL
GUDMHXUL]LGXSPDVLQWUDUHFWDOVXS]LVHDUD conservatoare clasice.
5HDFLL DGYHUVH JUHD GLDUHH HSLJDVWUDOJLL VkQJHUUL
GLJHVWLYH PLQRUH HUXSLL FXWDQDWH FHIDOHH DPHHOL IRDUWe rar B. ,QGLFDLLWHUDSHXWLFH
UHDFLL DQDILODFWLFH WXOEXUUL DOH KHPDWRSRLH]HL DGPLQLVWUDUH Patologia litLD]LF
vQGHOXQJDW QHIULW LQWHUVWLLDO DGPLQLVWUDUHD LQWUDUHFWDO
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&RQWUDLQGLFDLL XOFHU JDVWURGXRGHQDO DFWLY VkQJHUUL pelvini sau iliaci);
gastrointestinale, leucopenie, trombocitopenii, porfirie,
LQWROHUDQODDQWLLQIODPDWRULLLQKLELWRDUHGH&2SUXGHQvQFD]  vQGHSUWDUHD IUDJPHQWHORU GH FDOFXOL UH]XOWDWH vQ XUPD
de antecedente ulceroase la astmatici, la cardiaci, la renali, n (6:/ FDUH IRUPHD] vPSLHWUXLUHD XUHWHUDO
,+ 1X VH DGPLQLVWUHD] vQ XOWLPXO WULPHVWUX GH VDUFLQ L OD
termen. ("steinestrasse");
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VXSHUILFLDOVLWXDWSHXUHWHU cistinice; alcanizarea urinii n cursul tratamentului cu uricozurice


LFitostatice; WUDWDPHQWXOVLPSWRPHORUvQSRUILULDFXWDQDW
 instalarea unei sonde ureterale "la vedere" n caz de
Mod de administrare: RUDOGR]DVHDMXVWHD] vQIXQFLHGHS+-
REVWUXFLH VDX ILVWXO XUHWHUDO GLODWDUHD VDX LQFL]LD ul urinar (determinat nainte de fiecare administrare), doza
PHGLHPVXULUDVHGH8UDO\W U granule orale.
stenozelor ureterale;
&RQWUDLQGLFDLL hipersensibilitate, I.H., hipotensiune
 tratamentul endoscopic al stenozelRU GH MRQFLXQH RUWRVWDWLFUHWHQLHKLGURVDOLQ
pieloureterale congenitale; 5HDFLLDGYHUVHIRDUWHUDULQWROHUDQ JDVWULF
Asocieri medicamentoase: Allopurinol n litiaza
 extragerea unei sonde ureterale autostatice (tip "JJ")
XULF
DVFHQVLRQDW SH XUHWHU VDX D XQXL IUDJPHQW GH VRQG
IX. ANTIINFLAMATORII
XUHWHUDO FHV-a rupt n ureter).
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3UH]HQWDUH IDUPDFHXWLF: comprimate cu eliberare PRGLILFDW
Sunt similare cu cele ale nefrolitotomiei percutane, pe FHFRQLQQDSUR[HQPJVLHVRPHSUD]ROPJ
care le reamintim succint: $FLXQH WHUDSHXWLF naproxenul este un antiiflamator
QHVWHURLGLDQ FH UHGXFH GXUHUHD VL LQIODPDLD vQ WLPS FH
&RQWUDLQGLFDLL DEVROXWH WXOEXUUL GH FUD] VDQJXLQ SDFLHQW HVRPHSUD]ROXO UHGXFH VHFUHLD DFLG JDVWULF DVWIHO DMXW OD
FRPDWRVQHFRRSHUDQWVDUFLQ reducerea riscului de aSDULLH D XOFHUXOXL OD SDFLHQLL OD FDUH VH
administreaza AINS.
&RQWUDLQGLFDLL UHODWLYH 7%& DFWLY LQIHFLL nespecifice netratate, Indicatii FROLFD QHIUHWLF DUWUR]D SROLDUWULWD UHXPDWRLG
tratament prelungit cu anticoagulante, diabet zaharat VSRQGLOLWDDQFKLOR]DQW
Mod de administrare: Un comprimat la 12 ore
GHFRPSHQVDW DIHFLXQL FDUGLR-respiratorii decompensate, ulcer Contraindicatii: alergie la naproxen sau esomeprazol,
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FXQRVFXLFXXOFHUJDVWULF
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LPSRVLELOVDXGLILFLODERUGXORULILFLXOXL ureteral. WUDQVSLUDLLH[FHVLYHLQVRPQLDSDOSLWDLLYHUWLMJUHD
InteraFLXQL PHGLFDPHQWRDVH 'DWRULW OHJULL SXWHUQLFH GH
Etapele ce trebuie parcurse n cadrul ureteroscopiei SURWHLQHOH SODVPDWLFH D QDSUR[HQXOXL SDFLHQLL FDUH SULPHVF
retrograde sunt: simultan KLGDQWRLQH WUHEXLH DWHQW PRQLWRUL]DL SHQWUX R
HYHQWXDO DMXVWDUH D GR]HL &D L DOWH $,16 QDSUR[HQ VRGLF
- cistoscopia de evaluare a veziFLLLDRULILFLLORUXUHWHUDOH SRDWH FUHWH ULVFXO DIHFWULi renale asociat cu utilizarea IECA.
-introducerea XUHWHURVFRSXOXL vQ YH]LF DSRL n ureter (VWH QHFHVDU SUXGHQ vQ FD]XO SDFLHQLORU DIODL vQ WUDWDPHQW
FXFLFORVSRULQ WDFUROLPXVGLXUHWLFHGHDQVGLXUHWLFHWLD]LGLFH
DVFHQGHQW UHWURJUDG 'DF RULILFLXO HVWH VXILFLHQW GH ODUJ VDX LGLJR[LQ
pacientului i s-DPRQWDWDQWHULRU RVRQG --DFHDVWHWDSHVWH
2. KETOROLAC (Ketanov):
UHODWLY IDFLO 'DF RULILFLXO XUHWHUDO HVWH VWUkPW VH SURFHGHD] OD 3UH]HQWDUH IDUPDFHXWLF cp 10 mg; fiole 1 ml, 30 mg/ml.
GLODWDUHD OXL vQ IXQFLH GH LQVWUXPHQWDUXO DYXW OD GLVSR]LLH L $FLXQH WHUDSHXWLF antiinflamator, antialgic L DQWLSLUHWLF GLQ
clasa AINS nesteroidiene.
GHVLJXUH[SHULHQDXURORJXOXL ,QGLFDLL FROLF QHIUHWLF GXUHUHD SRVWWUDXPDWLF
 SRVWFKLUXUJLFDO GXUHUHD DFXW GLQ EROLOH LQIODPDWRULL FURQLFH
 
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atrio-YHQWULFXODUJU,,VDX,,,RIDWXOHVWHFRQWUDLQGLFDWWLPSGHR -vizualizarea calculului;


RU GXS DGPLQVWUDUH LY SUHFDXLL vQ VDUFLQ L DOSWDUH vQ
-extragerea sau prelucrarea calculilor. n cazul n care calculul
asociere cu levodopa.
5HDFLL DGYHUVH FHIDOHH YHUWLM SDOSLWDLL JUHD KLSRWHQVLXQH YL]DW DUH GLPHQVLXQL PLFL VXE  PP  HO SRDWH IL vQGHSUWDW FX
RUWRVWDWLFGXSDGPLQLVWUDUHDLY
pensa de calcul sau cu sonda Dormia R VRQG VSHFLDO IRORVLW
Asocieri medicamentoase: antiinflamatorii nesteroidiene n
FROLFDQHIUHWLF SHQWUX H[WUDJHUHD GH FDOFXOL VDX IUDJPHQWH  (D DUH vQ FDSW XQ
FRXOH IRUPDW GLQ -6 spire, care cnd se strng cuprind calculul
VII. INHIBITORII DE XANTIN-2;,'$=
SHFDUHYUHPV-OH[WUDJHP8QHRULVRQGD'RUPLDHVWHWUHFXWSULQ
ALLOPURINOL:
canalul secundar de lucru al ureteroscopului, pentru a fixa calculul,
3UH]HQWDUHIDUPDFHXWLF cps 10 mg
$FLXQHWHUDSHXWLFLQKLE xantinoxidaza diminund formarea HIHFWXkQG OLWRWULLD LQWUDFRURSRUHDO vQWUH ILUHOH PHWDOLFH DOH
acidului uric.
FRXOHXOXL 'RUPLD &alculii cu dimensiuni mai mari vor fi
,QGLFDLL- WUDWDPHQWXO OLWLD]HLXULFHJXWDFURQLF OD bolnavii cu
leucemie, limfoame, alte boli canceroase, sub tratament cu GH]LQWHJUDL KLGUDXOLF SQHXPDWLF XOWUDVRQLF VDX ODVHU L DSRL
citostatice sau terapie.
H[WUDL VXE IRUP GH IUDJPHQWH FX SHnsa de calculi. Riscul de
Mod de administrare: oral 1 cp x   ]L GXS mese; la boli
canceroase cu valori foarte mari ale acidului uric se pot PLJUDUH DVFHQGHQW D FDOFXOXOXL HVWH SUHYHQLW LQVWDOkQG R VRQG
administra 4-6 cp/zi.
XUHWHUDO VSHFLDO FX EDORQ FDUH VH XPIO GHDVXSUD REVWDFROXOXL
&RQWUDLQGLFDLL - LQWROHUDQ OD DOORSXULQRO FUL]D GH JXW
KHPRFURPDWR] LGLRSDWLF vQ VDUFLQ L SH GXUDWD DOSWULL litiazic (fig.VI.7).
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HR]LQRILOLH RFD]LRQDO HSLJDVWUDOJLL IHEU YUVWXUL GLDUHH
dureri abdominale, cefalee, DPHHOL VRPQROHQ OHXFRSHQLH evacuarea fragmenWHORUDIRVWPDLGLILFLOVDXDXUPDVIUDJPHQWH
fenomene hepatotoxice.
pe ureter, instalarea unei sonde ureterale autostatice pentru 48 ore
,QWHUDFLXQL PHGLFDPHQWRDVH LQKLE metabolizarea
mercapto-SXULQHL D]DWLRSULQHL LQKLE PHWDEROL]DUHD HVWH EHQHILF LQVWDOkQGX-VH vQ DFHODL WLPS L R VRQG YH]LFDO
anticoagulantelor orale; se reduce doza de AC sub controlul
pentru a preveni refluxul vezico-ureteral.
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HOLPLQDUHDGHDOORSXULQRO1XVHDVRFLD]FXDPSLFLOLQD risc de
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UHDFLLKLSRJOLFHPLFHSUHOXQJLWH PDLDOHVODSDFLHQLLFX,5 
Asocieri medicamentoase: cu alcalinizante urinare n
tratamentul litiazei urice.

VIII. ALCANIZANTE URINARE


URALYT U:
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RUDOH GH KLGURJHQRFLWUDW GH SRWDVLX L VRGLX  OLQJXUL
dozatoare + calendar de control + hrtie indicator).
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FDOFXOLORUGHDFLGXULFLSUHYHQLUHDUHIDFHULLORU Fig.VI.7 Introducerea ureteroscopului n ureter
,QGLFDLL OLWLD]D XULF; tratament adjuvant al litiazei urinare


 
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+%3UHGXFHUHDULVFXOXLGHUHWHQLHDFXWGHXULQLDQHFHVLWLL
Incidente intraoperatorii
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LVHQVLELOLWDWHODQLYHOXOVkQLORU
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XUHWHURVFRSLH WUHEXLH V DYHP vQ YHGHUH FHOHODOWH RSLXQL VI. ANTISPASTICE

terapeutice. 1. PAPAVERINA:
-/H]LXQL DOH PXFRDVHL XUHWHUDOH SHUIRUDUHD XUHWHUXOXL L FKLDU 3UH]HQWDUH IDUPDFHXWLF cp 100 mg; fiole - 1 ml = 40 mg
SDSDYHULQ; PO PJSDSDYHULQ
LHLUHDFDOFXOXOXLGLQXUHWHUSULQEUHDFUHDW $FLXQH WHUDSHXWLF: vasodilatator L DQWLVSDVWLF SULQ DFLXQH
-5XSHUHD L GH]LQVHULD XUHWHUXOXL QXPLW L VWULSSLQJ XUHWHUDO SULQDFLXQHGLUHFWSHPXVFXODWXUDQHWHG
,QGLFDLL FROLFL ELOLDUH LQWHVWLQDOH FROLFL QHIUHWLFH WXOEXUUL
GXS LQWHUYHQLD FODVLF SHQWUX YDULFHOH PHPEUHORU LQIHULRDUH  FLUFXODWRULL LQWHVWLQDOH GH QDWXU VSDVWLF VGU 0HQLHUH VGU
DSDUH PDL DOHV GDF VH IRUHD] H[WUDJHUHD XQHL VRQGH 'RUPLD DQJLQRVVSDVPSLORULFFRQVWLSDLHVSDVWLF
Mod de administrare: oral 1 cp x 3-5 / zi la nevoie; i.m., i.v. 1-2
vQFUFDWFXXQFDOFXOYROXPLQRV fiole(ml) x 2-3/zi la nevoie.
-&RPSOLFDLL VHSWLFH GDF XULQD GH GHDVXSUD REVWDFROXOXi era 5HDFLL DGYHUVH n administrare i.v. aritmii L EORF
atrioventricular, colaps, deprimare respiratorie; la doze mari:
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&RQWUDLQGLFDLLforma inj. cu bloc atrioventricular, hipertensiune
-Dureri lombare, hematurie, sunt probleme ce apar mai ales intracranianSUXGHQvQJODXFRPLDGHQRPGHSURVWDW
postoperator. Postoperator tardiv s-DX GHVFULV FRPSOLFDLL GH FDUH ,QWHUDFLXQL PHGLFDPHQWRDVH QX VH DVRFLD] cu -DJRQLWL
ULVF FUHVFXW GH DULWPLL SDSDYHULQD FUHWH HIHFWXO KLSRWHQVLY DO
WUHEXLHVLQHPVHDPDreflux vezico-ureteral; stenoze ureterale.
medicamentelor antihipertensive.
,QGLFDLLOHLFRQWUDLQGLFDLLOH856
2.NO-SPA: VXEVWDQD DFWLY clorhidrat de GRWUDYHULQ
LQkQG FRQW GH IDSWXO F SULPD RSLXQH vQ OLWLD]D XUHWHUDO
3UH]HQWDUH IDUPDFHXWLF No-spa cp 1-40 mg; fiole 1 ml (20
ORPEDU D UPDV (6:/ GHVL QX H[LVWD XQ FRQVHQV LQ DFHDVWD mg/ml); No-spa forte cps 80 mg; fiole 4 ml (20 mg/ml)
SUREOHPDLQGLFDLLOH856VHOLPLWHD]GRDUOD $FLXQH WHUDSHXWLF L LQGLFDLL antispastic: colici nefretice,
biliare; tratament adjuvant n ulcer gastric sau duodenal, gaVWULW
-FDOFXOLLGXULDQFODYDLREVWUXFWLYLvQXUHWHUXOORPEDU la care ESWL FROLW  VSDVPH DOH VILQFWHUHORU FDUGLD L SLORULF VGU GH LQWHVWLQ
DHXDW LULWDELOFRQVWLSDLLVSDVWLFHGLVPHQRUHH
Mod de administrare: 120-240 mg / zi, 2- SUL]H FROLF
-vPSLHWUXLUHD XUHWHUDO ORPEDU VWHLQVWUDVVH  DSUXW GXS QHIUHWLFVDXELOLDU-80 mg i.m. sau i.v. lent.
! &RQWUDLQGLFDLL I.H., I.R. LQVXILFLHQ FDUGLDF VHYHU EORF
  
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FRPSOH[XOVLPSWRPHORULULWDWLYHLREVWUXFWLYHvQLQVWDODUHDFUXLD (6:/LFDUHQXV-DHOLPLQDWVSRQWDQVDXWRWSULQ(6:/
LQVWDELOLWDWHD YH]LFLL XULQDUH L WHQVLXQHD PXVFXODWXULL QHWHGH D
-extragerea sondelor care, n timpul manevrelor endourologice, s-
WUDFWXOXLXULQDULQIHULRUMRDFXQUROLPSRUWDQW
,QGLFDLL WHUDSHXWLFH Tratamentul simptRPHORU IXQFLRQDOH DOH au rupt n zona ureterului superior;
hiperplaziei prostatice benigne (HBP).
-introducerea la vedere a unui fir ghid, vQSHUVSHFWLYDUH]ROYULL
&RQWUDLQGLFDLL Hipersensibilitate la tamsulosin HCl sau la
oricare alt component al produsului. Antecedente de endoscopice a stenozelor ureterale strnse.
KLSRWHQVLXQHRUWRVWDWLF,QVXILFLHQKHSDWLFVHYHU
1RLOHXUHWHURVFRDSHIOH[LELOHSRWDMXQJHFXXVXULQSHXUHWHUXO
5HDFLL DGYHUVH ameteli HMDFXODUH UHWURJUDG L FX IUHFYHQ
PDLVF]XW - FHIDOHHDVWHQLHKLSRWHQVLXQHRUWRVWDWLFL ORPEDULUH]ROYDVLWXDLDDVWIHO vQFkWXUHWHURVFRSLDDQWHURJUDGL-
SDOSLWDLL
Mod de administrare: 6H DGPLQLVWUHD] FkWH R FDSVXO pe zi a restrns mult aria de aplicare.
GXSPLFXOGHMXQ $FHDVW SURFHGXU IRORVHWH XQ WUDLHFW SHUFXWDQ OD IHO
,QWHUDFLXQLFXDOWHPHGLFDPHQWH administrarea FRQFRPLWHQW
FD L QHIUROLWRWRPLD SHUFXWDQDW 1/3  Q FRQVHFLQ se
FX DOL DOID-EORFDQL SRDWH FRQGXFH OD DSDULLD HIHFWHORU
hipotensive. SVWUHD] DFHOHDL FRQWUDLQGLFDLL FD OD 1/3 FX PHQLXQHD F
DERUGXOVHIDFHSULQFDOLFHOHPLMORFLXLDUFDOFXOXOWUHEXLHVILHPDL
,9,1+,%,725,'($/)$5('8&7$=
sus de L5.
AVODART 'XWDVWHULG
8UHWHURVFRSLDDQWHURJUDGare urmatoarele etape:
3UH]HQWDUHIDUPDFHXWLF: cps 0,5 mg
$FLXQH WHUDSHXWLF: - LQKLE 5 1 L  2 reductaza. ,QGLFDLL -FLVWRVFRSLD L XOWHULRU GXS YL]XDOL]DUHD RULILFXOXL XUHWHUDO
tratamentul simptomelor moderate, severe de hiperplazie
respectiv, introducerea sondei ureterale;
EHQLJQGHSURVWDWUHGXFHULVFXOUHWHQLHLDFXWHGHXULQ
-opacefierea sistemului pielo-FDOLFHDO SULQ LQMHFWDUH UHWURJUDG GH
Mod de administrare: 1 cp/zi.
&RQWUDLQGLFDLL IHPHL FRSLL DGROHVFHQL ,+ VHYHU OD VXEVWDQ GH FRQWUDVW GLOXDW FX VHU IL]LRORJLF 'DF FDOFXOXO HVWH
SDFLHQLL FX KLSHUVHQVLELOLWDWH OD LQKLELWRUL GH  -UHGXFWD] FRPSOHWREVWUXFWLYLQXSHUPLWHVXEVWDQHLGHFRQWUDVWVSWUXQG
5HDFLL DGYHUVH LPSRWHQ VFGHUHD OLELGRXOXL WXOEXUUL GH
ejaculare, ginecomastie. LVRSDFiILH]HFDYLWLOHUHQDOHVHSUDFWLFSXQFLDHFRJKLGDWD
,QWHUDFLXQL PHGLFDPHQWRDVH Itraconazol, Ketoconazol, XQHLFDYLWLUHQDOHGLODWDWHVHLQWURGXFHVXEVWDQGHFRQWUDVWL
,QGLQDYLU 9HUDSDPLO VFDG PHWDEROL]DUHD HQ]LPDWLF D
LQKLELWRULORU GH  -reductaza ceea ce duce OD FUHWHUHD XOWHULRU VH SXQFLRQHD] IOXRURVFRSLF XQ FDOLFH PLMORFLX VDX
FRQFHQWUDLHLVHULFH superior;
Asocieri medicamentoase: inhibitorii de 5 -reductaza se pot
-SXQFLD FDOLFHDO HVWH UHFRPDQGDW D VH HIHFWXD OD MXPWDWHD
DVRFLD FX -EORFDQWH SHQWUX DPHOLRUDUHD PDL UDSLG D VFRUXOXL
simptomatic. LQIHULRDU D VSDLXOXL Lntercostal (pentru a evita lezarea pachetului
vasculo-QHUYRVLQWHUFRVWDO SHOLQLDD[LODUSRVWHULRDU
9 ,1+,%,725, '(  $/)$ 5('8&7$= 
ALFABLOCANT -GLODWDLDWUDLHFWXOXL ODIHOFDOD1/3 
-LQWURGXFHUHD QHIURVFRSXOXL L HIHFWXDUHD QHIURVFRSLHL FDUH
DUODART
LGHQWLILF HYHQWXDOD OLWLD] DVRFLDW ED]LQHWDO L MRQFLXQHD SLHOR-
Prezentare IDUPDFHXWLFCapsule FRQLQkQG 0,5mg
dutasterida si 0,4 mg tamsulosin.  
! 
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XUHWHUDO $FLXQH WHUDSHXWLF analgezic prin metamizol; antispastic


muscXORWURS L DWURSLQLF SULQ SLWRIHQRQ L IHQLSLSUDPLG
-LQWURGXFHUHD XUHWHURVFRSXOXL SULQ WHDFD QHIURVFRSXOXL L DFFHVXO
,QGLFDLLFROLF QHIUHWLFFROLF ELOLDUGLVNLQH]LHELOLDUFROLWH
acestuia pe ureter (fig.VI.8); 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
Fig.VI.8 Introducereanefroscopului prin teaca nefroscopului
atropinice).
-YL]XDOL]DUHDLHYHQWXDOH[WUDJHUHDFDOFXOXOXL VXEFP FXDMXWRUXO III. ALFABLOCANTE
SHQVHORU 3HQWUX FDOFXOL PDL PDUL VH LPSXQH GLVWUXFLD 1. UROREC: (Silodosin)
LQWUDFRUSRUHDODFDOFXOXOXLLXOWHULRUH[WUDJHUHDGHIUDJPHQWH 3UH]HQWDUHIDUPDFHXWLFcapsule de 8 mg.
$FLXQHWHUDSHXWLF blocarea receptorilor alfa1A
-YHULILFDUHDSHUPHDELOLWLLXUHWHUDOHSULQLQMHFWDUHDDQWHURJUDGGH
adrenoreceptori din prostata, vezica urinara si uretra.
VXEVWDQ GH FRQWUDVW 'DF H[LVW VDX VH EQXLHVF OH]LXQL ,QGLFDLL tratamentul simptomelor de hiperplazie prostatica
benigna.
XUHWHUDOH GDWRUDWH FDOFXOXOXL VDX PDL DOHV PDQHYUULL VH
Mod de administrare: Doza recomandata este de o capsula de
UHFRPDQG LQVWDODUHD XQHL VRQGH -- DQWHURJUDG SHQWUX D 8 mg o data pe zi. Pentru barbatii cu probleme renale moderate,
doza initiala trebuie sa fie de 4 mg o data pe zi. Dupa o
preveni stHQR]DUHDXUHWHUXOXLLVDXH[WUDYD]DUHDGHXULQ
VSWPkQDFHDVWDSRDWHILPULWDODPJRGDWDSH]L
&RPSOLFDLLOH 856$ $ERUGXO SHUFXWDQ ILH F HVWH SHQWUX &RQWUDLQGLFDLL hipersensibilitate (alergie) la silodosin sau la
oricare dintre celelalte componente ale medicamentului.
QHIURVFRSLH VDX XUHWHURVFRSLH VH SRDWH vQVRL GH DFHOHDL
Sindromul de iris flasc intraoperator (SIFI) apare la unii pacienti
incidente pe care le-DPPHQionat n capitolul dedicat NLP. tratati cu antagonisti de alfa-adrenoreceptori si poate cauza
complicatii in timpul operatiei de cataracta.
VII. LAPAROSCOPIA
5HDFLL DGYHUVH: ejaculare retrograda, hipotensiune ortostatica,
Unul din domeniile n care tehnicile minim invazive (mai cefalee.
FRUHFW WHKQLFL FX DFFHV PLQLP GHRDUHFH LQWHUYHQLD SURSULX-]LV
2.OMNIC 0,4: (Tamsulosinum HCl)
poate fi de amploare) au avansat spectaculos n ultimii ani este cel 3UH]HQWDUHIDUPDFHXWLFcapsule 0,4mg.
al chirurgiei laparoscopice, acest domeniu al urologiei fiind unul din $FLXQL WHDSHXWLFH 2PQLF  FUHWH YDORDUHD GHELWXOXL XULQDU
PD[LP SULQ UHGXFHUHD WHQVLXQLL PXVFXODWXULL QHWHGH GLQ SURVWDW
L XUHWU GHWHUPLQkQG GLPLQXDUHD REVWUXFLHL $PHOLRUHD]


 
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,QGLFDLL ,QIHFLLDOHFLORUUHVSLUDWRULLEURQLWDFURQLFVLQX]LWD FHOHPDLGLQDPLFHvQDFHVWVHQV$FHDVWWHQGLQDIRVWVXVLQXW


LQIHFLLOHFLORUXULQDUHSLHORQHIULWDFURQLFLQIHFLLDOHWUDLHFWXOXL
vQXOWLPLLDQLLGHLQWURGXFHUHDWHKQRORJLHLURERWLFHFHDSHUPLVXQ
GLJHVWLY SURYRFDW GH 6DOPRQHOOD 6KLJHOOD L ( FROL ,QIHFLL
JHQLWDOH LQFOXVLY XUHWULWD JRQRFRFLF DOWH LQIHFLL EDcteriene SURJUHVFRQVLGHUDELOvQWUDWDPHQWXOSDFLHQLORU
VLVWHPLFHLQIHFLLFXWDQDWHVHSWLFHPLL
Principalele avantaje ale laparoscopiei sunt legate de
Mod de administrare: 'R]D LQLLDO -3 cp. Biseptol 480, de 2
RULSH]L'R]DGHLQWUHLQHUHFRPSULPDWGHRULSH]L inciziilH PLFL FH FRQWULEXLH OD R UHGXFHUH LPSRUWDQW D QHFHVDUXOXL
&RQWUDLQGLFDLL +LSHUVHQVLELOLWDWHIDGHVXOIDPLGHVDXIDGH
GHDQDOJH]LFHSRVWRSHUDWRULODUHFXSHUDUHDUDSLGFXUHGXFHUHD
trimetoprim, sarFLQDLSHULRDGDGHDOSWDUHSUHFDXLLvQFD] GH
LQVXILFLHQ KHSDWLF VDX UHQDO SUHFXP L OD SUHGLVSR]LLH VHPQLILFDWLY D VSLWDOL]ULL SRVWRSHUDWRULL 'H DVHPHQHD GDWRULW
PDUFDQWODDOHUJLLODDVWPXOEURQLF
faptului ca imaginea ce se observa de catre chirurg pe monitor
5HDFLL DOUHJLFH DJUDQXORFLWR] DQHPLL OHXFRSHQLL LQIHFLL HVWH PULW VH SRDWH UHDOL]D R GLVHFWLH PXOW PDL SUHFLV D
cutanate alergice, Erythema multiforme, uUWLFDULLSUXULWGHUPDWLW
structurilor anatomice avnd ca rezultat pierderi minime de snge.
H[IROLDWLY WXOEXUDUL GLJHVWLYHLQIODPDLL DOH SDUHQFKLPXOXL
hepatic, cefalee, tulburari temporare ale sistemului nervos 5LVFXULOH LQWUDRSHUDWRULL DOH LQWHUYHQLLORU ODSDURVFRSLFH VXQW vQV
central.
DWkW FHOH GLQ FKLUXUJLD GHVFKLV FkW L XQHOH VSHFLILFH DFHstei
II. ANTALGICE
metode.
1. TRAMADOL:
3UDFWLF RULFH LQWHUYHQLH FKLUXUJLFDO FODVLF SRDWH IL
3UH]HQWDUH IDUPDFHXWLF - cps 50 mg; fiole 50 mg / 1 ml; sup
100 mg HIHFWXDW vQ YDULDQW ODSDURVFRSLF SULQ UHDOL]DUHD XQXL DERUG
$FLXQHWHUDSHXWLFDQDOJH]LFFXDFLXQHLQWHQV transperitoneal, properitoneal sau retroperitoneal. Principalele
,QGLFDLL - dureri intense sau moderate, acute sau cronice;
pentru analgezii cu prilejul unor manevre diagnostice sau LQWHUYHQLL ODSDURVFRSLFH XURORJLFH VXQW QHIUHFWRPLD UDGLFDO VDX
terapeutice. SDULDO QHIUHFWRPLD GRQDWRUXOXL GH JUHI DEODLD JODQGHL
Mod de administrare: i.v., i.m., sc. 1-2 fiole; 1 sup la nevoie,
maxim 400 mg/24 h. VXSUDUHQDOH SLHORSODVWLD DEODLD FKLVWXULORU UHQDOH SLHOROLWRWRPLD
&RQWUDLQGLFDLL - LQWR[LFDLH DFXW cu alcool, hipnotice, ureterolitotomia, reimplantarea uretero-YH]LFDO SURVWDWHFWRPLD
DQDOJH]LFH SVLKRWURSH SUXGHQ vQ FD] GH ,5 ,+ GR]H PDL
mici). UDGLFDO FLVWHFWRPLD UDGLFDO OLPIDGHQHFWRPLD SHOYLQ FXUD
5HDFLL DGYHUVH VHGDUH RERVHDO VXGRUDLL DPHHOL YDULFRFHOXOXL vQ WUDWDPHQWXO FULSWRRUKLGLHL FKLUXUJLD LQFRQWLQHQHL
XVFFLXQHDJXULLJUHDYRPKLSRWHQVLXQHRUWRVWDWLF
InWHUDFLXQL PHGLFDPHQWRDVH QX VH DVRFLD] cu alte XULQDUHDEODLDGLYHUWLFXOXOXLYH]LFDOHWF
GHSULPDQWH FHQWUDOH SRWHQDUH ; QX VH DVRFLD] FX ,0$2 ULVF INSTRUMENTAR NECESAR:
toxic mare).
3ULQFLSDOD GLIHUHQ vQWUH LQWHUYHQLLOH FKLUXUJLFDOH FODVLFH VL
2. PIAFEN:
cele laparoscopice este modul de abordare al regiunii anatomice
3UH]HQWDUH IDUPDFHXWLF: cps: 500 mg metamizol sodic, 5 mg
SLWRIHQRQFORUKLGUDWLPJIHQSLSUDPLGEURPRPHWLODW; sup. DVXSUD FUHLD LQWHUYHQLP DFHDVWD ILLQG DFFHVDW SULQ LQWHUPHGLXO
 J PHWDPL]RO VRGLF  PJ SLWRIHQRQ FORUKLGUDW L  PJ FkWRUYD PLFL LQFL]LL LQWHUYHQLD FKLUXUJLFDO ILLQG YL]XDOL]DW SH XQ
IHQSLSUDPLG EURPRPHWLODW ILROH PO 2,5 g metamizol sodic,
 PJ SLWRIHQRQ FORUKLGUDW L  PJ IHQSLSUDPLG PRQLWRU XQGH LPDJLQLOH DMXQJ GDWRULW XQXL sistem video ce este
bromometilat.

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

F. SULFAMETOXAZOLTRIMETOPRIM (Biseptol)

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,
FIG. VI.9. - ,QWHUYHQLHODSDURVFRSLF PLFUREDFWHULLYLUXLLIXQJL

 $
;0(',&$0(17()2/26,7(135$&7,&$852/2*,& 9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(

&RQWDLQGLFDLL SUHFDXLH L DMXVWDUHD GR]HORU OD SDFLHQLL FX Sistemul electric este format dintr-un generator de curent
LQVXILFLHQUHQDOvQIXQFLHGHFOHDUFH-XOGHFUHDWLQLQ
FX IUHFYHQ vQDOW FH SHUPLWH DMXVWDUHD LQWHQVLWLL IXQFLH GH
5HDFLL DGYHUVH GLDUHH YUVWXUL JUHD HUXSLL WUHFWRDUH SH
piele, leucopenie, neutropenie, trombocitopenie. QHFHVLWL FRDJXODUH VDX WLHUH  H[LVWkQG FD vQ FKLUXUJLD FODVLF
posibilitatea folosirii DWkWDFXUHQWXOXLPRQRSRODUFkWLELSRODU
C. 7,&$5&,/,1
 ACID CLAVULANIC (Timentin)
6LVWHPXO GH LULJDUHDVSLUDLH permite realizarea att a
3UH]HQWDUHIDUPDFHXWLFflacon 1,6 g LJ LULJULL XQHL ]RQH DFRSHULWH GH XQ FKHDJ FkW L D DVSLUULL IOXLGHORU
0RG GH DFLXQH L LQGLFDLL LQIHFLL JUDYH DOH DSDUDWXOXL
XURJHQLWDO UHVSLUDWRU VIHUD 25/ VHSWLFHPLL LQIHFLL GLQ FDPHUD GH OXFUX ODSDURVFRSLF vQ VHQVXO IDFLOLWULL XQHL
SRVWFKLUXUJLFDOHSHULWRQLWHLQIHFLLRVWHRDUWLFXODUHLQIHFLLVHYHUH YL]XDOL]ULRSWLPH.
ODSDFLHQLLLPXQRGHSULPDL
Mod de administrare: uzual 1 f (3,2 g) OD RUHvQLQVXILFLHQ Instrumentarul laparoscopic operator este format din
UHQDO - FOHDUDQFH FUHDWLQLQ !  POPLQ  J x 3 / zi; trocarele laparoscopice ce permit introducerea instrumentelor de
FOHDUDQFH FUHDWLQLQ -30 ml/min, 1,6 g x 3/zi; clearance
FUHDWLQLQ OXFUXGHODH[WHULRULQFDPHUDODSDURVFRSLFLVXQWIRUPDWHGLQWU-o
ml/min, 1,6 g la 12 ore. WHDF PHWDOLF VDX GLQ PDWHULDO SODVWLF FH SUH]LQW L R YDOY FH
&RQWUDLQGLFDLL KLSHUVHQVLELOLWDWH OD SHQLFLOLQ SUXGHQ la
SDFLHQLLFXGLVIXQFLLKHSDWLFHVDUFLQDOSWDUHVDXWXOEXUULGH poate fi FRQHFWDW OD LQVXIODWRU L XQ WURFDU FH IDFLOLWHD]
coagulare. SDWUXQGHUHD WHFLL SULQ SHUHWHOH DEGRPLQDO GDWRULW YkUIXOXL VX
5HDFLLDGYHUVHVXQWUDUHLFRPXQHSHQLFLOLQHORULQMHFWDELOH
ascuLW&DLLQVWUXPHQWHRSHUDWRULLODSDURVFRSLFHH[LVWSHQVHGH
D. $03,&,/,1SULBACTAM (Ampiplus) diferite tipuri, foarfeci, port-ace, aplicatoare de clipuri, staplere,

3UH]HQWDUH IDUPDFHXWLF IODFRDQH FH FRQLQ DPSLFLOLQ  J  departatoare, etc., toate adaptate nevoii de a fi introduse prin
sulbactam 0,5 g. FDQXOFXSDUWHDDFWLYvQLQWHULRUXOFDPHUHLGHOXFUXODSDURVFRSLFH
AFLXQH WHUDSHXWLF sulbactamul este un inhibitor de beta
ODFWDPD] GHWHUPLQkQG vQ DVRFLHUH FX DPSLFLOLQD R OUJLUH D LFX]RQDGHPDQHYUDUHODH[WHULRU
spectrului acesteia (stafilococul rezistent la peniciline, E. Coli, (FKLSD RSHUDWRULH HVWH IRUPDW GLQ FKLUXUJXO RSHUDWRU
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gastrointestinale, dentare, cutanate, osteoarticulare. 3ULQFLSDOHOH PRPHQWH DOH XQHL LQWHUYHQLL FKLUXUJLFDOH
Mod de administrare: JGHGRX RULSH]LvQLQIHFLLOHVHYHUH laparoscopice sunt:
SkQ OD  J]L IU D VH GHSLL  J GH VXOEDFWDP UHGXFHUHD
GR]HORUvQFD]GHLQVXILFLHQUHQDO 1. pregatirea pacientului ce cuprinde: a. pregatirea
&RQWDLQGLFDLL DOHUJLH OD SHQLFLOLQH PRQRQXFOHR]D LQIHFLRDV SHUHWHOXL DEGRPLQDO SULQ vQGHSUWDUHD SUXOXL YHULILFDUHD IDStului
KHUSHV OHXFHPLH LQIHFLL VHQVLELOH QXPDL OD DPSLFLOLQ
PRQRWHUDSLHvQLQIHFLLOHJUDYH F QX H[LVW IRFDUH LQIHFLRDVH FXWDQDWH L DVHSWL]DUHD FX VROXLL
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OHXFRSHQLHWXOEXUULGLJHVWLYHPLQRUHFRQGLGR]HGXUHULOD locul
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VH DGPLQLVWUHD] R VLQJXU GR] GH J vQ WUDWDPHQWXO LQIHFLHL
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cateter vezical; d. antibioticoprofilaxie pre- sau intra-operatorie,
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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  ACID CLAVULANIC (Augmentin)
A. AMOXICILINA

n decubit lateral. In cazul oSHUDLLORUSHQWUXRUJDQHVXSUDRPELOLFDOH 3UH]HQWDUHIDUPDFHXWLFcp 375 mg, 625 mg, 1000 mg; fl: 600
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mg/5 ml, 312 mg/ 5 ml;
SODVDWvQIDDRSHUDWRUXOXL, DFHVWDvPSUHXQFXFDPHUDPDQXOILLQG $FLXQH WHUDSHXWLF LQKLE sinteza peretelui bacterian. Activ
SODVDLSHSDUWHDRSXVOH]LXQLLGHRSHUDW3HQWUXDIRORVLJUDYLWDLD pe: streptococ, pneumococ, meningococ, gonococ, listeria,
6WDILORFRFXO DXULX VHFUHWRU GH SHQLFLOLQD] L EDFLOOL *UDP-
n scopul de a UHWUDFWDLQWHVWLQHOHPDVDRSHUDWRULHWUHEXLHvQFOLQDW QHJDWLYL VHFUHWRUL GH -lactamaze: Haemophilus influenzae, E.
VSUH SDUWHD RSXV RUJDQXOXL GH RSHUDW Q FD]XO RUJDQHORU coli,
Klebsiella, Proteus mirabilis, Shigella, Bacteroides fragillis.
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mici n I.R.
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 LQWURGXFHUHD WURFDUHORU GH OXFUX WUHEXLH IFXW FX JULM
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pentru a evita leziunile de organe intraabdominale, primul introdus LQMHFWDELOSHUIX]DELO FH FRQLQ  J SLSHUDFLOLQD J
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,QGLFDLL LQIHFLL PHGLL L VHYHUH DOH WUDFWXOXL XULQDU LQFOXVLY
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9HUHVV OD LQVHULD WURFDUHORU VDX FHOH GHWHUPLQDWH GH JD]XO GH
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14. MACROLIDELE CO2 vQ DOW UHJLXQH GHFDW LQWUDSHULWRQHDO DVWIHO DSUkQG ILH
prepneumoperitoneu, fie pneumoepipORQVDXLQVXIODUHVXEFXWDQDW
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pozitivi, stafilococi penicilinazo-secretori, streptocici, 2. La plasarea trocarelor de fapt vorbim de plasarea
pneumococi,
unele bacterii gram negative din genul neisseria, haemophilus, primului trocar (cel folosit pentru laparoscop), restul fiind introduse
micoplasme. VXEFRQWURORSWLFVLLQDFHVWIHODYDQGRUDWDLQFLGHQWHORUPXOWPDL
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peniciline. OH]LXQL JDVWULFH VDX YH]LFDOH vQ PRPHQWXO LQVHULHL SULPXOXL WURFDU
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RUH SkQ OD PD[LP  J]L 'R]HOH SRW IL GXEODWH vQ LQIHFLLOH Pentru a SUHYHQL DFHVW OXFUX LQVHULD WURFDUXOXL RSWLF VH IDFH SULQ
severe. SURJUHVLD VD SHUSHQGLFXODU SH SHUHWHOH PXVFXODU FX SDUWHD
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DGHUHQH YLVFHUR-SDULHWDOH ULVFXO GH OH]LXQH LQWHVWLQDO DWkW OD
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$FLXQH WHUDSHXWLF SUH]LQ VSHFWUX EDFWHULDQ VLPLODU PDUHvQFkWVHUHFRPDQGUHQXQDUHD OD DERUGXOFXDMXWRUXO acului
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subunitatea 50S, avnd efect bacteriostatic.
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,QGLFDLL PLFURRUJDQLVPH JUDP SR]LWLYH DHUREH L DQDHUREH
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pseudomonas aeruginosa, enterococci, proteus, klebsiella,
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urinare necomplicate.
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2 SDUWLFXODULWDWH D LQWHUYHQLLORU ODSDURVFRSLFH VH UHIHU OD DGPLQLVWUHD]vQGR]XQLFGH JvQDLQWHGHPDVLFXYH]LFD
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SXLQ DWHQXDWH GH SDUFXUVXO ORU SULQ HVXWXUL SLHOH PXFKL  L
+HPDWRORJLFH WURPERFLWHPLH UHYHUVLELO HR]LQRILOLH
lichide. (QHUJLD DFHVWRU XQGH HVWH GHVFUFDW OD LQWHUIDD GLQWUH WURPERFLWRSHQLHLQHXWURSHQLH
PHGLXOOLFKLGLDQ XULQ LFDOFXO,QGLIHUHQWGHPRGXOGHSURGXFHUH
B. IMIPENEM/CILASTATIN (Tienam)
XQGHOHGHRFDXFDHIHFWILQDOGH]LQWHJUDUHDVWUXFWXULORUPLQHUDOH
3UH]HQWDUH IDUPDFHXWLF IODFRDQH FX SXOEHUH SHQWUX VROXLH
fragmentabile (marea majoritate a calculilor renali).
SHUIX]DELO FX FDSDFLWDWHD GH  PO ce contin
TrebuiH V QH LPDJLQP IURQWXO XQGHORU GH RF DYkQG R Imipenem/Cilastatin 500 mg/500 mg sau 250 mg/250 mg
$FWLXQHWHUDSHXWLF bactericid, intervenind la nivelul procesului
RUJDQL]DUHFRQLFDDFXPUH]XOWGLQILJXUDXUPWRDUH ILJ9,  vital al sintezei peretelui celulei bacteriene.
,QGLFDLL XWLO LQ WUDWDPHQWXO LQIHFLLORU SROLPLFURELHQH L PL[WH FX
DJHQLDHURELDQDHURELSUHFXPLvQWUDWDPHQWXOLQLLDOvQDLQWHGH
CALCUL 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
SISTEM DE FOCALIZARE 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
6856$81'(2& CRQWUDLQGLFDLL QX VH DGPLQLVWUHD] vQ PHQLQJLWH SUHFDXLH vQ
Fig.VI.10 - )URQWXOXQGHORUGHRF caz de alergie la antibiotic betalactaminice.
5HDFLL DGYHUVH ORFDOH (ULWHP GXUHUH L LQGXUDLH ORFDO
WURPERIOHELW 5HDFLL DOHUJLFH L FXWDQDWH UDVK SUXULW XUWLFDULH
)UDJPHQWDUHDFDOFXOLORUVHED]HD]SHIDSWXOFLPSHGDQD
eritem multiform, sindrom Steven-Johnson, angioedem,
DFXVWLF D FDOFXOLORU UHQDOL HVWH VHPQLILFDWLY GLIHULW ID GH FHD D QHFUROL] HSLGHUPLF WR[LF GHUPDWLW H[IROLDWLY UDUHRUL 
FDQGLGR]
HVXWXULORU GLQ MXU 3ULQ VWUXFWXUL FX LPSHGDQ DFXVWLF
IHEU UHDFLL DQDILODFWLFH 5HDFLL JDVWURLQWHVWLQDOH JUHDD
DVHPQWRDUH XQGDGHRFWUHFHIUSLHUGHULGHHQHUJLH. YUVWXUL GLDUHH SWDUHD GLQLORU 5HDFLL KHPDWRORJLFH
eozinofilie, leucopeniH QHXWURSHQLH LQFOXVLY DJUDQXORFLWR]
/D IUDJPHQWDUHD FDOFXOLORU SDUWLFLS L fenomenul de
WURPERFLWRSHQLH WURPERFLWR] L VFGHUH D KHPRJORELQHL
FDYLWDLH produs de undele de RF 8QGHOH GHRF UHXHVF prin SUHOXQJLUHDWLPSXOXLGHSURWURPELQ
IRUHOH GH SUHVLXQH FUHDWH OLFKLGXOXL GLQ YHFLQWDWHD FDOFXOXOXL V
!
  
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J. CEFEPIM creeze bule de gaz care se sparg rapid L violent, formnd


microjeturi FH YRU ORYL VXSUDIDD SLHWUHL producnd eroziuni la
3UH]HQWDUHIDUPDFHXWLFSXOEHUHSWVROXLHLQMHFWDELOGHJ
$FLXQH WHUDSHXWLF DFLXQH DVHPQWRDUH FX FHIDORVSRULQHOH VXSUDIDDFDOFXOXOXL
GH JHQHUDLD D ,,,-D GDU PDL SXWHUQLF SH 3HXGRPRQDV
7UHEXLH V vQHOHJHP L IDSWXO F IUDJLOLWDWHD FDOFXOLORU HVWH
Haemophilus, Neisseria, Enterobacter, S. aureus, S. pneumonia.
,QGLFDLL sepWLFHPLH EDFWHULHPLH LQIHFLL DOH DSDUDWXOXL vQ VWUkQV FRUHODLH FX UHHWD OXL ELRFKLPLF 'DF V-ar face un
UHVSLUDWRU LQIHFLL XULQDUH LQIHFLL DOH WUDFWXOXL ELOLDU IHEU OD
clasament privind duritatea calculilor, pe locul nti ar fi desigur
SDFLHQLLFXQHXWURSHQLH
Mod de administrare: i.v. n doza de 0,5-2 g sau i.m. profund n oxalatul de calciu monohidrat, cistina LEUXVKLWXO. La categoria
doza de 0,5- J GH GRX RUL SH ]L 5HGXFHUHD GR]Hlor n
"duritate medie" am putea introduce oxalatul de calciu dihidrat,
LQVXILFLHQDUHQDOvQIXQFLHGHFOHDUHFH-XOGHFUHDWLQLQ
&RQWUDLQGLFDLL DOHUJLH VH DGPLQLVWUHD] FX SUXGHQ vQ DFLGXOXULFLDUvQXOWLPDFDWHJRULHDFDOFXOLORUXRUGHIUDJPHQWDW
VDUFLQLvQSULPHOHOXQLGHDOSWDUH
ar intra fosfatul amoniaco-magne]LDQ FDOFXOLL GH LQIHFLH  S-au
5HDFLL DGYHUVH DOHUJLH WXOEXUUL GLJHVWLYH HR]LQRILOLH
neutrofilie, tombocitopenie, nefrotoxicitate la doze mari, IFXWFRUHODLL LvQWUHJUDGXOGHUDGLR-opacitate al FDOFXOXOXLL
IHQRPHQHQHXURWR[LFHFDQGLGR]GXUHULORFDOHGXSDLQMHFWDUH
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
distana de la calcuOODSLHOH VNLQWRVWRQHGLVWDQFH &XH[FHSLD
5HSUH]HQWDQLertapenem, doripenem, imipenem, meropenem.
FDOFXOLORUGHFLVWLQVHSRDWHVSXQHFradio-opacitatea este invers
A. MEROPENEM (Meronem)
SURSRULRQDOFXUDWDGHIUDJPHQWDUHDFDOFXOXOXL
3UH]HQWDUHIDUPDFHXWLF )ODFRQSHQWUXLQMHFLLLYVDXSHUIX]LL APARATELE DE ESWL
ce FRQLQPJVDXJ PHURSHQHPVXEIRUPGHWULKLGUDWvQ 2ULFH WLS GH OLWRWULWRU SUH]LQW XUPWRDUHOH VLVWHPH
amestec cu carbonat de sodiu anhidru pentru constituire.
$FLXQHWHUDSHXWLF bactericid, intervenind la nivelul procesului componente:
YLWDO DO VLQWH]HL SHUHWHOXL FHOXOHL EDFWHULHQH 8XULQD FX FDUH
x VXUVDGHSURGXFHUHLPHFDQLVPXOGHGLULMDUHDXQGHORUGH
penetreaz SHUHWHOH EDFWHULDQ QLYHOXO VX ULGLFDW GH VWDELOLWDWH
ID GH WRDWH EHWD-ODFWDPD]HOH VHULFH L DILQLWDWHD VD PDUFDW RFvQIRFDU
SHQWUX 3%3 3HQLFLOOLQ %LQGLQJ 3URWHLQV  H[SOLF DFLXQHD
x VLVWHPXOGHUHSHUDMLYL]XDOL]DUHDFDOFXOXOXL
EDFWHULFLG SXWHUQLF D PHURSHQHP vPSRWULYD XQXL VSHFWUX ODUJ
de bacterii aerobe si anaerobe. x PDVDPRELO FXSODWVXUVHLGHXQGHGHRF 
,QGLFDLL 3QHXPRQLLLQFOXVLYSQHXPRQLLQRVRFRPLDOHLQIHFLLDOH
WUDFWXOXLXULQDULQIHFLLLQWUD-DEGRPLQDOHLQIHFLLJLQHFRORJLFHGH x SXSLWUXOGHFRPDQG
H[HQGRPHWULWDLERDODLQIODPDWRULHSHOYLDQLQIHFLLFXWDQDWHL a) 6XUVHGHXQGHGHRF
ale tesuturilor moi; meningite; septicemii.
Mod de administrare: injectabil i.v. n bolus lent sau n perfuzie 1. (PLWRDUHOH supersonic (supersonic emitters) HOLEHUHD]
LQWUDYHQRDV WLPS GH DSUR[LPDWLY - PLQ 'R]D ]LOQLF energia ntr-XQ VSDLX OLPLWDW SURGXFkQG XQGH GH RF DFXVWLFH L
UHFRPDQGDW HVWH  PJ LY OD ILHFDUH  RUH vQ WUDWDPHQWXO
SQHXPRQLHLLQIHFLLORUWUDFWXOXLXULQDULQIHFLLORUJLQHFologice, de SODVP$VWIHOGHXQGHGHRFDSDUvQQDWXUSHWLPSGHIXUWXQ
H[HQGRPHWULWDLQIHFLLORUFXWDQDWHLDOHHVXWXULORUPRLJLY (fulgerul XUPDW GH WXQHW  Q VLWXDLL DQXPLWH R DVWIHO GH XQG GH
la 8 ore n tratamentul pneumoniilor nosocomiale, peritonitei,
 
! 
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RFDFXVWLFSRDWHIUDJPHQWDFXVXFces calculii. Aceste litotritoare 5HDFLL DGYHUVH WXOEXUUL GLJHVWLYH FUHWHUHD 7*2
nefrotoxicitate, dureri locale la locul de administrare,
GH WLS VSDUN JDS EXMLH  SUHVXSXQ GHVFUFDUHD vQWU-un mediu
WURPERIOHELW IHQRPHQH QHXURWR[LFH FRQYXOVLL WXOEXUUL GH
OLFKLGLDQ DSD GHJD]HLILDW  D XQRU HQHUJLL PDUL vQWUH  9 L FRQWLHQPLFULDQRUPDOH 
9vQWUHGRLHOHFWUR]L VFXIXQGDLvQOLFKLG 
H. CEFTAZIDIM (Ceftamil)
2. (PLWRDUHOH FX DPSOLWXGLQH ILQLW crea] unde acustice
3UH]HQWDUH IDUPDFHXWLF SXOEHUH SHQWUX VROXLH LQMHQFWDELO
SXOVDWLOH SULQ GHSODVDUHD XQHL VXSUDIHH DFWLYDWH SULQ GHVFUFUL
500 mg, 1 g, 2 g.
HOHFWULFH([LVWGRXWLSXULGHDVWIHOGHHPLWRDUH $FLXQHWHUDSHXWLF efect bactericid, cu activitate pe specii de
Proteus, Enterobacter, E. Coli, citrobacter, Salmonella,
-(PLWRDUHHOHFWURPDJQHWLFH
Pseudomonas, Haemophilus,Nisseria, Bordetella, Yersinia;
-(PLWRDUHSLH]RHOHFWULFH Stafilococul auriu.
,QGLFDLL LQIHFLJUDYHFXVSHFLLVHQVLELOHVHSWLFHPLLPHQLQJLWH
b) 6LVWHPXOGHIRFDOL]DUHDOXQGHORUGHRF
Mod de administrare: J]LvQSUL]H'R]HOHVHDMXVWHD]vQ
n diagrama de mai jos, VH SRDWH XRU UHPDUFD IDSWXO F IXQFLHGHFOHDUHQFH-XOGHFUHDWLQLQ
&RQWUDLQGLFDLL aOHUJLH VH DGPLQLVWUHD] FX SUXGHQ vQ
SXQFWXOVSUHFDUHVHvQGUHDSWXQGHOHGHRFSURGXVHvQFXYSULQ
VDUFLQLvQSULPHOHOXQLGHDOSWDUH
GHVFUFDUHD HOHFWULF UHSHWDW GH -19kV, coincide cu calculul 5HDFLL DGYHUVH DOHUJLH WXOEXUUL GLJHVWLYH HR]LQRILOLH
neutrofilie, trombocitopenie, nefrotoxicitate la doze mari,
ED]LQHWDO UHSHUDW UDGLRORJLF ELGLPHQVLRQDO L YL]XDOL]DW SH FHOH
IHQRPHQHQHXURWR[LFHFDQGLGR]GXUHULORFDOHGXSDLQjectare.
douPRQLWRDUH ILJ9, 6UHPDUFPGHDVHPHQHDIDSWXOF
I. CEFPIROM (Cefrom)
pacientul este imersat ntr-R FDG FX DS GHJD]HLILFDW FDUH
SHUPLWHXQGHORUGHRF VDMXQJODLQWHUIDDGLQWUHFDOFXO LXULQD 3UH]HQWDUHIDUPDFHXWLFflacoane 500 mg, 1000 mg, 2000 mg.
$FLXQH WHUDSHXWLF L LQGLFDLL FHIDORVSRULQ GH JHQHUDLD D
FRQLQXWvQbasinet
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 La celelalte tipuri de litotritoare electro-hidraulice mai
septicemiLLQIHFLLRVRDVHFXWDQDWH
PRGHUQH FDGD FX DS FDUH GHVLJXU SXQHD SUREOHPH GH FRQIRUW
Mod de administrare: 1-2 g/zi ntr-RVLQJXU GR]
&RQWUDLQGLFDLL - DOHUJLH OD FHIDORVSRULQH SUXGHQ la cei cu SDFLHQWXOXL D IRVW vQORFXLW FX R SXQJ VSHFLDO GH FDXFLXF
DOHUJLL OD SHQLFLOLQ SUXGHQ VDX VH YD HYLWD vQ VDUFLQ L OD
PHPEUDQ GH FXSODUH  DGDSWDW FXYHL vQ FDUH VH SURGXF
IHPHLOH FDUH DOSWHD] GR]H PDL PLFL OD SDFLHQLL FH SUH]LQW
I.R.sau I.H. GHVFUFULOH HOHFWULFH /LWRWULWRDUHOH HOHFWURPDJQHWLFH L
5HDFLL DGYHUVH GLDUHH JUHD YUVWXUL JORVLW OHXFRSHQLH SLH]RHOHFWULFH DX VXUVD GH XQGH GH RF DFRSHULW FX DFHODL WLS
DQHPLHKHPROLWLFWURPERFLWRSHQLHSUXULWFXWDQDWXUWLFDUH
FHIDOHHIHEUIULVRDQH GHSXQJGHFDXFLXFFXSODUHDSDFLHQWXOXLIFkQGX-VHvQIXQFLHGH
Asocieri medicamentoase: vQ LQIHFLL FX 3VHXGRPRQDV HVWH SR]LLDFDOFXOXOXL
DYDQWDMRDVDVRFLHUHDFXXQ$*
0RGDOLWLOHGHUHSHUDMDOHFDOFXOXOXLVXQWFHOHXWLOL]DWHL
F. CEFIXIM (Eficef) vQGLDJQRVWLFXOOLWLD]HLIOXRURVFRSLDLHFRJUDILD

3UH]HQWDUHIDUPDFHXWLF capsule de 200 mg. Reperajul radiologic vQ GRX SODQXUL DUH FHUWH DYDQWUDMH
$FLXQH WHUDSHXWLF LQKLE sinteza peretelui bacterian; stabil majoritatea calculilor urinari sunt radioopaci; amplificatoarele de
IDGH-ODFWDPD]
,QGLFDLL LQIHFLL DOH FLORU UHVSLUDWRULL 25/ DOH FLORU XULQDUH LPDJLQHRIHUR EXQUH]ROXLHLQIRUPkQGFXPXOWSUHFL]LHGHVSUH
FLORU biliare produse de streptococ, pneumococ, Moraxella, HYROXLDFDOFXOXOXLVXEWLUXOXQGHORUGHRFVHSRWORFDOL]D GHVLJXU
Haemophilus, Nisseria, Serratia.
Mod de administrare: 400 mg pe zi n 2 prize. L vQ IXQFLH GH WLSXO GH OLWRWULWRU  FDOFXOLL VLWXDL SH XUHWHU SHUPLWH
&RQWUDLQGLFDLL DOHUJLH OD FHIDORVSRULQH SUXGHQ la cei cu plasarea sondelor ureterale, nainte sau chiar n timpul lLWRWULLHLVDX
DOHUJLL OD SHQLFLOLQ SUXGHQ VDX VH YD HYLWD vQ VDUFLQ L la
IHPHLOH FDUH DOSWHD] GR]H PDL PLFL OD SDFLHQLL FH SUH]LQW HYHQWXDOD LQWURGXFHUH D VXEVWDQHORU GH FRQWUDVW LQWUDYHQRV VDX
I.R.sau I.H. SULQ FDWHWHU XUHWHUDO SHQWUX R PDL EXQ YL]XDOL]DUH D FDOFXOLORU
5HDFLL DGYHUVH GLDUHH JUHD YUVWXUL JORVLW OHXFRSHQLH
DQHPLH KHPROLWLF WURPERFLWRSHQLH SUXULW FXWDQDW  XUWLFDUH UDGLRWUDQVSDUHQL
FHIDOHHIHEUIULVRDQH Reperajul ecografic. Avantajele reperajului calculilor

G. CEFOTAXIM UDGLRWUDQVSDUHQLLHYLWDUHDULVFXOXLGHLUDGLHUHSUHXOGHFRVWLGH
vQWUHLQHUH PDL VF]XW DPSODVDUHD vQ RULFH LQFLQW VXQW
Prezentare faUPDFHXWLF SXOEHUHSHQWUXVROXLHLQMHFWDELOLP
sau i.v. 500mg, 1g, 2g. contrabalansate de imposibilitatea reperajului calculilor ureterali
$FLXQH WHUDSHXWLF efect bactericid pe streptococ, ORPEDUL L SHOYLQL SUHFXP L HYDOXDUHD FkWHRGDW GLILFLO D
penumococi, stafilococi penicilinazo-secretori, gonococi,
meningococ, Klebsilla, Enterobacter, Proteus, Salmonella, IUDJPHQWULLFDOFXOXOXL
Shigella, Citrobacter, Providenatia, Moraxela, clostridium. Masa mRELO SH FDUH HVWH DH]DW SDFLHQWXO a FXQRVFXW L HD
,QGLFDLL LQIHFLL JUDYH VHYHUH VHSWLFHPLL HQGRFDUGLWH
meningite. PXOWLSOH DGDSWUL vQ VFXUWD LVWRULH D OLWRWULLHL H[WUDFRUSRUHDOH
Mod de administrare: i.m. sau i.v. 12g/zi n 3-4 prize; n 0RGHOHOH PDL QRL SHUPLW QX QXPDL R PDL EXQ PRELOLWDWH D
LQIHFLLOH XULQDUH VH DGPLQLVWUHD] J]L 5HGXFHUHD GR]HL OD
MXPWDWHFkQGFlearence-ul creatininei scade sub 5 ml/min. SDFLHQWXOXL GDU L SRVLELOLWDWHD HIHFWXULL PDQHYUHORU
&RQWUDLQGLFDLL alergie.

 
9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9( ;0(',&$0(17()2/26,7(135$&7,&$852/2*,&

HQGRXURORJLFHFKLDULvQWLPSXOOLWRWULLHL Klebsiella, Citobacter, Neisseria gonorrheae, Propionibacteria


DFQHVL%DFWHURLGHVVSSSHSWRFRFLSHSWRVWUHSWRFRFL
2. 3XSLWUXO GH FRPDQG, GH XQGH VXQW GHFODQDWH XQGHOH GH RF
,QGLFDLL LQIHFLL DOH WUDFWXOXL XULQDU LQIHFLL 25/ LQIHFLL
HVWH VLWXDW vQ YHFLQWDWHD PRQLWRUXOXL PRQLWRDUHORU  XQGH VH UHVSLUDWRULLLQIHFLLFXWDQDWHFXJHUPHQLVHQVLELOLOD&HIDFORU
Mod de administrare: RUDO X]XDO  PJ OD  K vQ LQIHFLL
YL]XDOL]HD] FDOFXOXO ,QGLIHUHQW GH WLSXO GH DSDUDW GH DLFL HVWH
severe 500 mg la 8 h (doza max. 4 g/zi).
UHJODW NLORYROWDMXO XQGHORU GH RF IUHFYHQD ORU L VXQW GHFODQDWH 5HDFLL DGYHUVH HUXSLL FXWDQDWH SUXULW XUWLFDULH JUHD,
YUVWXUL UDU KHSDWLW WUDQ]LWRULH L LFWHU FROLVWDWLF
PDL PXOW VDX PDL SXLQ ]JRPRWRDVHOH XQGH GH RF Q FD]XO
&RQWUDLQGLFDLL ODEROQDYLLDOHUJLFLODFHIDORVSRULQHSUXGHQ la
DSDUDWHORU FX UHSHUDM UDGLRORJLF SXSLWUXO GH FRPDQG HVWH ILH cei alergici la peniciline.
Asocieri medicamentoase: Aminoglicozide Metronidazol n
instalat ntr-RvQFSHUHDOWXUDWILHSURWHMDWGHXQHFUDQGHVWLFO
LQIHFLLVHYHUH DQDEROLL 
VSHFLDOLPSHQHWUDELOSHQWUXUD]HOH X (fig.VI.12).
D. CEFTIBUTEN (Cedax)
monitoare
Pern cu ap 3UH]HQWDUH IDUPDFHXWLF Capsule a 400 mg. Pulbere pentru
Calcul renal 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
Coloan de lichid EURQLWHORU FURQLFH SQHXPRQLL DFXWH ,QIHFLL XULQDUH FRPSOLFDWH
Monitor
Generator de sau nu. Enterite LJDVWURHQWHULWHODFRSLL
unde de oc
Mode de administrare: $GXOL 400 mg/zi. Capsulele pot fi
EKG
administrate independent de mese. Copii: 9 mg/kg/corp/zi de
Reflector VXVSHQVLHRUDO
&RQWUDLQGLFDLL /D SDFLHQLL DOHUJLFL OD FHIDORVSRULQH VDX OD
Fig. VI.12 6FKHPDXQXLOLWRWULWRUHOHFWURKLGUDXOLFGHJHQHUDLDDGRXD
RULFDUHGLQWUHFRQVWLWXHQLLVL
5HDFLL DGYHUVH $X IRVW UDSRUWDWH UDU UHDFLL DGYHUVH
JDVWURLQWHVWLQDOHJUHDGLDUHHFHIDOHH
ESWL - ,1',&$,,
Se pot trata prin ESWL: E. CEFTRIAXON (Cefort)
x calculi caliceali superiori L PLMORFLL VLQJXUD FRQGLLH fiind
3UH]HQWDUH IDUPDFHXWLF: flac: 259 mg, 500 mg, 1 g, 2 g.
R WLM FDOLFHDO VXILFLHQW GH ODUJ FDUH V SHUPLW $FLXQH WHUDSHXWLF LQKLE sinteza peretelui bacterian; stabil
IUDJPHQWHORUVSOHFHVSUHED]LQHW ID GH -ODFWDPD] Spectru antibacterian: Stafilococul aureus,
Staf.epidermidis, Streptococus pneumoniae, Enterobacter, E.
x calculi caliceali inferiori. Pentru a beneficia de ESWL coli, HaemRSKLOXV LQIOXHQ]DH L SDUDLQIOXHQ]DH .OHEVLHOOD
WUHEXLHVF vQGHSOLQLWH SHQWUX HOLPLQDUH QLte criterii Neisseria gonorheae, Proteus mirabilis, Pseudomona
aeruginosa.
 ,QGLFDLL LQIHFLL XULQDUH LQIHFLL JHQLWDOH LQFOXVLY JRQRUHH 
 $
;0(',&$0(17()2/26,7(135$&7,&$852/2*,& 9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(

ceftibuten, cefotaxim, ceftizoxim, ceftriaxon, ceftazidim, anatomice favorabile: unghiul infundibulo-pelvic mai mare
FHIRSHUD]RQ JHQHUDLDD,9D FHIHSLPFHISLURP  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, x calculi bazinetali mai mici de 2 cm n diametru.
SXOEHUHSHQWUXVXVSHQVLHRUDOPOPOPO
$FLXQH WHUDSHXWLF bactericid pe bacterii JUDP SR]LWLYH L SH x calculi ureterali lombari SkQ vQFPDFURU aspect
unele specii de bacili gram negativi. radiologic VXJHUHD] SRVLELOD IUDJPHQWDUH calculi
,QGLFDLL LQIHFLL 25/ LQIHFLL UHVSLUDWRULL LQIHFLL XULQDUH L
cutanate cu germeni sensibili, n special gram pozitivi. semiopaci;
Mod de administrare: p.o. 0,5-1g, n 4 prize. x calculi ureterali iliaci GDF DSDUDWXO GH OLWRWULLH DUH
5HDFLLDGYHUVH JUHXULYUVWXULFUHWHULDOHWUDQVDPLQD]HORU
icter colestatic. DFHDVWIDFLOLWDWH
&RQWUDLQGLFDLLDOHUJLHLQIHFLLVHYHUHVHSWLFHPLL x calculi ureterali pelvini SHQWUX PXOL DXWRUL (6:/ fiind

B. CEFUROXIM (Zinnat) SULPDRSLXQHvQDLQWHDXUHWHURVFRSLHL


&DOHD XULQDU VXEMDFHQW FDOFXOXOXL WUHEXLH V ILH
3UH]HQWDUH IDUPDFHXWLF cps film 125 mg, 250 mg, 500 mg;
SHUPHDELO $FHDVWD HVWH XQD GLQ FRQGLLLOH GH ED] ce trebuie
suspensie 125 mg/5 ml.
$FLXQH WHUDSHXWLF - spectru: Coci Gram-pozitivi: pneumococ, YHULILFDW vQDLQWH GH RULFH WHQWDWLY GH OLWRWULLH 8URJUDILD LY vL
Streptococ piogen, Stafilococul omini, Stafilococul epidermidis;
JVHWH L DLFL XWLOLWDWea de necontestat, preciznd att locul
Bacili Gram-pozitivi: N. Pneumoni; E. coli, Proteus mirabilis,
Citobacter, Providentia, N. Influenzae. REVWDFROXOXLFkWLJUDGXOGHSHUPHDELOLWDWHDFLLXULQDUH
,QGLFDLL LQIHFLL XULQDUH SQHXPRQLL PHQLQJLWH sinuzite cu
&RH[LVWHQD LQIHFLHL XULQDUH FX OLWLD]D a constituit L
germeni sensibili.
Mod de administrare: LQIHFLL XULQDUH  PJx2/zi; pneumonii, FRQVWLWXLHRSUREOHPIRDUWHVHULRDVGLQSHUVSHFWLYDWUDWDPHQWXOXL
EURQLWHPJx2/zi.
L D HYHQWXDOHORU FRPSOLFDLL 7UDWDUHD HQHUJLF FRQIRUP
&RQWUDLQGLFDLL- KLSHUVHQVLELOLWDWHODFHIDORVSRULQHSUXGHQ la
SDFLHQLLDOHUJLFLODSHQLFLOLQH DQWLELRJUDPHL D HYHQWXDOHL LQIHFLL vQDLQWH GH OLWRWULLH HVWH
5HDFLLDGYHUVH - HUXSLL FXWDQDWH XUWLFDULHVWULIHEULOHIRDUWH
obligatorie.
UDUUHDFLLDQDILODFWLFHJUHDYUVWXULGLDUHH
Asocieri medicamentoase: se pot asocia cu AG sau &2175$,1',&$,,/((6:/
PHWURQLGD]ROvQLQIHFLLVHYHUH
 Absolute: sDUFLQDLQGLIHUHQWGHEXQDHYROXLH tXOEXUULGH
C. CEFACLOR (Ceclor) FUD]VDQJXLQQHFRQWURODELOHREVWDFROGLVWDOFDOFXOXOXLGH
WUDWDW VWHQR] XUHWHUDO DOW FDOFXO HWF  SDFLHQW FRPDWRV
3UH]HQWDUH IDUPDFHXWLF: cps: 250 mg; 500 mg; suspensie
pentru DGPLQLVWUDUHRUDOPJPOPJPO QHFRRSHUDQW +7$ QHFRQWURODELO SDFLHQL OD FDUH FDOFXOXO
$FLXQHWHUDSHXWLFLLQGLFDLL FHIDORVSRULQ gen. III - LQIHFLL QX SRDWH IL DGXV vQ IRFDU REH]LWDWH JU ,,, GHIRUPUL DOH
cu stafilococi coagulazo-SR]LWLYL L QHJDWLYL L SHQWUX FHL
SURGXFWRUL GH SHQLFLOLQD] 6WUHSWRFRF S\RJHQHV VWUHSWRFRF coloanei vertebrale).
pneumonie, Moraxella catarrhalis, Haemophillus influenzae  Relative: +7$ LQIHFLD XULQDU SDFLHQLL DIODL VXE
LQFOXV VHFUHWRUL GH -ODFWDPD]  ( FROL 3URWHXV PLUDELOLV

 
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.
5HSUH]HQWDQLtetraciclina, doxiciclina,minociclina.
35(*7,5($3$&,(178/8,3(1758(6:/
3HQWUX SDFLHQLL FDUH vor urma ESWL pe un litotritor cu A. DOXICICLINA : (doxycylinum)
UHSHUDM UDGLRORJLF WUHEXLH V VH HIHFWXH]H R SUHJWLUH
Forma de prezentare: &DSVXOH FRQLQkQG  PJ GR[LFLFOLQD
preoperatorie. 9RP DYHD vQ YHGHUH R EXQ SUHJWLUH D WXEXOXL sub forma de clorhidrat.
GLJHVWLYSHQWUXFDDHURFROLDLVDXPDWHULLOHIHFDOHVQXDFRSHUH $FLXQH WHUDSHXWLF Doxiciclina este un antibiotic DSDULQkQG
JHQHUDLHLDGRXDGHWHWUDFLFOLQH
calculul vizat. ,QGLFDLL ,QIHFLL DOH DSDUDWXOXL UHVSLUDWRU LQIHFLL DOH DSDUDWXOXL
&RQVLGHUPFsunt EHQHILFHXUPWRDUHOHUHFRPDQGUL XURJHQLWDO DQWLELRWLF GH SULP DOHJHUH vQ LQIHFLLOH SURYRFDWH GH
Chlamydia, Calymmatobacterium granulomatis (granulom
 evitarea cu 12-24 ore nainte de ESWL a consumului de inghinal), UreaplaVPDXUHDO\WLFXP&DDOWHUQDWLYODWUDWDPHQWXO
PkQFUXUL L EXWXUL FH SURYRDF IODWXOHQ EDORQDUH  FX SHQLFLOLQ vQ LQIHFLLOH SURYRFDWH GH JRQRFRFFL JRQRUHH
XUHWULWH  +DHPRSKLOXV GXFUH\ VDQFUXO PRDOH  L 7UHSRQHPD
IDVROHFDUWRILGXOFLXULIUXFWHEXWXULFDUERJD]RDVHFXVDX SDOOLGXP DJHQWXO HWLRORJLF DO VLILOLVXOXL LQIHFLL JDVWURLQWHVWLQDOH
LQIHFLLRFXODUHDOHSLHOLLLHVXWXULORUPRL
IU]DKU
Mod de administrare: 'R]D RELQXLW la adult este de 200 mg
 HYLWDUHD IXPDWXOXL L D FRQVXPXOXL Ge cafea nainte de doxiciclina n prima zi (intr-R VLQJXUD SUL] VDX vQ GRXD SUL]H
HJDOH XUPDWGHPJ]LQLQIHFLLOHJUDYHGR]DGH
SURFHGXU
LQWUHLQHUHYDILGHPJ7UDWDPHQWXOVHYDFRQWLQXDFHOSXLQ
oo  ]LOH GH OD GLVSDULLD VLPSWRPHORU EROLL 3RVRORJLH SDUWLFXODU
 FOLVPHYDFXDWRDUHvQMXUXORUHL   vQSUH]LXDHIHFWXULL
8UHWULWD JRQRFRFLF DFXW OD EUEDW 2 GR] XQLF de 300 mg
OLWRWULLHL sau 100 mg de 2x/zi, timp de 2-4 zile. ,QIHFLLJRQRFRFLFHDFXWH
la femei:  [  PJ]L SkQ la vindecare. DQFUXO SULPDU,
 HVWH LQGLFDW FRQVXPXO GH DOLPHQWH IU UH]LGXXUL FDUQH
sifilisul secundar:  PJ]L IUDFLRQDW vQ PDL PXOWH SUL]H  FHO
ILDUW SDVWUDP XQF EUkQ] GH YDFL RX WDUL SkLQH SXLQ]LOHUretrita cu Chlamydia: 2 x 100 mg/zi timp de 7 zile.
XVFDWLVDXSUMLW Trahoma: 200 mg/zi timp de 40 de zile.
&RQWUDLQGLFDLL HipeUVHQVLELOLWDWH OD GR[LFLFOLQ VDUFLQD L
 VH RSUHWH FX FHO SXLQ -10 zile nainte de ESWL SHULRDGDGHDOSWDUH
5HDFLL DGYHUVH DQRUH[LH JUHD YUVWXUL GLDUHH JORVLW
WUDWDPHQWXO FX $VSLULQ VDX 7URPERVWRS SHQWUX D HYLWD
HQWHURFROLWH VDX FROLW SVHXGRPHPEUDQRDV UHDFLL DOHUJLFH
VkQJHUDUHD SRVWSURFHGXU ,QYHVWLJDUHD SDUDPHWULORU 3UHFDXLL Se va evita administrarea capsulelor de Doxiciclina la
EROQDYLLSUH]HQWkQGDOWHUULIXQFLRQDOHDOHHVRIDJXOXL
FRDJXOULLHVWHREOLJDWRULHODWRLSDFLHQLL 
'R]HOH X]XDOH PD[LPH VXQW GH  XQGH GH RF SHU HGLQ 7. CEFALOSPORINELE
pentUX FDOFXOLL ED]LQHWDOL VDX FDOLFHDOL L  GH XQGH GH RF
5HSUH]HQWDQL JHQHUDLD , FHIDOH[LQ FHIDGUR[LO FHIUDGLQ
pentru calculii ureterali. FHID]ROLQ FHIDORWLQ FHIDSLULQ  JHQHUDLD D ,,-a (cefaclor,
cefuroxime-axetil, cefprozil, cefuroxim, cefamandol, ceforanid,
NGRIJIRI POST ESWL
FHIXQRFLG  JHQHUDLD D ,,,D FHISRGR[LPD-axetil, cefixim,

 
;0(',&$0(17()2/26,7(135$&7,&$852/2*,& 9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(

pozitivi inclusiv cei secretori de beta-lactamaza (stafilococi si 'XSOLWRWULLHRSDUWHGLQSDFLHQLvQFHSVHOLPLQHIUDJPHQWH


VWUHSWRFRFL  ID GH WXOSLQL GH &ORVWULGLXP /LVWHULD
GH FDOFXO FKLDU vQ FXUVXO VSLWDOL]ULL QWUH  L  GLQ SDFLHQL
Lacttobacillus, Actinomyces, Bacillus.
,QGLFDLL ,QIHFLL VHYHUH FX JHUPHQL VHQVLELOL OD YDQFRPLFLQ HOLPLQ fragmentele cu dureri, ce pot fi calmate printr-o strategie
LQFOXVLY FROLW SVHXGRPHPEUDQRDV LQIHFLL FX WXOSLQL GH
VLPSO
VWDILORFRFL UH]LVWHL OD PHWLFLOLQD EHWD-lactamo-UH]LVWHQL  VDX OD
SDFLHQLFXDOHUJLHODSHQLFLOLQ  restrngerea consumului de lichide;
Mod de administrare: Tratamentul este individualizat. In
general se administreaza i.v. sub forma de perfuzie 5 mg/ml cel  administrarea de KETOROLAC TRAMADOL;
PXOW PJPLQ SXWkQG FUHWH GR]D FHO PXOW SkQD OD  PJPO %LODQXO HGLQHL GH OLWRWULLH SHQWUX FDOFXOLL UHQDOL VH
/DSDFLHQLLFXIXQFLHUHQDOQRUPDOGR]D]LOQLFLYHVWHGH
J FkWH  PJ OD  RUH VDX  J OD  RUH /D SDFLHQLL FX poate face la 15- ]LOH RFD]LH FX FDUH UDGLRJUDILD UHQDO
DIHFWDUHD IXQFLHL UHQDOH GR]HOH VXQW PDL PLFL vQ IXQFLH GH VLPSOLHFRJUDILDYRULQIRUPDGHVSUHJUDGXOGHIUDJPHQWDUH
clearance-XOODFUHDWLQLQ
WRSRJUDILD IUDJPHQWHORU L UVXQHWXO HYHQWXDOHL REVWUXFLL
5HDFLL DGYHUVH 5HDFLL DOHUJLFH vQURLUHD SULL VXSHULRDUH D
FRUSXOXL FX FRQWUDFWXU PXVFXODU ,Q FD]XO DGPLQLVWUDULL UDSLGH asupra rinichiului.
afectarea functiei renale (n special n cazul asocierii cu
()(&7(/(1('25,7($/(81'(/25'(2&
aminoglicozidH  KLSRDFX]LH SULQ RWRWR[LFLWDWH /D SDFLHQLL FX
DIHFWDUHD IXQFLHL UHQDOH QHXWURSHQLH UHYHUVLELO IOHELWD OD ORFXO Q FHHD FH SULYHWH DIHFWDUHD UHQDO, cel mai comun semn
DGPLQLVWUULL 
clinic al agresiunii l constituie KHPDWXULD PDFURVFRSLF, din
&RQWUDLQGLFDLL +LSHUVHQVLELOLWDWHFXQRVFXW la produs.
IHULFLUHWUDQ]LWRULHDSUXWGXSRHGLQGH(6:/6HWLHDVW]L
5. POLIPEPTIDELE
F DFHDVW KHPDWXULH HVWH VHFXQGDU vQ SULPXO UkQG OH]LXQLORU
5HSUH]HQWDQLbacitracina, colistinum. SDUHQFKLPDWRDVH L vQ PLF PVXU DFLXQLL IUDJPHQWHORU DVXSUD
uroteliului.
COLISTIN (sulfat de colistina)
$OWH FRPSOLFDLL FH DX IRVW GHVFULVH vQ OLWHUDWXU UXSWXUD
3UH]HQWDUH IDUPDFHXWLF Comprimate continand 250.000 U.I.
UHQDO KHPDWRDPH UHQDOH KHPDWRDPH VSOHQLFH KHPDWRDPH
GHVXOIDWGHFROLVWLQDLIODFRDQHGH8,L8,
$FLXQHWHUDSHXWLF EDFWHULRVWDWLFVLEDFWHULFLGVHH[HUFLWSULQ pulmonare, pancreatita acuta, leziuni ale mucoasei gastrice sau
deteriorarea membranei celulare a germenilor microbieni, att n
VWDGLXOGHPXOWLSOLFDUHFkWLvQUHSDXV DOHFRORQXOXLVWRSFDUGLDF DXRLQFLGHQIRDUWHPLFGLQIHULFLUH
,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.
$
 
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 3UH]HQWDUHIDUPDFHXWLF: cps 400 mg
$FLXQHWHUDSHXWLFLGHPFLSURIOD[RFLQ
(UROSTOMIA) ,QGLFDLLWUDWDPHQWXOLQIHFLLORUFXWXOSLQLVHQsibile la QRUIOR[DFLQ
SLHORQHIULWH FLVWLWH SURVWDWLWH XUHWULW JRQRFRFLF
'HULYDLD XULQDU UHSUH]LQW GHYLHUHD SULQWU-R LQWHUYHQLH JDVWURHQWHULW 
FKLUXUJLFDO D FXUVXOXL IOX[XOXL XULQDU L SRDWH IL WHPSRUDU VDX Mod de administrare: XUHWULWD JRQRFRFLF  PJ SUL] XQLF;
SURVWDWLWPJx]LVSWPkQL; cistita 400 mgx2/zi, 3-5 zile;
GHILQLWLY /H]LXQLOH FDUH QHFHVLW DFHDVW VDQFLXQH WHUDSHXWLF pielonefrite 400 mgx2/zi, 14-21 zile.
VXQW FHO PDL DGHVHD DIHFLXQL DOH WUDFWXOXL XULQDU LQIHULRU &RQWUDLQGLFDLL KLSHUVHQVLELOLWDWH OD FKLQRORQH VDX H[FLSLHQL
FRSLL VDUFLQ DOSWDUH SUHFDXLL OD SDFLHQLL FX $9& VDX
intHUHVkQG YH]LFD XULQDU vQ PDMRULWDWHD FD]XULORU L SRW IL OH]LXQL DIHFLXQLFDUGLR-vasculare.
PRUIRORJLFH FRQJHQLWDOH WXPRUL LQIHFLL WUDXPDWLVPH LUDGLHUH  5HDFLL DGYHUVH GXUHUL DEGRPLQDOH JUHD FROLW pseudo-
PHPEUDQRDVUDVKFXWDQDWprurit, fotosensibilitate.
VDXIXQFLRQDOH QHXURORJLFH (VWHQHFHVDUSHQWUXDvQORFXLVDXD
XQWDRSRULXQHVHYHUDIHFWDWDWUDFWXOXLXULQDULscopul este de a 4. GLICOPEPTIDELE
FRQVHUYDIXQFLDUHQDO
5HSUH]HQWDQL teicolpanina, vancomicina, televancin.
'HULYDLLOHXULQDUHSRWILcontinente sau incontinente.
A. TEICOLPLANINA (targocid)
&HOH PDL FXQRVFXWH IRUPH GH GHULYDLH XULQDU LQFRQWLQHQW
sunt ureterostomiile cutanate directe, transileale sau transcolice. 3UH]HQWDUHIDUPDFHXWLF: flacoane 200 mg, 400 mg.
$FLXQH WHUDSHXWLF L LQGLFDLL LQIHFLL JUDYH FX JHUPHQL
Ureterostomiile cutanate directe presupun deconectarea
Gram-pozitivi: urinare, respiratori, digestive, endocardite,
XQXLD VDX DPEHORU XUHWHUH GH YH]LFD XULQDU L DGXFHUHD ORU OD RVWHRPLHOLWH SURILOD[LH SUHRSHUDWRULH ID GH JHUPHQLL *UDP-
VXSUDIDD SHUHWHOXL DEGRPLQDO FX IRUPDUHD XQHL VWRPH SULQ FDUH pozitivi.
Mod de administrare: i.m., i.v. 400 mg x 1-]LvQLQVXILFLHQ
GUHQHD]FRQWLQXXXULQD UHQDO GR]HOHQXVHDMXVWHD]vQSULPHOH]LOHGHWUDWDPHQWOD
n cazul ureterostomiilor cutanate transileale sau un clearance al creatininei de 40-60 ml/min doza se va reduce la
MXPWDWH
transcolice XUHWHUHOH VXQW GHFRQHFWDWH GH YH]LFD XULQDU L &RQWUDLQGLFDLLKLSHUVHQVLELOLWDWHODVXEVWDQDDFWLYVDUFLQ
DQDVWRPR]DWH OD H[WUHPLWDWHD SUR[LPDO D XQXL VHJPHQW DOSWDUHSUXGHQ QXVHHOLPLQSULQGLDOL]KLSHUVHQVLELOLWDWH
vQFUXFLDW FX YDQFRPLFLQD WHVWDUHD IXQFLHL UHQDOH L KHSDWLFH
LQWHVWLQDO L]RODW LOHDO VDX FROLF  D FUXL H[WUHPLWDWH GLVWDO HVWH n cursul tratamentului.
HVWHDGXVODVXSUDIDDDEGRPHQXOXLSHQWUXDIRUPDVWRPD 5HDFLL DGYHUVH locale: HULWHP GXUHUL WURPERIOHELW generale:
UDVK SUXULW IHEU JUHD YUVWXUL GLDUHH HR]LQRILOLL
3ULQFLSDOHOH LQGLFDLL SHQWUX HIHFWXDUHD GHULYDLLORU XULQDUH OHXFRSHQLHWURPERFLWRSHQLHWURPERFLWR]QHXWURSHQLHDPHHOL
VXQWWXPRULOHYH]LFDOH LQILOWUDWLYH GXSFLVWHFWRPLDUDGLFDO VDX cefalee.

DIHFLXQL FDUH DIHFWHD] VHYHU IXQFLD DSDUDWXOXL XULQDr inferior B. VANCOMICINA (clorhidrat de vancomicina)
DQRPDOLL FRQJHQLWDOH WUDXPDWLVPH FLVWLW FURQLF GLVIXQFLL
3UH]HQWDUHIDUPDFHXWLFFlacoane a 500 mg (cutie cu 1 fl.).
neurologice etc.). $FLXQH WHUDSHXWLF $QWLELRWLF FX DFWLXQH EDFWHULFLG FDUH VH
Dispozitive pentru urostomie 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,&$852/2*,& 9,,'(5,9$,$85,1$5(;7(51,1&217,1(17

5HDFLLDGYHUVHJUHDGLDUHHGXUHULDEGRPLQDOHLFWHU arsuri, ([LVW R JDP ODUJ GH VLVWHPH GH FROHFWDUH SHQWUX
HUXSii cutanate, urticarie, fotosensibilitate, sdr. Stevens
SDFLHQLL FX XURVWRPLH GDU WRDWH SRW IL vPSULWH vQ GRX FDWHJRULL
-RKQVRQ QHIULW LQWHUVWLLDO DUWUDOJLL KDOXFLQDLL WURPERFLWR]
anemie. principale: QSLHVXQLFVDXFXGRXSLHVH
$VRFLDLLPHGLFDPHQWRDVHPeniciline, Metronidazol.
6LVWHPXOvQSLHVXQLFFXSULQGHDWkWSXQJDFROHFWRDUHFkW
B. OFLOXACIN: LIROLDDGH]LYHVWHIOH[LELOLRFXSXQYROXPPDLPLF
6LVWHPXOFXGRXSLHVHFXSULQGHIROLDDGH]LYODFDUHHVWH
3UH]HQWDUH IDUPDFHXWLF cps filmate 200 mg, 400 mg; sol
SHUIX]DELO IO POPJPO DWDDWIODQDFDUHSHUPLWHFXSODUHDSXQJLL colectoare.
$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 7RDWH VLVWHPHOH FXSULQG R YDOY DQWLUHIOX[ FH vPSLHGLF
ReDFLL DGYHUVH IHEU YUVWXUL GLDUHH GXUHUL DEGRPLQDOH
DQRUH[LH XVFFLXQHD JXULL PHWHRULVP FRQVWLSDLL PLDOJLL vQWRDUFHUHD XULQLL FWUH VWRP L XQ URELQHW FH SHUPLWH JROLUHD
DWUDOJLL FRQYXOVLL FHIDOHH WXOEXUUL GH YHGHUH VRPQROHQ SHULRGLFDGLVSR]LWLYXOXLFROHFWRUDFUXLFDSDFLWDWHHVWHFXSULQV
KDOXFLQDLL HUuSLL FXWDQDWH SUXULW OHXFRSHQLH HR]LQRILOLH
trombocitopenie. vQWUHLP/
3HQWUX D PUL YROXPXO FROHFWDW FX HYDFXDUHD PDL UDU OD
C. LEVOFLOXACINA (Tavanic)
VLVWHPHOH GHVFULVH PDL VXV VH SRW DWDD SXQJL SHQWUX GUHQDM
3UH]HQWDUH IDUPDFHXWLF: cps filmate 250 mg, 500 mg; sol nocturn sau pungi, ce pot fi fixate la nivelul unuia din membrele
SHUIX]DELOPJPJ PJPO 
LQIHULRDUH FRDSVVDXJDPE 
$FLXQHIDUPDFHXWLFLGHPFLSURIOR[DFLQ
,QGLFDLLLQIHFLLDOHDSDUDWXOXLXURJHQLWDOUHVSLUDWRU25/ 1*5,-,5($3$&,(178/8,&8'(5,9$,(85,1$5
Mod de administrare: RUDOPJ]LSUL] XQLFSHUIX]LHLY (;7(51 8526TOMIE)
PJ]LSUL]XQLF Crearea unei urostomii definitive are un impact major fizic
&RQWUDLQGLFDLL FRSLL DGROHVFHQL vQ FUHWHUH KLSHUVHQVLELOLWDWH
la chinolone, deficit de G-6-PDH; SUHFDXLL - convulsii n L SVLKLF DVXSUD SDFLHQLORU VFKLPEkQG PXOWH DVSHFWH DOH YLHLL
DQWHFHQGHQWHLQVXILFLHQUHQDO FRWLGLHQH &RQVLOLHUHD SUHRSHUDWRULH UHDOL]DW GH personalul
5HDFii adverse: GLDUHH DPHHOL FHIDOHH YHUWLM PHOHQ FROLW
pseudo-PHPEUDQRDVKLSRJOLFHPLHHUXSLLFXWDQDWH VSHFLDOL]DW VWRPD QXUVH!) aduce beneficii majore n planul
D. NORFLOXACIN:

$
 
9,,'(5,9$,$85,1$5(;7(51,1&217,1(17 ;0(',&$0(17()2/26,7(135$&7,&$852/2*,&

HYROXLHL SRVWRSHUDWRULL L SH WHUPHQ OXQJ D SDFLHQWXOXL FX B. AMIKACIN:


XURVWRPLH LQFRQWLQHQW &RQVLOLHUHD VH SRDWH H[WLQGH FX HIHFWH
3UH]HQWDUHIDUPDFHXWLFflacoane 2 ml, 4 ml (350 mg/ml); fiole
EHQHILFH SHQWUX SDFLHQW L DVXSUD PHPEULORU DSURSLDL DL IDPLOLHL 2 ml, 50 mg/ml, 125 mg/ml, 250 mg/ml.
acestuia. $FLXQHWHUDSHXWLFLGHPJHQWDPLFLQ
,QGLFDLL LQIHFLL DOH DSDUDWXOXL XURJHQLWDO UHVSLUDWRU VLVWHPXOXL
,QIRUPDLLOH WUHEXLH V LQFOXG HOHPHQWH OHJDWH GH RVWHRDUWLFXODU 61& DOH SLHOLL L HVXWXULORU PRL LQIHFLL
inteUYHQLD FKLUXUJLFDO XURVWRPLD L UROXO DFHVWHLD vQJULMLUHD LQWUDDEGRPLQDOHFXJHUPHQLVHQVLELOLODDPLNDFLQ
Mod de administrare: i.m., i.v., - GXS HYDOXDUHDIXQFLHL renale
VWRPHLLGLVSR]LWLYHOHXWLOL]DWHSDFLHQLLSRWILvQYDLSUHRSHUDWRU LDFOHDUDQFH-ul creatininei; 15 mg/kgc/zi GR]XQLFVDXvQ-
V-L vQJULMHDVF VWRPD L V-L VFKLPEH GLVSR]LWLYXO FROHFWRU 3 doze administrate la intervale de timp egale vQ LQVXILFLHQ
UHQDOVHUHFRPDQGDMXVWDUHDGR]HORUvQIXQFLHGHFOHDUDQFH-ul
6WDELOLUHD SUHRSHUDWRULH D ORFXOXL vQ FDUH YD IL SODVDW stoma este GHFUHDWLQLQ
XQHOHPHQWLPSRUWDQWSHQWUXDVLJXUDUHDHWDQHLWLLLDVFKLPEULL &RQWUDLQGLFDLLKLSHUVHQVLELOLWDWHODDPLNDFLQ n antecendente;
SUXGHQODSDFLHQLLFXPLDVWHQLHJUDYLVVDX%RDO3DUNLQVRQ
facile a sistemului colector. 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

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).
ngrijirea postoperatorie $FLXQH WHUDSHXWLF LQKLE ADN JLUD]D EDFWHULDQ sau
,PHGLDW GXS LQWHUYHQLD FKLUXUJLFDO VWRPD WUHEXLH V ILH WRSRL]RPHUD],,EORFkQGGLYL]LXQHDFHOXODU
,QGLFDLL LQIHFLL JHQLWDOH SLHORQHIULWH FLVWLWH SURVWDWLWH LQIHFLL
DFRSHULW FX XQ GLVSR]LWLY GH FROHFWDUH WUDQVSDUHQW SHQWru a UHVSLUDWRULL 25/ RFXODUH ELOLDUH D RDVHORU L DUWLFXODLLORU
SHUPLWH VXSUDYHJKHUHD IDFLO D DFHVWHLD ,QVSHFLD VWRPHL vQ spectru Coci Gram-SR]LWLYLLEDFLOL*UDP-negativi.
Mod de administrare: oral 250-500 mg x 1-2 ori/zi; sol
SHULRDGD SRVWRSHUDWRULH LPHGLDW WUHEXLH V ILH HIHFWXDW FX R SHUIX]DELO-400 mg de 1-RUL]LODSDFLHQLLYkUVWQLFLVDXFX
IUHFYHVLPLODUVXSUDYHJKHULLFDUGLRYDVFXODUH LQVXILFLHQUHQDOVHDMXVWHD]GR]HOHvQIXQFLHGHFOHDUDQFH-ul
! FUHWLQLQHLLJUDYLWDWHDEROLL
 $ 
;0(',&$0(17()2/26,7(135$&7,&$852/2*,& 9,,'(5,9$,$85,1$5(;7(51,1&217,1(17

C. OXACILINA 'UHQDMXO XULQDU WUHEXLH V ILH FRQWLQXX LDU VLVWHPXO GH


colectare trebuie s ILH JROLW UHJXODW SHQWUX D DVLJXUD FRQIRUWXO
3UH]HQWDUH IDUPDFHXWLF capsule 250 mg, 500 mg, 1000 mg,
LSXOEHUHLQMHFWDELOIODFRQGHPJPJLPJ SDFLHQWXOXLLDUHGXFHSUHVLXQHDDVXSUDVWRPHL
$FLXQH WHUDSHXWLF EDFWHULFLG LQKLE VLQWH]D SHSWLGRJOLFDQL ,QVSHFLD VWRPHL WUHEXLH V GHFHOH]H RULFH VHPQ GH
DQWUHQkQGOL]DLPRDUWHDFHOXODU
,QGLFDLLLQIHFLLVWDILORFRFLFHORFDOL]DWHVDXJHQHUDOL]DWH LVFKHPLH 6WRPD QRUPDO DUH FXORDUHD UR] VDX URX VLPLODU
Mod de administrare: 2-3 g/zi n 4- SUL]H VROXLLOH LQMHFWabile PXFRDVHL EXFDOH DVSHFWXO HGHPDWRV LQLLDO YD GLVpare n
VHSUHSDULPHGLDWvQDLQWHGHLQMHFWDUHVHDGPLQLVWUHD]LYOHQW
XUPWRDUHOH - OXQL LDU vQ XULQ L vQ MXUXO VWRPHL VH REVHUY
VDXLPSURIXQGvQDFHOHDLGR]H
&RQWUDLQGLFDLLDOHUJLHLQIHFLLVHQVLELOHODSHQLFLOLQD*VDXDOWH acumulare de mucus.
peniciline. ,PHGLDWFHVWDUHDFOLQLFRSHUPLWHSDFLHQWXOYDILLPSOLFDW
5HDFLL DGYHUVH DOHUJLH vQFUXFLDW FX DOWH SHQLFLOLQH UDUHRUL
WXOEXUUL UHQDOH DOEXPLQXULD KHPDWXULD  SRDWH GHWHUPLQD vQ VFKLPEDUHD VLVWHPXOXL FROHFWRU QDLQWH GH GHFODQDUHD DFHVWHL
FUHWHUHD7*2 SURFHGXUL HVWH LPSRUWDQW asigurarea tuturor materialelor

2. AMINOGLICOZIDE necesare.
7LPSLLSULQFLSDOLDLVFKLPEULLVLVWHPXOXLGHXURVWRPLHVXQW
5HSUH]HQWDQL: SURGXLGHELRVLQWH] VWUHSWRPLFLQQHRPLFLQ
VXSULPDUHDFXEOkQGHHDSXQJLLLDIROLHLDGH]LYH
NDQDPLFLQ WREUDPLFLQ VSHFWLQRPLFLQ SDURPRPLFLQ
JHQWDPLFLQ VLVRPLFLQ SURGXL GH VHPLVLQWH] DPLNDFLQ LQVSHFLD  VWRPHL  L  D  WHJXPHQWXOXL  GLQ  MXUXO
QHWLOPLFLQ  acesteia;
VSODUHDWHJXPHQWXOXLSHULVWRPDO
A. GENTAMICINA:
uscarea tegumentului peristomal;
3UH]HQWDUHIDUPDFHXWLFfiole 2 ml, 40 mg/ml.
aplicarea produselor de ngrijire a tegumentului
$FLXQH WHUDSHXWLF LQKLE subunitatea 30 S a ribozomilor
EORFkQGVLQWH]DSURWHLFEDFWHULDQ peristomal;
,QGLFDLL LQIHFLLFX&RFL*UDP-pozitivi LQHJDWLYL L%DFLOL Gram- DSOLFDUHDDWHQWDQRXOXLVLVWHPGHXURVWRPLHSHQWUX
negativi ale aparatului urogenital, respirator, oftalmologice, ORL.
DDVLJXUDHWDQHLWDWHDDFHVWXLD
Mod de administrare: inj 2-3 mg/kgcorp/zi n 2-SUL]HSkQ la
5 mg/kgcorp/zi n 3-4 prize. $SD FDOG L WDPSRDQHOH GH EXPEDF VXQW GH RELFHL
&RQWUDLQGLFDLLhipersensibilitatHODDPLQRJOLFR]LGHSUXGHQ n
VXILFLHQWHSHQWUXVSlarea tegumentului peristomal; alternativa este
LQVXILFLHQ UHQDO EROL QHXURPXVFXODUH DIHFLXQL YHVWLEXODUH
VDXLFRKOHDUHYkUVWQLFL UHSUH]HQWDW GH HUYHHOH XPHGH VSHFLDO FRQFHSXWH SHQWUX
5HDFLL DGYHUVH YHUWLM QLVWDJPXV VGU 0HQLHUH WXOEXUUL GH
FXUDUHDWHJXPHQWXOXLGLQMXUXOVWRPHL
HFKLOLEUXKLSRDFX]LHSHQWUXVXQHWHvQDOWHVDXVXUGLWDWHFRPSOHW
tXOEXUULKHPDWRORJLFHDOHUJLFHJUHXULYUVWXUL )ROLDDGH]LYWUHEXLHVILHSUHFLVGHFXSDWGXSPULPHD
,QWHUDFLXQLPHGLFDPHQWRDVHFXDOWHVXEVWDQHRWRWR[LFHVDX
LIRUPDVWRPHLSHQWUXDSURWHMDWHJXPHQWXOGLQMXUXODFHVWHLDLD
nefroWR[LFHEORFDQLQHXURPXVFXODUL efect sinergic.
Asocieri medicamentoase: peniciline efect sinergic. DVLJXUDHWDQHLWDWHDQXWUHEXLHXLWDWIDSWXOFVWRPDvLYDUHGXFH

 
$! 
9,,'(5,9$,$85,1$5(;7(51,1&217,1(17 ;0(',&$0(17()2/26,7(135$&7,&$852/2*,&

WUHSWDW YROXPXO FHO SXLQ  OXQL GXS LQWHUYHQLH DVWIHO vQFkW L 9,,0(',&$0(17()2/26,7(135$&7,&$852/2*,&
GHFXSDMXO IROLHL WUHEXLH V ILH PRGLILFDW FRUHVSXQ]WRU 3LOR]LWDWHD
I. ANTIBIOTICE
SHULVWRPDO SRDWH UHGXFH DGHUHQD dispozitivului colector sau
poate determina dureri la desprinderea foliei, motiv pentru care 1. PENICILINE ( lactamice)
PDMRULWDWHD SDFLHQLORU SUHIHU V UDG VSWPkQDO WHJXPHQWXO
5HSUH]HQWDQL: peniciline naturale (penicilina G, penicilina V,
respectiv. procain penicilina, benzathil penicilina), peniciline rezistente la
$YvQG vQ YHGHUH IDSWXO F vQ XULQD GUHQDW SULQ XURVWRPLH betalactamaze (meticilina, nafcilina, oxacilina, cloxacilina,
dicloxacilina, flucoxacilina), aminopenicilinele (ampicilina,
VH HYLGHQLD] vQ PRG RELQXLW un numar semnificativ de bacterii
amoxicilina), carboxipenicilinele (carbenicilina, ticarcilina),
(bacteriurie), tratamentul antibiotic nu este recomandat la ureidopenicilinele (azlocilina, mezlocilina, piperacilina).
SDFLHQLLDVLPSWRPDWLFLFKLDUGDF SUH]LQW uroculturi pozitive.
A. AMPICILINA
$SRUWXODGHFYDWGHOLFKLGHIUDFLRQDWSHSHULRDGD]LOHLHVWH
HVHQLDOSHQWUXDUHGXFHULVFXOGHLQIHFLLXULQDUH1XHVWHQHFHVDU 3UH]HQWDUH IDUPDFHXWLF capsule 250 mg, 500 mg, 1000 mg,
LIODFRDQHGHPJPJLPJ
HYLWDUHDYUHXQXLDOLPHQWODSDFLHQLLFXXURVWRPLH $FLXQHWHUDSHXWLFLQKLEVLQWH]DSHUHWHOXLEDFWHULDQ
&RPSOLFDLL ,QGLFDLL LQIHFLLXRDUHL PHGLLGHWUDFWUHVSLUDWRUWUDFWXULQDU
ELOLDU IHEU WLIRLG WXVH FRQYXOVLYH OHSWRVSLUR]H LQIHFLL
&RPSOLFDLLOH GHULYDLLORU XULQDUH H[WHUQH LQFOXG stenoza SRVWFKLUXUJLFDOH GLYHUVH WHUDSLD LQLLDO D PHQLQJLWHORU FX
stomei, KHUQLD SDUDVWRPDO, LQIHFLD tractului urinar superior, JHUPHQL QHLGHQWLILFDL LQIHFLL JUDYH VHSWLFHPLD HQGRFDUGite,
meningite, peritonite.
formarea de calculi si deteriorarea IXQFLRQDO UHQDO. n plus Mod de administrare: vQLQIHFLLOHXRDUHLPHGLLSR-4 g/zi la
SRW DSDUH FRPSOLFDLL OHJDWH GH IRORVLUHD LOHRQXOXL WHUPLQDO vQ KvQLQIHFLLOHVHYHUHLY-12 g/zi n 4 prize.

GHULYDLDXULQDUDFLGR]PHWDEROLFKLSHUFORUHPLFKLSRNDOLHPLH &RQWUDLQGLFDLL DOHUJLH LQIHFLL FX SLRFianic, anaerobi,


eterobacter.
KLSRYLWDPLQR]%GHPLQHUDOL]DUHRVRDVSURGXFLHH[FHVLYGH
5HDFLLDGYHUVHHUXSLLFXWDQDWH
mucus, anomalii de metabolizare a medicamentelor. Asocieri medicamentoase: DPSLFLOLQVXlbactam (ampiplus).
,ULWDLD WHJXPHQWXOXL SHULVWRPDO SRDWH IL JHQHUDW GH
B. $02;,&,/,1
contactul prelungit cu urina, leziuni mecanice (produse la
vQORFXLUHD GLVSR]LWLYXOXL FROHFWRU  LQIHFLL IROLFXOLW HWF  DIHFLXQL 3UH]HQWDUH IDUPDFHXWLF: cps 250 mg, 500 mg; pulbere in
suspensie 125 mg/5 ml, 250 mg/5 ml.
dermatologice (psoriazis, dermatite etc.) sau imunologice $FLXQHWHUDSHXWLFLQGLFDLLLGHP$PSLFLOLQ
GHUPDWLWGHFRQWDFW  Mod de administrare: oral 250 500 mg/8h.
&RQWUDLQGLFDLL LGHP$PSLFLOLQ
+HUQLD SDUDVWRPDO DSDUH FD R ERPEDUH D ]RQHL GLQ MXUXO 5HDFLLDOHUJLFH LGHP$PSLFLOLQ
VWRPHL L VH SRDWH SURGXFH OD LQWHUYDO GH OXQL VDX DQL GH OD Asocieri medicamentoase: $PR[LFLOLQ  $F&ODYXODQLF
(Augmentin).
SUDFWLFDUHD XURVWRPLHL 3DFLHQWXO SRDWH IL DVLPSWRPDWLF GDU GDF



 $
,;35267$7(&720,$5$',&$/ 9,,'(5,9$,$85,1$5(;7(51,1&217,1(17

YDULDQWDWUDQVSHULWRQHDO LGHLQVXIODLD&22. VHJPHQWXO GH DQV LQWHVWLQDO HVWH WUDQJXODW FHHD FH LPSOLF L
&RPSOLFDLLOH SRVWRSHUDWRULL SUHFRFH FXSULQG WURPER]D VXSULPDUHDGUHQDMXOXLXULQDUHVWHQHFHVDULQWHUYHQLDFKLUXUJLFDO
YHQRDV SURIXQG D PHPEUHORU LQIHULRDUH HPEROLD SXOPRQDU GHXUJHQ
FRQVWLWXLUHDXQXLOLPIRFHOLLQIHFLDSOJLLRSHUDWRULL 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
FRQFHQWUDWGHPHULRU FUDQEHUU\ 
$OWHUDUHD IXQFLHL UHQDOH UHSUH]LQW R FRPSOLFDLH PDMRU
JHQHUDW GH SLHORQHIULWD UHFLGLYDQW DVRFLDW FX REVWUXFLH
SRVWUHQDO VWULFWXULDQDVWRPRWLFHVWHQR]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 VIII. TRANSPLANTUL RENAL

&RPSOLFDLLOH LQIHFLRDVH apar n diferite perioade VIII. TRANSPLANTUL RENAL


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
imunosupresiv. RELQXWSULQUHFROtare chirurgLFDOGHODXQdonator este implantat la
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
II. (9$/85,35(23(5$725,,
A. EVALUAREA DONATORILOR VII
'RQWRULL YLL UHSUH]QW VXUVD PDMRU GH RUDJH vQ PXOWH UL
SULQWUHFDUHL5RPkQLD
Evaluarea donatorului viu LPSXQHXUPWRDUHOHLQYHVWLJDLL:
x 'HWHUPLQDUHDFRPSDWLELOLWLLvQVLVWHPXO$%2
x Crossmatch,
x Determinarea gradului de matching HLA.
(YDOXDUHD VWDWXVXOXL GH VQWDWDWH VH UHDOL]HD] SULQ WHVWH
FOLQLFH SDUDFOLQLFH GH ODERUDWRU L LPDJLVWLFH WHVWH DOH IXQFLHL
UHQDOHLWHVWHDGLLRQDOH

$ 
 
VIII. TRANSPLANTUL RENAL VIII. TRANSPLANTUL RENAL

x $QDPQH]LH[PHQIL]LFFRPSOHW x )XQFLRQDUHD vQWkU]LDW D JUHIHL vQ SHULRDGD LPHGLDW


x 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 'LVIXQFLD SUHFRFH D JUHIHL vQ SULPHOe 2-3 luni
x 5DGLRJUDILH SXOPRQDU RSLRQDO WHVWH GH IXQFLH posttransplant, (rejetul acut, obstacol urinar, fiVWXO
SXOPRQDU YHQWLODWRULLLVDXUHVSLUDWRULL  XULQDU QHIURWR[LFLWDWHD imunosupresoarelor,
x EKG, optional ecocardiografie pielonefrLWD DFXW PLFURDQJLRSDWLD WURPERWLF
x ([DPHQ VXPDU GH XULQ VHGLPHQW XURFXOWXU hipovolemia, hipotensiunea).
XULQDK FOHDUFHQFH FUHDWLQQLQ SURWHLQXULD  x 'LVIXQFLD WDUGLY D JUHIHL GXS  OXQL GH OD
probe de concentrare, microalbuminurie, transplantare, (boli renale intrinseci QHIURSDWLDFURQLF
x (FRJUDILHDEGRPLQDO DJUHIHLQHIURWR[LFLWDWHDFURQLFDLPXQRVXSUHVRDUHORU

x ArterioJUDILHUHQDODQJLR-RM, CT, UHMHWXO DFXW WDUGLY QHIULWHOH LQWHUVWLLDOH VWHQR]D GH

x 6FLQWLJUDPUHQDOSHQWUXHYDOXDUHDUDWHLGHILOWUDUH DUWHUUHQDOREVWUXFLLGHWUact urinar, stricturi uretrale,

JORPHUXODULDIXQFLRQDOLWLLILHFUXLULQLFKL OLWLD] 

x (YDOXUL PLFURELRORJLFH VHURORJLH OXHV WHVWH Rejetul acut (refractaUODFRUWLFRWHUDSLHLODKHPRGLDOL] SRDWH

virusologice (VHB, VHC, CMV, HIV, virus Epstein- QHFHVLWDQHIUHFWRPLHGHVDOYDUH DYLHLLEROQDYXOXL DWXQFLFkQG

Barr, virus herpes simplex, zoster, toxoplasma), ODDQXULHVHDGDXJLRVQJHUDUHLPSRUWDQW

x ([DPHQ JLQHFRORJLF DO VkQXOXL L DO prostatei n D. &203/,&$,,&+,585*,&$/(

FD]XULVHOHFLRQDOWH &RPSOLFDLL YDVFXODUH tomboza arterial sau

&RQWUDLQGLFDLLOHGRQULL venoaVVWHQR]DDUWHULDO
&RPSOLFDLL XURORJLFH FROHFLL IOXLGH ILVWXO XULQDU -
 Boli renale (reducerea clearence-XOXLGHFUHDWLQLQID
urinom OLPIRFHO REVWUXFLL GH WUDFW XULQDU KHPDWXULH OLWLD]
de valorile normale conform vrstei, proteinuria,
reflux vezico-XUHWHUDOGLVIXQFLHHUHFWLOQHRSOD]LL 
microhematuria, istoric famLOLDO GH ERDO SROLFKLVWLF
E. COM3/,&$,,0(',&$/(,
DXWRVRPDO GRPLQDQW QHIURFDOFLQR]D OLWLD]D UHQDO
,1)(&,2$6(
anomalii urologice importante),
&RPSOLFDLL PHGLFDOH boli cardio-vasculare, boala
 Incompatibilitate n sitemul ABO,
LVFKHPLF FRURQDULDQ +7$ KLSHUOLSHPLD '= SRVWWUDQVSODQW
 Cross-match pozitiv,
bolile maligne, afecLXQLOH KHSDWLFH EROLOH JDVWUR-intestinale,
 +7$VHYHUFXOH]LXQLRUJDQLFH
guta, complLFDLLRVRDVH

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VIII. TRANSPLANTUL RENAL VIII. TRANSPLANTUL RENAL

LPXQRVXSUHVLYLDIXQFLRQDOLWDLLJUHIHLUHQDOH Antibioterapia  Diabet zaharat,


este obligatorie timp de 10 zile postoperator, ideal fiind ca  ,QIHFLLGRYHGLWH +,99+&9+% 
polnavul (la externare) sDLERXURFXOWXUQHJDWLY  1HRSOD]LLEROLDXWRLPXQH FXYLVFHUDOL]DUHUHQDO 
B. IMUNOSUPRESIE  Boli cronice severe pulmonare, cardiace, hepatice,
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 $WXQFL FkQG GRQDWRUXO DUH R SDWRORJLH UHQDO DVRFLDW
LPXQRVXSUHVLYvQDOWSHRSHULRDGVFXUWFXVFRSXO PLQRU FKLVW VROLWDU UHQDO KLGURQHIUR] FRQJHQLWDO SLHORQ
GH D VFGHD ULVFXO GH UHMHW DFXW vQ SULPHOH OXQL GXEOX XUHWHU UHWURFDY  UHJXOD QH REOLJ V ODVP DFHVWXLD
posttransplant, ULQLFKLXOFDUHDUHRIXQFLRQDOLWDWHPDLEXQ
 3HULRDGD GH PHQLQHUH SUHFRFH FDUDFWHUL]DW SULQ 'HRDUHFH GXUDWD PHGLH GH IXQFLRQDUH D XQXL ULQLFKL
stabilirea unor regimuri imunosupresive individuale transplantat este de 10-DQL PD[LPDQL ODDFHODLEROQDY
(primele luni posttransplant), sHSRDWHHIHFWXDXQDOWWUDQVSODQWvQ]RQDLOLDFFRQGURODWHUDO
 3HULDGD GH PHQLQHUH FURQLF utilizarea unor doze B. EVALUAREA DONATORILOR N MOARTE
reduse (minim eficiente), relativ constante de &(5(%5$/
imunosupresoare care vor fi modificate numai n cazul 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 monoclonali (OKT3, anti-Tac,OKT4) sau organe.
SROLFORQDOLDQWLPHWDEROLL D]DWLRSLQD00)P-TOR inhibitori). 'LDJQRVWLFXOSR]LWLYGHPRDUWHFHUHEUDO
C. ',6)81&,('(*5() x ([ FOLQLF QHXURORJLF FDUH V HYLGHQLH]H VWDUHD GH
(WLRORJLD L VWDUWHJLLOH WHUDSHXWLFH DOH GLVIXQFLHL GH JUHI FRPD SURIXQG DUHDFWLY DEVHQD UHIOH[HORU
UHQDO VXQW GLIHULWH vQ IXQFLH GH WLPSXO VFXUV GH OD trunchiului cerebral,
transplantare: x $EVHQD YHQWLODLHL VSRQWDQH FRQILUPDW SULQ WHVWXO
de apnee,

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VIII. TRANSPLANTUL RENAL VIII. TRANSPLANTUL RENAL

x 'RX WUDVHH ((* HIIHFWXDWH OD LQWHUYDO GH  RUH GHVXERUHGHODUHFROWDUH LDUHFKLSDFKLUXUJLFDOWUHEXLHV
care sa indice lipsa electrogenezei corticale, realizeze anastomozele vasculare n maxim 40 de minute.
x Excluderea altor cauze care ar putea produce un VI. URMARIRE POSTTRANPLANT
tablou clinic L XQ WUDVHX ((* DVHPQWRDUH FX A. 8505,5($326723(5$725,(
cHOHGLQPRDUWHFHUHEUDO n perioada SRVWRSHUWDWRULH LPHGLDW urmarirea
%LODQXOGHRUJDQH SDFLHWXOXL LQFOXGH PDVXULOH GH UHDQLPDUH VSHFLILFH RULFUHL
x Teste de laborator (grup sangvin, Rh, tipizare HLA, 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 hemodinamic, hidro-electUROLWLF L DFLGR-
virusuri din grupul herpes, citomegalus, Epstein- bD]LFFXDWHQWDPRQLWRUL]DUHDGLXUH]HLRUDUH
Barr), VFUHHQLQJ SHQWUX LQIHFLL EDFWHULHQH n primele zile postoperaWRU WUHEXLH PHQLQXWH Psurile
(hemoculturi, uroculturi, culturi din sput), de suport KHPRGLQDPLFPRQLWRUL]DUHDGLXUH]HLLFRPSHQVDUHD

x &RUG HFRJUDILH FDUGLDF (.* &3. &3.-MB, SROLXULHL SDFLHQWXO WUDQVSODQWDW SXWDQG XQHRUL DYHD R GLXUH]

troponina, FDUH V GHSDHDF  O   h. Deasemenea este importaQW

x 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

x )LFDW HFRJUDILH DEGPLQDO HFR-Doppler pedicul GDWRULW ULVFXOXL PDMRU GH LQIHFLH DYkQG vQ YHGHUH Vtatusul

KHSDWLFELODQKHSDWLFFRPSOHW imunologic, echografii 'RSSOHUSHQWUXDSUHFLHUHDYDVFXODUL]DLHL

x Rinichi: ecografie abdomino-SHOYLQ HFR-Doppler UHQDOHLDHYHQWXDOHORUFROHFLL

SHGLFXO UHQDO GLXUH] FUUHDWLQLQ VHULF ScurtaUHDLXOWHULRUVXSULPDUHDWXEXULORUGHGUHQOD-5

SURWHLQXULDKHPDWXULDXURFXOWXU ]LOH SRVWRSHUDWRU VDX FkQG QX VH PDL vQUHJLVWUHD] GUHQDM
suprimarea sondei uretrovezicale la 13-14 zile postopeUDWRU L,
x 3DQFUHDVDPLOD]HLOLSDVHVHULFHJOLFHPLH
ulterior, DILUHORUGHVXWXU
&RQWUDLQGLFDLLDEVROXWHSULYLQGGRQDUHDGHRUJDne:
Suprimarea sondei ureterale JJ la aproximativ 6
 Istoric de neoplazie,
VSWPkQL SRVWWUDQVSODQW GH DVHPHQHD vQ FRQGLLL VWULFWH GH
 ,QIHFLL YLUDOH L EDFWHULHQH VHURORJLH SR]LWLY +,9
VWHULOLWDWHODVDODGHRSHUDLL
6,'$ KHSDWLW DFXW YLUDO $%& WXEHUFXOR] VHSVLV
8UPULUHD XOWHULRDU D PRGDOLWLL GH YLQGHFDUH L
VHYHU LQIHFLL YLUDOH VLVWHPLFH-UXMHRO UDELH
cicatrizare a plagii operatorii prin controale perioadice clinicHL
adenovirus, meningoencefalite),
HFRJUDILFH GDU L PRQLWRUL]DUHD QHIURORJLF D WUDWDPHQWXOXL

 
 
VIII. TRANSPLANTUL RENAL VIII. TRANSPLANTUL RENAL

ficatul, pancreasul, ULQLFKL VSOLQD 'LQWUH RUJDQHOH PHQLRQDWH  Istoric de promiscuitate (toxicomanie iQWUDYHQRDV
FRUGXOUH]LVWFHOPDLSXLQODLVFKHPLDUHFHLDUULQLFKLXOUH]LVW DFWLYLWDLhomosexuale) ULVFFUHVFXWGHLQIHFLH+,9 
cel mai mult . &RQWUDLQGLFDLLUHODWLYHSULYLQGGRQDUHDGHRUJDQH
IV. PREZERVARE  ,QIHFLLYLUDOHLEDFWHULHQH LQIHFLLEDFWHULHQHORFDOL]DWH
3UH]HUYDUHD EXQ L FRUHFW D ULQLFKLXOXL vQWUH PRPHQWXO EDFWHULHPLHVDXIXQJHPLHVHURORJLH+&9SR]LWLYGDF
UHFROWULL L PRPHQWXO LPSODQWULL DUH XQ URO LPSRUWDQW vQ receptorul are srRORJLH+&9SR]LWLY
fuQFLRQDOLWDWHDXOWHULRUDJUHIHLUHQDOH  ,VWRULFGHPDUHLYHFKLIXPWRU ULVFGHDWHURVFOHUR] 
3UH]HUYDUHD UHQDO VH DGUHVHD] OLPLWULL OH]LXQLORU GH  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 'XS vQGHSOLQLUHD FHORU GRX HWDSH WUHEXLH UH]ROYDWH
FHDXFRPSR]LLHHOHFWUROLWLFVLPLODUVSDLXOXLLQWUDFHOXODU  probleme etice, juridice legate de prelevarea de organe
V. IMPLANTARE (contactarea familiei, informarea acestei privind moartea
7UDQVSODQWXOUHQDOHVWHRSURFHGXUFKLUXUJLFDOPDMRUFH FHUHEUDO RELQHUHD FRQVLPPkQWXOXL SULYLQG GRQDUHD GH
SUHVXSXQH R FRPSRQHQW 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:DVKQLFN QWRWGHDXQDWUHEXLHVOLPLWPODPD[LP x 6SHUDQDGHYLDWVXEXQDQ
perioada de ischemie rece a rinichiului (optima este o pHULRDG x Neoplasme recente netratabile,
x ,QIHFLLDFXWHVDXLQIHFii cornice netratabile,

 
 
VIII. TRANSPLANTUL RENAL VIII. TRANSPLANTUL RENAL

x ,QIHFLL+,9VDX6,'$  (YDOXDUHD EROLORU UHQDOH FX SRWHQWLDO GH UHFXUHQ


x Probleme psihosociale: boli psihice majore (glomeruloscleroza IRFDO VHJPHQWDO
QHFRQWURODWHWR[LFRPDQLHQRQFRPOLDQD JORPHUXORQHIULWD PHPEUDQRDV QHIURSDWLD ,J$
x Mismatch n sistemul ABO, glomerulonefritele membranoproliferative,
x Cross-match SR]LWLY vQWUH OLPIRFLWHOH GRQDWRUXOXL L  5HFXUHQD SH JUHID UHQDO D EROLORU VLVWemice
serul primitorului. QHIURSDWLD OXSLF DPLORLGR]D SXUSXUD +HQRFK-
&RQWUDLQGLFDLLUHODWLYH Schonlein, sindromul hemolitic uremic, nefropatia
x ,QIHFLLDFWLYH GLDEHWLF KLSHUR[DOXULD SULPDU FLVWLQR]D

x %RDOFRURQDULDQ, QHROSD]LLOH LQIHFLLOH ERDOD FRURQDULDQ

x Hepatite active, ateroscleroza, HTA, vasculopatiile, AVC,

x Ulcere peptice active, LQVXILFLHQDFDUGLDFFRQJHVWLY'= etc).

x %RDOFHUHEURYDVFXODU (YDOXDUHD LPXQRORJLF - tipizarea HLA, maching L

Evaluarea pre-WUDQVSODQWDUHFHSWRULORUWUHEXLHVLGHQWLILFH crossmaching

IDFWRULPHGLFDOLFKLUXUJLFDOLLPXQRORJLFLLSVLKR-sociali care ar Elementul cheie pentru transplantul renal de succes, este

SXWHDLQIOXHQDVXSUDYHXLUHDSHWHUPHQOXQJDSDFLHQWXOXLLD UHSUH]HQWDW GH DELOLWDWHD LGHQWLILFULL FRUHFWH D SRWULYLULL

grefei renale. histoFRPSDWLELOLWLL GLQWUH SULPLWRU L GRQDWRU SHQWru un

(YDOXDUHDPHGLFDOSUHRSHUDWRULHFDUHHVWHHIHFWXDWGH SURJQRVWLF IDYRUDELO GH IXQFLRQDOLWDWH YLQGHFDUH L GH YLD

FWUHHFKLSDGHQHIURORJLFXSULQGH SHQWUX DFHWL SDFLHQL DYkQG vQ YHGHUH SRVLELOiWDWHD DSDULLHL


IHQRPHQXOXLGHUHMHW JD]GYV alogreIUHQDO 
 $QDPQH]LH[FOLQLFFRPSOHW
III. RECOLTARE
 Ex. de laborator HLG; probe de coagulare,
Recoltrea rinichiului pentru transplant de la donatorul
biochimie, probe hepatice, lipidograma, serologie,
vQYLD se poate efectua prin oricare dintre tehicile nefrectomiei
tipizare HLA (anticorpi citotoxici),
(abord transperitoneal, lombar, laparoscopic). Majoritatea
 5[3XOPRQDU(.*
FHQWUHORU GH WUDQVSODQW UHFRPDQG UHFROWDUHD ULQLFKLXOXL VWkQJ
 8URFXOWXU
YHQD UHQDO PDL OXQJ  GDU SRDWH IL UHFROWDW L ULQLFKLXO GUHSW
 ([JLQHFRORJLFPDPRJUDILHH[SURVWDW
GDFFRQGLLLOHDQDWRPLFHSOHGHD]SHQWUXRUHFROWPDLIDFLO
 Ex. imagistice renale, cistouretrografie,
5HFROWDUHDULQLFKLXOXLGHODGRQDWRUvQPRDUWHFHUHEUDO
 Consulturi: cardiologic, urologic, pneumologic,
HVWH GH FHOH PDL PXOWH RUL R HWDS vQ FDGUXO UHFROWULL
gastroenterologic, hematologic, psihiatric,
multiorgan, fiind astfel recoltate n ordine cordul, plamnul,

!