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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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 BIBLIOGRAFIE
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specialitate), pentru a fi alaturi de noi n lupta cu VXIHULQelor
urologice, QX GRDU SHQWUX D IDFH XQ WXeu rectal corect sau a
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Autorii

Livingstone 1993
Wojtowycz M - Interventional Radiology and Angiography, Year
Book Medical Publishers In


 
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UROLOGY ; JOURNAL DUROLOGIE; JOURNAL OF UROLOGY ; UROLOGY
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XOWUDVRQRJUDILHFOLQLF9RO,(GLWXUD0HGLFDOD%XFXUHWL
Boja R, Nedelcu S (QGRSLHORWRPLDDQWHURJUDG n tratamentul
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stricturilor uretrale, Editura Academiei Romne
Coman Ioan, Sergiu Duca Urological laparoscopic surgery
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M 9 40 Ul/l
RJOLQGD HYROXLHL FD]XOXL L SUHPL]a LPSRUWDQW D XQHL HSLFUL]H
F 8 200 Ul/l
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$VWIHOHSLVRDGHOHUHSHWDWH 7LURLG
de iQIHFLHXULQDUGLQDQWHFHGHQWH (mai ales cu Proteus, Piocianic, &DOFLWRQLQ < 100 pg/ml
Klebsiella), tratate de cele mai multe ori incorect sau incomplet, pot Tiroxina 45 120 mcg/l
H[SOLFD DSDULLD vQ WLPS D OLWLD]HL FRUDOLIRUPH; sau eliPLQULOH Triiodotironina 0,6 1,8 mcg/l
spontane de calcul la un pacient litiazic pot forma o idee despre Paratiroide
QDWXUDFDOFXOLORULSRWHQLDOXOUHFLGLYDQWDOEROLL Parathormon 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

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 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$3IRVIDWD]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
631 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]DWHQVLXQHDDUWHULDOSXOVXOHYHQWXDOGHILFLWXOGH
)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
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 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

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 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


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 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 DULQLFKLXOXLvQWkOQLWXQHRULvQSWR]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

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 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

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

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]LELOLSDOSDELOYH]LILJ,,


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

5HQDODVLPSO
8URJUDILH


&7501

7UDWDPHQWPHGLFDPHQWRV



7UDWDPHQWXURORJLF




3DUWLFXODULWLDOHFD]XOXL




&RFOX]LLFRPHQWDULL







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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]LFDOYH]LILJ,,



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

Caietul stagiului de urologie

Nume VLSUHQXPH)2
Vrsta DQL 6H[
0RWLYHOHLQWHUQULL

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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

&RPSRUWDPHQWHIXPDWDOFRROHWF 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]LFDOYH]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
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YDULDQWD GHVFKLGHULL PHDWXOXL XUHWUDO SH IDD GRUVDO D SHQLVXOXL


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 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

PLFLXQLYH]LILJ,,
7UDWDPHQWPHGLFDPHQWRV



7UDWDPHQWXURORJLF




3DUWLFXODULWLDOHFD]XOXL



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

XUHWUDOHDQWHULRDUHXUHWULWDFXW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
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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

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$+& 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

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,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).

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

HSLGLGLPLWHLRUKLHSLGLGLPLWH


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 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]HGHVFHQVXV &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]DFRQVLVWHQDVDRPRJHQIHUP


UHQLWHQW YROXPXO VXSUDIDD VHQVLELOLWDWHD DWURILD VDX FKLDU
DEVHQD DFHVWXLD FRQJHQLWDO VDX SRVW FKLUXUJLFDO 3DFKHWHOH

vasculare dilatate n cazul varicocelului au fost comparate cu
LQWHVWLQHOH GH SDVUH 1X VH YD RPLWH QLFL SDOSDUHD RULILFLXOXL

inghinal superficial tocmai pentru a preciza posibilele variante de
KHUQLHLQJKLQDO


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

Caietul stagiului de urologie

Nume VLSUHQXPH)2
Vrsta DQL 6H[
0RWLYHOHLQWHUQULL

$+&

$3)

$33


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

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 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


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

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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FDYLWDWHDUHFWDOWXPRU 

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]DUHDHYROXLHLEROLLVWDGLXOORFDOL]DW

sau local avansat);
1XPHVLSUHQXPH)2
Vrsta DQL 6H[ x TR efectuat de gastroenterolog DMXW OD GLIHUHQLHUHD
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invaginare);
&RPSRUWDPHQWHIXPDWDOFRROHWF
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

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 VHIDFHFXDFRUGXOSDFLHQWXOXLLFXEOkQGHHXQHRULLVXE

anestezie loco-UHJLRQDO FXWkQG V QX DJUDYP VDX V

Analize efectuate:
6DQJH DPSOLILFPVXIHULQDFOLQLF
Contraindicatiile TR sunt:

8ULQD x 5HIX]XOH[DPHQXOXLGHFWUHEROQDY
 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
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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
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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
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invecinate

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

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

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presupun: &7501

- vQGHSUWDWHD SOLXULORU DQDOH, evaluare tonusului
7UDWDPHQWPHGLFDPHQWRV
VILQFWHUXOXLDQDO6HPQXOFODSHWHLGHSLDQ
- 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
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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

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SHUPLWHRELQHUHDXQRULQIRUPDLLIRDUWHXWLOHPHGLFXOXLFRQWULEXLQG

GHDVHPHQLODVWDELOLUHDXQXLGLDJQRVWLFUDSLG(VWHRPHWRGFDUH
$3)
QHFHVLW R LQYHVWLLH LQLLDO GDU DSRL HVWH QHFRVWLVLWRDUH VH SRDWH
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&RQGLLLGHYLDLPXQF HIHFWXDW L IU SUHJWLUH OD SDFLHQL vQ FROLF FKLDU L OD IHPHL

gravide, putnd fi utilizatFXVXFFHVvQFRQWURDOHOH SDFLHQLORU

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- RPHWRGvQWLPSUHDORIHULQGLPDJLQLGLQDPLFHGDUHVWH

MedicatLHGHIRQG RPHWRGVXELHFWLYLGHSHQGHQWGHH[DPLQDWRU
(FKRJUDILDDUHLRVHULHGHOLPLWHFDUHWUHEXLHFXQRVFXWH

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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
vQLQYHVWLJDUHDRUJDQHORUDEGRPLQDOHULQLFKLYH]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

&RPSRUWDPHQWHIXPDWDOFRROHWF 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

&RPSRUWDPHQWHIXPDWDOFRROHWF 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
WXEXOXLGLJHVWLYHVWHELQHVDDPkQPvQDFHVWHFRQGLLLLQMHFWDUHD


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


FLVWRJUDILD  FLVWRXUHWURJUDILD PLFLRQDO L FLVWRJUDILD
SRVWPLFLRQDOUH]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
PRGHUDWHJUHXULFOGXUURHDORFDOODORFXOLQMHFLHLXUWLFDULH

SkQ OD UHDFLL JHQHUDOH VHYHUH VWDUH OLSRWLPLF GLVSQHH

expiratorie, bronhospasm).
8URJUDILD LQWUDYHQRDV 8,9 XUPUHWH UDGLRJUDILF

eliminarea de SDC prin rinichi:

x la 5 min WHVW IXQFLRQDO - HOLPLQDUH VLPHWULF
ELODWHUDOHJDO

$
 
 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 VXEVWDQHLGHFRQWUDVW6'&

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

&RPSRUWDPHQWHIXPDWDOFRROHWF 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

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SHVWXGLD]WUHLID]HGLVWLQFWH

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

&RPSRUWDPHQWHIXPDWDOFRROHWF
marile ramuri arteriale, apoi a arteriolelor mici interlobare. n caz de
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,,,)D]DYHQRDV 7-VHFGXS injectare.
 &XQRDWHUHD JUDGXOXL GH LQYD]LH YHQRDV WXPRUDO HVWH

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Analize efectuate: GHWXPRUUHQDO

SanJH 9. ,19(67,*$IILE RADIOIZOTOPICE N UROLOGIE

 x VXQWXWLOL]DWHGHFHOSXLQGHFHQLL
8ULQD x LQLLDO GRX WLSXUL GH H[DPLQDUH PRUIRORJLF VWDWLF

LIXQFLRQDOGLQDPLFvQHYROXLHDDSUXWFDPHUDGHVFLQWLODLH
8URFXOWXUD FDUH FXSODW OD XQ FRPSXWHU D SHUPLV GLVSDULLD VHSDUDLHL
Echografie: 
PRUIRORJLFIXQFLRQDO HIHFWXkQGX-VH DFXP R VLQJXU H[DPLQDUH
SULQFDUHVHRELQDPEHOHLQIRUPDLL
99m
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131
, QRQLQYD]LYH FX R LUDGLHUH PDL PLF GHFkW SUHSDUDWHOH 5HQDODVLPSO
radiologice; 8URJUDILH

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

FRUHVSXQGHLQWUULLVkQJHOXLUDGLRDFWLYvQULQLFKLVHJPHQWFXDVSHFW
7UDWDPHQWPHGLFDPHQWRV
GHSDQWDVFHQGHQWDEUXSW
2. DOGRLOHDVHJPHQWDVFHQGHQWFXSDQWOLQHVWHFHO


tubular VDX VHFUHWRU L FRUHVSXQGH DFXPXOULL L]RWRSXOXL 7UDWDPHQWXURORJLF
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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 XII. CAIETUL STAGIULUI DE UROLOGIE ,,,(;3/25$5($,0$*,67,&1852/2*,(

Caietul stagiului de urologie

1XPHVLSUHQXPH)2
Vrsta DQL 6H[
0RWLYHOHLQWHUQULL 

$+&

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APP


&RQGLLLGHYLDLPXQF
Fig.III.2 - (FRJUDILHFDOFXOFDOLFHDOLQIHULRUIU distensia sistemului
pielocaliceal
&RPSRUWDPHQWHIXPDWDOFRROHWF.

MedicatLHGHIRQG

,VWRULFXOEROLL




Analize efectuate:
6DQJH


8ULQD


8URFXOWXUD
(FKRJUDILH


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

Fig.III.3 - RRS, calcul caliceal superior drept, calcul bazinetal

5HQDODVLPSO
8URJUDILH


&7501

7UDWDPHQWPHGLFDPHQWRV



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


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

Caietul stagiului de urologie

Nume si SUHQXPH)2
Vrsta DQL 6H[
0RWLYHOHLQWHUQULL

$+&

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Comportamente (IXPDWDOFRROHWF Fig.III.6 - RRS, calcul coraliform drept tip E

0HGLFDLHGHIRQG

,VWRULFXOEROLL




Analize efectuate:
SanJH


8ULQD


8URFXOWXUD
(FKRJUDILH Fig.III.7 - (FRJUDILHSLHORQHIULW FURQLFULQLFKLPLFFRQWXUQHUHJXODWLQFL]XU
FLFDWULFLDOPHGLRUHQDOSHFRQWXU

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

5HQDODVLPSO: ..
Urografie: ...


&7501

Tratament medicamentos: 

.

Tratament urologic: 




Particulariti ale cazului 

Fig. III 8 Ecografie calcul ureteral cu UHN suprajDFHQW 


Cocluzii/comentarii: 



















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

Caietul stagiului de urologie

1XPHVLSUHQXPH)2
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0RWLYHOHLQWHUQrii: 

AHC: 

$3).

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Comportamente (IXPDWDOFRROHWF

0HGLFDie dHIRQG

Istoricul bolii: 




Analize efectuate:
6DQJH


8ULQD..


Urocultura:
Echografie: 

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

suprajacent nalt



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

VU- LPDJLQH ODFXQDU FX VHPLWRQ vPSUHMXU SH SHUHWHOH ODWHUDO

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


Tratament medicamentos:



7UDWDPHQW XURORJLFTUR-VHOHFWURUH]HFQLD WUDQVXUHWUDO D
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
Fig.III.11 CT, chist renal QHRSOD]LL  IXPDWRDUH OXFUX LQ PHGLX WR[LF WDWO FX R IRUPD GH
cancer)


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Fig.III.12 &7FXVXEVWDQ de contrast abces renal

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XII. Caietul stagiului de urologie

1XPHOHi prenumele: ..Florescu Georgeta)22536

Varsta: 62DQL 6H[feminin
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LQWHUPLWHQW
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(decedat)-neoplasm de colon, un frate LQ YLD aparent
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DFWXDOPHQWHSHQVLRQDU
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$PORGLSLQ 5 mg , 1 cp/zi
Istoricul bolii:..3DFLHQWD UHODWHD] GHEXWXO VLPSWRPDWRORJLHL GH DSUR[ Fig.III.13 UIV - Rinichi polichistic, duplicitate SLHORFDOLFHDOLXUHWHUDOLQFRPSOHW
2 OXQLSULQKHPDWXULHPDFURVFRSLFSHQWUXFDUHODLQGLFDWLDPHGLFXOXL VWkQJ
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,

! 
 ,,,(;3/25$5($,0$*,67,&1852/2*,( XI NGRIJIREA PACIENTULUI UROLOGIC

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PRELOL]DW vQF GLQ SULPD ]L SRVWRSHUDWRU L SULPHWH OLFKLde p.o.;
XOWHULRUvQIXQFLHGHWROHUDQDOLPHQWDLDYDILUHLQWURGXVSURJUHVLY
Q]LOHOHXUPWRDUHSDFLHQLLSRWSUH]HQWDWHQHVPHYH]LFDOHFHLPSXQ
Fig.III.15 &7D[LDOFXVXEVWDQ de contrast, hidronefroz SULQOLWLD] ED]LQHWDO
DGPLQLVWUDUHD GH DQWLPXVFDULQLFH VROLIHQDFLQ WROWHURGLQ HWF $OWH
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QIXQFLHGHFRQGLLLOHvQFDUHV-a realizat anastomoza vezico-
XUHWUDOLGHHYROXLDSRVWRSHUDWRULHGXS-]LOHGHODLQWHUYHQLH
se va HIHFWXD R FLVWRJUDILH UHWURJUDG 'DF QX H[LVW H[WUDYD]DUH D
VXEVWDQHLGHFRQWUDVWFDWHWHUXOXUHWUDOYDILVXSULPDWvQFD]FRQWUDU
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VXSULPDUHD VRQGHL XUHWUDOH SHQWUX D IDFLOLWD UHFkWLJDUHD FRQWUROXOXL
sfincterian.
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SRVLELOLWDWHD SURWHMULL EDQGHOHWHORU QHXURYDVFXODUH vQ FXUVXO
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de fosfodiesteraz-5 (sildenafil, tadalafil etc.) n doze zilnice mici,
GXSVSWPkQLGHOD35
5HFRPDQGULOH HIHFWXDWH OD H[WHUQDUH LQFOXG HYLWDUHD
Fig.III.16 &7WXPRU UHQDO
HIRUWXULORU IL]LFH PDUL L D DFWLYLWLL VH[XDOH SHQWUX - VSWPkQL Q
FRQGLLLOHXQHLLQWHUYHQLLHILFLHQWHGLQSXQFWGHYHGHUHRQFRORJLF36$-
XO VHULF DU WUHEXL V ILH QHGHWHFWDELO vQF GH OD  VSWPkQL GH OD
prostatectomia radical


 
 XI NGRIJIREA PACIENTULUI UROLOGIC ,,,(;3/25$5($,0$*,67,&1852/2*,(

sondei uretrovezicale la 13 - 14 zile postopeUDWRU L, ulterior, a firelor

GHVXWXU
Se impune suprimarea sondei ureterale JJ la aproximativ 6
VSWPkQLSRVWWUDQVSODQWGHDVHPHQHDvQ FRQGLLLVWULFWHGHVWHULOLWDWH
ODVDODGHRSHUDLL
8UPULUHDXOWHULRDUDPRGDOLWLLGHYLQGHFDUHLFLFDWUL]DUHD
plagii operatorii prin controale perioadice clinicH L HFRJUDILFH GDU L
PRQLWRUL]DUHD QHIURORJLF D WUDWDPHQWXOXL LPXQRVXSUHVLY L D
fXQFLRQDOLWDLL JUHIHL UHQDOH LQWUD LQ ILUHVFXO PRQLWRUL]DULL
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
FUHVFXW vQ SHULRDGD SRVWRSHUDWRULH LPHGLDW VH SRDWH GDWRUD XQHL
ILVWXOHXULQDUHSULQOLSVDGHHWDQHLWDWHDDQDVWRPR]HLYH]LFR-uretrale,
OLPIRUDJLHL GDF V-D SUDFWLFDW L OLPIDGHQHFWRPLH SHOYLQ VDX
KHPRUDJLHLSHOYLQHQFRQGLLLOHXQHLHYROXLLQRUPDOHWXEXULOHGHGUHQ
YRU IL GH RELFHL VXSULPDWH GXS - ]LOH GH OD LQWHUYHQLH +HPDWXULD
PDFURVFRSLF SRVWRSHUDWRULH SRDWH SHUVLVWD FkWHYD ]LOH GDF HVWH
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.


 
 ,,,(;3/25$5($,0$*,67,&1852/2*,( XI NGRIJIREA PACIENTULUI UROLOGIC

FKLUXUJLFDO FKLDU L vQ FD]XO XQRU LQWHUYHQii de mare amploare ca

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
Fig.III.19 ,50WXPRU UHQDO stg.
Fig.III.20 - 8,9SURFHVvQORFXLWRUGHVSDLXpolar superior stg, cu
DPSUHQWLGLODWDLHFDOLFHDOVXSHULRDU

 $
plasarea unuia a fost necesar VXSUDYHJKHUHD UHOXULL WUDQ]LWXOXL
LQWHVWLQDO L HYLWDUHD DSDULLHL GH FRPSOLFDLL LQIHFLRDVH QRVRFRPLDOH
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
GHVFKLVH PDMRUH WUHEXLH IDFXW GH FDWUH medicul anestezist-
reaminator LVHUHIHUODPHQLQHUHDLUHHFKLOLEUDUHDKHPRGLQDPLF,
KLGURHORHFUROLWLFLDFLGRED]LFVXSRUWLYDIXQFLLORUYLWDOHFXDWHQWD
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
ScurtaUHD L, ulterior, suprimarea tuburilor de dren la 4-5 zile
SRVWRSHUDWRU VDX FkQG QX VH PDL vQUHJLVWUHD] GUHQDM VXSULPDUHD
 XI NGRIJIREA PACIENTULUI UROLOGIC ,,,(;3/25$5($,0$*,67,&1852/2*,(

din jurul stomei.

)ROLDDGH]LYWUHEXLHVILHSUHFLVGHFXSDWGXSPULPHD
L IRUPD VWRPHL SHQWUX D SURWHMD WHJXPHQWXO GLQ MXUXO DFHVWHLD L D
DVLJXUD HWDQHLWDWHD QX WUHEXLH XLWDW IDSWXO F VWRPD vi va reduce
WUHSWDW YROXPXO FHO SXLQ  OXQL GXS LQWHUYHQLH DVWIHO vQFkW L
GHFXSDMXO IROLHL WUHEXLH V ILH PRGLILFDW FRUHVSXQ]WRU 3LOR]LWDWHD
SHULVWRPDO SRDWH UHGXFH DGHUHQD GLVSR]LWLYXOXL FROHFWRU VDX SRDWH
determina dureri la desprinderea foliei, motiv pentru care majoritatea
SDFLHQLORUSUHIHUVUDGVSWPkQDOWHJXPHQWXOUHVSHFWLY
Fig.III.21 - (FRJUDILHWXPRU YH]LFDO VWkQJ cu UHN suprajDFHQW
$YvQG vQ YHGHUH IDSWXO F vQ XULQD GUHQDW SULQ XURVWRPLH VH
HYLGHQLD] vQ PRG RELQXLW XQ QXPDU VHPQLILFDWLY GH EDFWHULL
(bacteriurie), tratamentul antibiotic nu este recomandat OD SDFLHQLL
DVLPSWRPDWLFLFKLDUGDFSUH]LQWXURFXOWXULSR]LWLYH
$SRUWXODGHFYDWGHOLFKLGHHVWHHVHQLDOSHQWUXDUHGXFHULVFXO
GH LQIHFLL XULQDUH 1X HVWH QHFHVDU HYLWDUHD YUHXQXL DOLPHQW OD
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.

Supravegherea postoperatorie D SDFLHLORU FX LQWHUYHQLL
ODSDURVFRSLFH DUH FD SDUWLFXODULWDWH PDMRU UDSLGLWDWHD FX FDUH
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SRVWRSHUDWRULHLPHGLDWWUHEXLHVILHHIHFWXDWFXRIUHFYHVLPLODU
supravegherii cardiovasculare.
VIII.          - iar sistemul de
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SDFLHQWXOXLLDUHGXFHSUHVLXQHDDVXSUDVWRPHL
,QVSHFLDVWRPHLWUHEXLHVGHFHOH]HRULFHVHPQGHLVFKHPLH
Fig.III.23 6HFYHQ D[LDO &7SRVWFRQWUDVWDFHODLFD]
6WRPD QRUPDO DUH FXORDUHD UR] VDX URX Vimilar mucoasei bucale;
 DVSHFWXO HGHPDWRV LQLLDO YD GLVSDUH vQ XUPWRDUHOH -6 luni, iar n
XULQLvQMXUXOVWRPHLVHREVHUYDFXPXODUHGHPXFXV
,PHGLDW FH VWDUHD FOLQLF R SHUPLWH SDFLHQWXO YD IL LPSOLFDW vQ
schimbarea sistemului colector. nainte de GHFODQDUHD DFHVWHL
SURFHGXULHVWHLPSRUWDQWDVLJXUDUHDWXWXURUPDWHULDOHORUQHFHVDUH
7LPSLLSULQFLSDOLDLVFKLPEULLVLVWHPXOXLGHXURVWRPLHVXQW
-VXSULPDUHDFXEOkQGHHDSXQJLLLDIROLHLDGH]LYH
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-VSODUHDWHJXPHQWXOXLSHULVWRPDO
-uscarea tegumentului peristomal;
-aplicarea produselor de ngrijire a tegumentului peristomal;
Fig.III.24 - (FRJUDILHDGHQRPGHSURVWDW -DSOLFDUHD DWHQW D QRXOXL VLVWHP de urostomie, pentru a
asigura HWDQHLWDWHDDFHVWXLD
Q WLPSXO QRSLL VH SRDWH FRQHFWD R SXQJ FROHFWRDUH OD
sistemul de urostomie pentru a asigura drenajul permanent al
acestuia.
$SDFDOGLWDPSRDQHOHGHEXPEDFVXQWGHRELFHLVXILFLHQWH
SHQWUXVSODUHDWHJXPHQWXOXLSHULVWRPDODOWHUQDWLYDHVWHUHSUH]HQWDW
GHHUYHHOHXPHGHVSHFLDOFRQFHSXWHSHQWUXFXUDUHDWHJXPHQWXOXL

 
 XI NGRIJIREA PACIENTULUI UROLOGIC ,,,(;3/25$5($,0$*,67,&1852/2*,(

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VLPSO SHQWUX D HYLGHQLD SR]LLRQDUHD VRQGHL L, HYHQWXDO SUH]HQD
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Sonda JJ LQVWDODW OD VIkULWXO XUHWHURVFRSiei retrograde - sau
XQHRUL OD VIkULWXO 1/3 - SRDWH IL PDL JUHX VXSRUWDW GH SDFLHQL vQ
IRQG HVWH XQ FRUS VWULQ 0HGLFDLD DQWLLQIODPDWRDUH .HWRURODF
;HIRUDSLGHWFLDOID-blocantele selective (Omnic sau Silodosin) pot
fi foarte utile n acest caz.
VII. NGRIJIREA 3$&,(178/8,&8'(5,9$,(85,1$5
(;7(51 (UROSTOMIE)
&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
Fig.IV.7 Cateter ureteral Chevassu
Fig.IV.8 GUHQDMLQWHUQDOULQLFKLXOXLFXDMXWRUXOVRQGHLGRXEOH-
Fig.IV.9 sonda Foley pentru nefrostomie
!
 
XI NGRIJIREA PACIENTULUI UROLOGIC
ORPEDU
9RU IL PRQLWRUL]DWH FX DWHQLH DOWXUL GH SDUDPHWULL YLWDOL
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
(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
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
Fig.IV.15 - Nefroscop
Fig IV.16 Ureteroscop semirigid
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! $OWXUL GH
DQWLELRWHUDSLH PVXULOH GH DQWLVHSVLH L LJLHQ SHUVRQDO VXQW
HVHQLDOH SHQWUX SUHYHQLUHD XQHL LQIHFLL XULQDUH LQWUDVSLWDOLFHWL GH
PXOWHRULFXJHUPHQLPXOWLGURJUH]LVWHQL
III. ADENOMECTOMIA TRANSVEZIC$/
Este o intervenLHFKLUXUJLFDOGHVFKLV GHFLLPSOLFvQJULMLULPDL
DPSOH DYkQG vQ YHGHUH FRPSOH[LWDWHD LQWHUYHQLHL 'H OD VDOD de
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 $FHVWH LQVWUXPHQWH
/D VIkULWXO LQWHUYHQLHL VH LQVWDOHD] R VRQG )ROH\ FX
devenite banale n ziuDGHDVW]LSULQXWLOL]DUHVXEGLIHULWHYDULDQWH
triplu curent, FX EDORQD PLF -PO L GHVLJXU ODYDM YH]LFDO 9RP
UHXHVFVDOLQHVXIHULQDFkWGHGXUHURDVHVWHUHWHQLDDFXWGH
DYHDDFHOHDLSUHRFXSULOHJDWHGHIXQFLRQDUHDVLVWHPOXLGHODYDMFD
XULQ L V VDOYH]H YLDD DQXULD REVWUXFWLY UHWHQLD GH XULQ
LvQFD]XO785-3DWkWvQWLPSXOWUDQVSRUWXOXLVSUHVDORQLLQVWDOULLvQ
LQIHFWDWvQFLOHXULQDUHVXSHULRDUH
pat.
Sondele VXQWQLWHWXEXULGLQplastic de diferite dimensiuni
Monitorizarea lavajului vezical GH RELFHL vQ SLFWXU OHQW
L IRUPH FH UHDOL]HD] FRPXQLFDUHD XQXL VHJPHQW al aparatului
VDXPHGLHDUHDFHHDLPRWLYDLHFDLOD785-P i anume prevenirea
H[FUHWRUFXPHGLXOH[WHUQvQFLUFXLWvQFKLVVRQGXUHWUR-YH]LFDO
FROPDWULLVRQGHLYH]LFDOHFXFKHDJXULvQFD]XODSDULLHLQHDWHSWDWHD QHIURVWRP VDX FX DOW VHJPHQW OHJWXUD VLVWHP SLHORFDOLFHDO-
XQHL VkQJHUUL GLQ SHUHWHOH YH]LFDO GH OD ORFXO de UH]HFLH YH]LFD XULQDU SULQ VRQG DXWRVWDWLF XUHWHUDO WLS -- &DOLEUXO
,QUHJLVWUDUHD FXUHQW D SDUDPHQWULORU IXQFLRQDOL 7$ 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
ODYDMXOXL YH]LFDO FRQVWLWXLH SUHRFXSULOH FRQVWDQte ale primei zile
pentru asistenta de salon. ntreruperea lavajului se face cnd ne
DVLJXUPFKHPRVWD]DHVWHVXEFRQWUROGHLvQUDUHFD]XULSRDWH
VDSDUGLQVHQLQRVkQJHUDUHOHJDWGHXQYDOGHVkQJHGLQSDWXO
WXPRUDOGLQFDUHDVULWFKHDJXO).
Vom recomanda mobilizarea precoce FX DFHOHDL SUHFDXLL
Sondele uretro-vezicale se folosesc pentru evacuarea
XULQLL GLQ YH]LF 6XQW IRUPDWH GLQ WXEXUL FX  FDSHWH XQXO
DMXQJkQG vQ YH]LF LDU FHOODOW UPkQkQG vQ H[WHULRU L OD FDUH VH
DWDHD]RSXQJFROHFWRDUH)RUPDVSHFLDODFDSWXOXLFDUHHVWH
intURGXVvQYH]LFSUHFXPVLMHOO\-anestezicul utilizat permit, n cele
mai multe cazuri, progresia uRDU L IDFLO D VRQGHL vQ YH]LF Q
prezent se folosesc mai frecvent 3 tipuri de sonde uretro-vezicale:

OHJDWH GH PDQLSXODUHD SXQJLL FROHFWRDUH L UHOXDUHD SURJUHVLY D
DOLPHQWDLHLFDLvQFD]XOUH]HFLLORUWXPRULORUSURVWDWLFH
6XSULPDUHD VRQGHL YH]LFDOH VH IDFH GRDU OD LQGLFDLD
operatorului L HVWH OHJDW vQ SULQFLSDO GH SURIXQ]LPHD UH]HFLHL
- Sonda Nelaton FX YkUI GUHSW L SOLQ DYkQG JXUL ODWHUDOH GH
preferat la femei (fig.IV.1);
- Sonda Tiemann FX YkUI FXGDW L HILODW FH SHUPLWH DQJDMDUHD
prin curbura uretrei bulbare (fig.IV.2);
De]DYDQWDMXO DFHVWRU VRQGH HVWH F HOH QX SRVHG XQ VLVWHP GH
HYHQWXDOH LQFLGHQWH FD GH H[HPSOX SHUIRUDLD DFFLGHQWDO D YH]LFLL
IL[DUHLQWHUQILLQGQHFHVDUIL[DUHDH[WHUQFXOHXFRSODVWLQVWDELO
GDU vQ FHOH PDL PXOWH FD]XUL VH IDFH GXS -5 zile. ,GHQWLILFDUHD L

 
 IV. INSTRUMENTARUL N UROLOGIE XI NGRIJIREA PACIENTULUI UROLOGIC

VDXOLJDWXUDODSUHSXGXUHURDV 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
FDSWXOLQWHUQvQvQYHOLXOSHUHWHOXLILJ,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
GHGUHQDMXULQDUXQDSHQWUXXPIODUHDEDORQDXOXLLXQDSULQFDUH
VHLQWURGXFHVHUVDXDSVWHULOvQYH]LFSHQWUXVSODUH
6H LQVWDOHD] DWXQFL FLQG GRULP UHDOL]DUHD XQXL ODYDM
YH]LFDO GXS UH]HFLLOH GH SURVWDW VDX GH WXPRUL YH]LFDOH FX ULVF
de hematurie (fig.IV.4).
([LVW VLWXDLL FkQG QX VH SRDWH VDX QX VH UHXHWH
cateterizarea uretro-YH]LFDO - OD EROQDYL FX VWULFWXU XUHWUDO VDX
GXSLQWHUYHQLDvQIRUDXQXLFRQIUDWHJHVWFHVHSRDWHVROGDFX
o caOH IDOV 'DFD XUHWUD HVWH LQDERUGDELO HYDFXDUHD XULQLL VH
UHDOL]HD]SULQWU-un drenaj suprapubian. $FHVWDVHUHDOL]HD]FX
un dispozitiv special (Cystofix) care cuprinde un ac gros (trocar),
FH FRQLQH vQ LQWHULRU XQ REWXUDWRU 6H SXQFLRQHD] VXSUDSXELan,
perpendicular pe planul abdomenului, se scoate obturatorul apoi
VHLQWURGXFHSULQWURFDUvQYH]LFXQWXEFXJXULFHVHIL[HD]OD
VWHULOHEDGLMRQDUHFX%HWDGLQ lavajului vezical pentru cteva ore, o
]LFKLDUODXQIOX[FDUHVvPSLHGLFH colmatarea sondei.
QFRQGLLLOHREQXLWHGHHYROXLHn ziua a 3-DVHVXSULP sonda
Foley, evacund complet OLFKLGXO GLQ EDORQD FX DMXWRUXO XQHL VHULQJL
fara ac. 'DF SHUVLVW R VHQ]DLH QHSOFXW GH GXUHUHXVWXULPH VH
SRDWH DGPLQLVWUD R PHGLFDLH DQWLDOJLFDQWLLQIODPDWRDUH 9RP LQYLWD
pacientul V FRQVXPH OLFKLGH din abunden L VH YD PRQLWRUL]D
FDQWLWDWHD GH XULQ HOLPLQDW L RUD 'DF SDFLHQWXO vQ FLXGD
FRQVXPXOXL GH OLFKLGH QX XULQHD] YD IL HYDOXDW HFKRJUDILF LDU
PHGLFXO GH JDUG YD GHFLGH DVXSUD RSRUWXQLWLL UHLQVWDOULL VRQGHL
vezicale.
3DFLHQLORU FX GLDJQRVWLF GH QHRSODVP GH SURVWDW OD FDUH V-a
luat decizia de a se praFWLFD VXE DFHHDL DQHVWH]LH 785-P de
GHEORFDUHLRUKLHFWRPLHOLVHYDXUPULDVSHFWXOSOJLORURSHUDWRULLL
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
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 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[HPSOXILJ,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
SDFLHQWXOvLUHLDWROHUDQDGLJHVWLY
'XS VXSULPDUHD WUDFLXQLL VRQGHL vQ FRO supravegherea
DVSHFWXOXL OLFKLGXOXL GH ODYDM YD FRQWLQXD FX DFHHDVL DWHQLH pentru
XUPWRDUHOH  GH RUH FkQG PHGLFXO RSHUDWRU YD VWDELOL GDF ODYDMXO
YH]LFDOSRDWHILvQWUHUXSWvQFRQGLLLOHvQFDUHIOX[XOXULQDUVLQJXU din ce
vQ FH PDL DEXQGHQW vQ FRQGLLLOH KLGUDWULL SHU RV SRDWH DVLJXUD
eliminarea micilor cheaguri.
Din ziua 1 postoperator SDFLHQWXO YD IL vQFXUDMDW V VH
PRELOL]H]HPDLvQWkLODPDUJLQHDSDWXOXLLDSRLSULQVDORQ GDF
caliceal prLQGHSDLUHDREVWDFROXOXLGHFHOHPDLPXOWHRULOLWLD]LF
SURILWPGHILUXOJKLGFDUHDSHUPLVDVFHQVLXQHDSHQWUXDLQWURGXFH
R VRQG XUHWHUDO VSHFLDO FXQRVFXW FD VRQGD 'RXEOH - sau
3LJ-tailvQIXQFLHGHIRUPDH[WUHPLWLORU2GDWDLQWURGXVVRQda,
ILUXOJKLGHVWHUHWUDVLDWXQFLVHIRUPHD]RSULPDEXFOvQED]LQHW
5HWUDJHUHD FRPSOHW D ILUXOXL YD IDFLOLWD vQFXUEDUHD VRQGHL L vQ
YH]LFUHDOL]kQGX-VHDVWIHODGRXDEXFOFHHDFHH[SOLFDQXPHOH).
De oELFHL HOH VH PHQLQ FkWHYD VSWPkQL GDr uneori se pot
PHQLQH L OXQL de zile, iar anumite sonde zise ORQJ OLIH pot fi
PHQLQXWH FKLDU SkQD OD  DQ FRPSR]LLD ORU vPSLHGLFkQG LQ
majoritatea cazurilor, vQ FRQGLLLOH XQXL IOX[ XULQDU QRUPDO
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
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 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] FXGRXSWXULVHDGDXJWHUPRIRDUHHYHQWXDOVHDGDXJDPHGLFDLD

VXEVWDQ GH FRQWUDVW DPHVWHFDW FX XQ FRORUDQW LQRIHVLY SUHVFULV GH PHGLF Ca gluconic, Mialgin, antibiotice conform

vizualizndu-se astfel sistemul pielo-caliceal, se introduce un ghid DQWLELRJUDPHL vQ FD]XO vQ FDUH IULVRQXO QX FHGHD] VH YRU UHFROWD
meWDOLF SULQ DF SkQ vQ ED]LQHW GXS FDUH VH H[WUDJH DFXO 3H KHPRFXOWXULXURFXOWXUSHQWUXHYLGHQLHUHDFDX]HL
ghidul PHWDOLFVH LQWURGXFHXQWXE GH QHIURVWRPLHFDUHVHIL[HD] 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).
&kQG QX H[LVW DOWHUQDWLYD UDGLRORJLF VH FRQWLQX
SURFHGXUD QXPDL VXE FRQWURO HFKRJUDILF GDU WUHEXLH V DFLRQP
UDSLG V QX VH SLDUG GLODWDLD SLHOR-FDOLFHDO FH SHUPLWH
FRQWLQXDUHD PDQHYUHORU 1HIURVWRPD HVWH WHPSRUDU vQ DIHFLXQLOH
PDOLJQHGXUHD]DSUR[LPDWLYRU /DVIkULWXOSURFHGXULLSDFLHQWXO
SUVHWH EORFXO RSHUDWRU DYkQG PRQWDW R SHUIX]LH LY R VRQG FX
WULSOX FXUHQW L XQ ODYDM YH]LFDO vQ PXOWH FD]XUL VRQGD SXWkQG IL
WUDFLRQDW L IL[DW GH FRDSV FX EHQ]L GH OHXFRSODVW j OD 6DOYDULV
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]DILDGXVvQIXQFLHGHGLDJQRVWLFGH
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

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 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
LHLUHDOLFKLGXOXLGXEOXFXUHQW
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
VHFLXQHVDXGHFRDOJXODUHLQIXQFLHGHHWDS
Nu trebuie fFXW FRQIX]LD vQWUH FXUHQWXO HOHFWULF IRORVLW L
laser! (vezi capitolul dedicat acestui subiect).
$FHDVWD SURFHGXU VH QXPHWH vQ OLPED HQJOH]
7UDQVXUHWKUDO 5HVHFWLRQ RI WKH 3URVWDWH GH XQGH SUHVFXUWDUHD
IUHFYHQWXWLOL]DWvQFOLQLFGH785-P.
,GHDO DU IL V SXWHP OXFUD FX VROXLL L]RWRQH FDUH GDF
ajung vQ VkQJH vQ WLPSXO LQWHUYHQLHL QX LQGXF GH]HFKLOLEUH KLGUR-
electrolitice. Dar, din motive economice, nu ne permitem folosirea
ORUDSHOkQGODEDQDODDSVWHULO8WLOL]DUHDDSHLVWHULOHIDFHFDvQ
DQXPLWH VLWXDLL V H[LVWH ULVFXO DSDULLHL DD QXPLWXOXL sindrom
TUR GDWRUDW SWUXQGHULL DSHL vQ VLVWHPXO FLUFXODWRU vQ H[FHV FHHD
FHGXFHODKHPROL]LLQVXILFLHQUHQDODFXW
5H]HFLD WUDQVXUHWUDO VH IRORVHWH DVW]L SH VFDUD ODUJ
SHQWUXDWUDWDWXPRULOHYH]LFDOHKLSHUSOD]LDEHQLJQGHSURVWDWGH
voluPPHGLXVDXGHEORFDUHDGHFROYH]LFDODSDUXWODSDFLHQLLFX
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3UHJWLUHDvQYHGHUHD(6:/
- VH YD IDFH GLQ ]LXD SUHFHGHQW vQ SULPXO UkQG FX XQ UHJLP
DOLPHQWDUFDUHVH[FOXGDFHOHDOLPHQWHFDUH, fermentndSURYRDF
balonare GXOFLXULOH L IUXFWHOH GH RULFH IHO EXWXUL GXOFL VDX
FDUERJD]RDVHSkLQHDIDVROHDFDUWRILLYDU]DvQJKHDWDHWF
-FRQVXPXO GH DS SODW HVWH SHUPLV SDFLHQLORU FDUH QX
SUH]LQW GXUHUL FROLFDWLYH (VWH IRDUWHELQH GDF vQDLQWH GH SURFHGXU
SDFLHQWXO DUH VWRPDFXO JRO vQWUXFkW GH OD PHGLFDLD DQHVWH]LF L
DQWDOJLF VDX GH OD SURFHGXUD vQ VLQH SRW DSDUH JUHXUL 2 FOLVP
HYDFXDWRULHHIHFWXDWVHDUDODRUDHVWHGHDVHPHQHDUHFRPDQGDW
mai ales la cei care prezinta constipatie habitual. Este interzis fumatul
nainte de procedur!
1*5,-,5,/(%2/1$9,/25'83,17(59(1,,
CHIRURGICALE PE APARATUL URINAR
QJULMLULOH SRVWRSHUDWRULL vQFHS LPHGLDW GXS LQWHUYHQLD
FKLUXUJLFDO L GXUHD] SkQ OD YLQGHFDUHD FRPSOHW D EROQDYXOXL

 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
recomandarea medicului.
3UHJWLULOHGLQGLPLQHDDLQWHUYHQLHL
-pacientul nu mai aUHYRLHVFRQVXPHOLFKLGH VIXPH]H
-vLYDHIHFWXDWRDOHWDRELQXLWGHGLPLQHD;
-L VH YRU PVXUD L QRWD FD GH RELFHL principalii parametri
FXSULQGHVWUkQJHLVSDUJHILJ,9
Desigur, calculii de inIHFLH FH DX UHSXWDLD GH D IL IULDELOL
GDULDFHLPDLGXULGDUSXLQPDLYROXPLQRLSRWILWULWXUDLDVWIHOQ
FD]XOFDOFXOLORUYH]LFDOLYROXPLQRLFDUHQXSRWILSULQLvQFOHWH
SXWHPIRORVLLQLLDO/,7+2&/$67-XOSHQWUXRIUDJPHQWDUHSULPDU
L DSRL OLWRWULWRUXO PHFDQLF SHQWUX VIDUkPDUHD vQ EXFDL FH SRW IL
7$SXOVUHVSLUDLHGLXUH]LYRUILREVHUYDWHHYHQWXDOHOHPRGLILFUL HYDFXDWH SH WHDFD LQVWUXPHQWXOXL ([LVW ULVFXO FD vQ WLPSXO
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LQWHUYHQLDUHQDOSHUFXWDQDWHVWHFRPSXVGLQ La finalul consultului preanestezic, medicul anestezist poate ncadra

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Tipuri de lasere folosite in urologie :
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1. Holmium (Ho): Yag (Ytrium aluminium garnet) laser;
10 zile nainte de puncie!!!
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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
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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
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vezicale; etc.

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x Incizia colului vezical; vQUHJLVWUD ]LOQLF vQ IRLD GH REVHUYDLH DQXPLL SDUDPHWUL 7$ SXOV
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5HDFLLDOHUJLFHFXWDQDWH 2. n endoscopia aparatului superior:

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

IUSUXULWUDVKFXWDQDW stenozate (endopielotomie);

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XUHWHURVFRSLHL L D calculilor pielocaliceali n cursul nefrolitotomiei
i.vIPO PJVDXGHULYDLFRUWL]RQLFL6ROX-Decortin 100-250mg sau
percutanate sau a ureteroscopiei retrograde flexibile.
Hemisuccinat de hidrocortizon 100mg).
Cele mai multe studii au avut drept obiectiv chirurgia
5HDFLLJHQHUDOHVHYHUH
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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
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laseri:
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1. Neodium YAG laser emite
nDLQWH GH LQMHFWDUH SDFLHQWXO HVWH SUHYHQLW DVXSUD VHQ]DLei de gust
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SURGXFkQG R FRDJXODUH WHUPLF OD
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VXSUDIDDHVXWXOXLLLPHGLDWVXELDFHQW
timpul urografiei.
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;< o
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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
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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
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3. Laserul Holmium: YAG
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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

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generare a laserului cu un volum
- H[SORUDUHUDGLRL]RWRSLF
relativ redus, sunt deplasabile n sala
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La dispozitivul de producere se
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DGDSWHD] ILEUH FH WUDQVPLW OXPLQD
speciale QXPLWHVXEVWDQHGHFRQWUDVW care ajungnd n rinichi se
laser, care se introduc pe canalele de
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lucru ale endoscoapelor, ajungnd n
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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
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- evitarea FRQVXPXOXL GH OLFKLGH GXOFL VPkQWkQ vQJKHDW DVHPHQHD XQGD GH RF FUHDW OD VSDUJHUHD FDOFXOXOXL HVWH PDL
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- 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
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laser).
pacienii diabetici aflai sub tratament cu metformin.
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 9,(;3255,/((1'2852/2*,&(,0,1,0,19$=,9( XI NGRIJIREA PACIENTULUI UROLOGIC

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- H[DPHQHLPDJLVWLFHUHQDOVLPSOXURJUDILHLYSLHORJUDILH
care trebuie efectuate respectnd normele de asepsie

 

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

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de 6mm);
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x VRQGHOH FX EDORQD VXQW DXWRVWDWLFH DGLF GXS
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foarte mare!
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Etapele cateterismului uretro-vezical:
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Dup efectuarea examenului clinic medicul curant poate face i respectnd normele menionate.

o evaluare a statusului de performa a pacientului n perspectiva unei

intervenii chirurgicale, unul dintre cele mai folosite e scorul de
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Fig.VI.1 - Cateterism uretral
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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
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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
unei bune ngrijiri a pacienilor urologici i nu numai, va aduce mai
trziu n practica clinic importante beneficii pacientului .
Modul n care preia asistenta pacientul, odat ajuns la salon,
ajuta mult la integrarea lui n noua situaie. Cu tact LFDOP, ea trebuie
s prezinte pacientului regulamentul de ordine interioar i s i
explice modul n care va decurge internarea (recoltarea analizelor,
efectuarea ecografiei, urografiei, EKG, consultul preanestezic, etc).
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pacient va depinde ntr-o buna PVXUFkWLJDUHDvQFUHGHULLSHFDUH
pacientul tUHEXLHVRDLEvQHFKLSDFDUHvOYDvQJULML
$VW]LSHEXQGUHSWDWH, nu mai este normal i nici posibil s
se interneze pacieni cu o stare general bun doar pentru a fi
investigai. Toate investigaiile, de la cele mai simple (analize de
snge i urin, etc.) pn la cele mai complexe (CT sau RMN) trebuie
desfaurate la aceast categorie de pacieni n condiii de ambulator,
i, cnd strategia terapeutic s-a conturat, pacientul accept
intervenia i riscurile ei iar comorbiditile sunt bine controlate, se
VWHULO VH SRDWH vQWRDUFH vQ YH]LF IDYRUL]kQG LQIHFLD XULQDU
(conform principiului vaselor comunicante).
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II. Acetazolamida n cazul sondelor Tiemann sau Nelaton care nu sunt

III. Furosemid DXWRVWDWLFH GXS LQWURGXFHUHD ORU vQ YH]LF YRU IL IL[DWH FX ILU GH
IV. Tiazide DLEHQ]LGHOHXFRSODVWGHSHQLV
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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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SDFLHQLL SXUWWRUL GH sond. Le vom pstra pentru a trata
eventalele complicaii infecioase acute ce pot apare (de ex.
epididimita).
3XQFLD YH]LFDO VXSUDSXELDQ un tub de plastic
introdus n vezicprintr-un trocar se utilizeaz cnd cateterizarea
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FDOH IDOV FUHDW SULQ PDQHYUDUH LQWHPSHVWLY, etc.) iar pacientul
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XULQ D DSUXW vQ FRQWH[WXO XQHL SURVWDWLWH DFXWH LDU FDWHWHULVPXO
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antisepsie fiind obligatorii!
3UHJWLUHDSDFLHQWXOXL



 
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7. Anticoagulante
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II. Fenindiona
8. Anticonvulsivante
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9. Antidiabetice orale
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persoanele cu risc crescut la care examinarea nu poate fi urinare cu un endoscop rigid sau flexibil.
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1. Antibiotice Chimioterapice SULQDFHVWHRULILFLLVXQWUHSHUHHVHQLDOHvQVWDELOLrea diagnosticului
a. Aminoglicozide L LPSOLFLW a conduitei terapeutice n multe DIHFLXQL XURORJLFH vQ
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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 (
HYDOXDUHDDGHFYDWDvQWUHJLLXUHWUHLDYH]LFLLXULQDUH2SWLFLOHGH
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


! 
 9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
unor stricturi uretrale, OLSVD XQHL FRODERUUL DGHFYDWH GLQ SDUWHD
pacientului.
,QYHVWLJDLDVHYDIDFe n sala de cistoscopie, medicul fiind
echipat steril (fig.VI.3). $QWLELRSURILOD[LD UHFRPDQGDW FRQVW vQ
DGPLQLVWUDUHD RUDO GH IOXRURFKLQRORQH VDX 7ULPHWRSULP-
6XOIDPHWR[D]ROSHQWUXRGXUDWGHPD[LPGHRUH
Pacientul va fi pus pe masa de cistoscopiH vQ SR]LLH
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
doze mari, discontinue, la repetarea tratamentului cu
5LIDPSLFLQ 3UH]HQD GH DQWLFRUSL L FRPSOH[H LPXQH DWHVW
PHFDQLVPXOLPXQRORJLFFDUHVWODED]DDFHVWHLUHDFLLDGYHUVH
Pentru diminuarea riscului, utilizarea acestora se face
QXPDL SHQWUX FD]XUL ELQH VHOHFWDWH FkQG QX H[LVW R DOW
DOWHUQDWLY 9D IL XUPULW FRUHFW GLXUH]D SHQWUX D VXUSULQGH
PRPHQWXO LQVWDOULL SROLXUHL FD VHPQ DO LQVWDOULL GLVIXQFLHL
UHQDOHvQVRLWGHGHWHUPLQDUHDSHULRGLFDGHQVLWLLXULQDUHL
JLQHFRORJLF'XSEDGLMRQDUHDFXVROXLHDQWLVHSWLF%HWDGLQD
RUJDQHORU JHQLWDOH L D UHJLXQLL SHULQHDOH VH LQWURGXFH SH XUHWU
jelly-DQHVWH]LFRVXEVWDQXOHLRDVFXUROOXEUHILDQW, antiseptic L ncepe tratamentul adecvat al IRA.
anestezic; pensarea penisului pentru 3-5 minute va facilita
contactul cu mucoasa, instalndu-VHDQHVWH]LDORFDO
Q FD]XO SDFLHQLORU GH VH[ PDVFXOLQ VH UHFRPDQG
DQHVWH]LH JHQHUDO VDX UDKLDQHVWH]LH SHQWUX D VH SXWHD UHDOL]a o
HYDOXDUH FLVWRVFRSLF GHWDOLDW 6H LQWURGXFH DSRL SH XUHWU
cisWRVFRSXO L VH SURJUHVHD] OD YHGHUH VSUH XUHWUD SURVWDWLF
evalundu-se aspectul mucoasei uretrale, eventuale stricturi,
tumori, calculi migraL.
 1.
Fig.VI.3. 3R]LLDEROQDYXOXLSHPDVDGHFLVWRVFRSLH

 
monitorizarea clerence-XOXL FUHDWLQLQHL 'DF VH FRQVWDW
GHWHULRUDUHD IXQFLHL UHQDOH VH RSUHWH DGPLQLVWUDUHD L VH
6H YD HYLWD XWLOL]DUHD vQ GR]H PDUL FXUH SUHOXQJLWH L
repetarea tratamentului cu aceste antibiotice.
6XEVWDQHOHGHFRQWUDVWLRGDWHGHWHUPLQDXQDGLQFHOH
PDLIUHFYHQWHIRUPHGHQHIURSDWLHWR[LFPHGLFDPHQWRDVGXS
DPLQRJOLFR]LGH 3ULQFLSDOLL IDFWRUL GH ULVF SHQWUX DSDULLD
acesteia sunt:
1. LQVXILFLHQDUHQDOSUHH[LVWHQW
2. QHIURSDWLDGLDEHWLFFXSURWHLXQXULHPDLPDUHGH
g/24 de ore;
3. mielomul multiplu;
4. transplantul renal;
5. YkUVWDvQDLQWDW
6. HTA;
7. DUWHULRVFOHUR]DSHULIHULF
8. LQVXILFLHQDFDUGLDF
9. GR]HOHPDULFXFRQFHQWUDLHFUHVFXWDVXEVWDQHORU
de contrast;
10. repHWDUHDH[DPLQULORUODLQWHUYDOHVFXUWHGHWLPS
0VXULOHWHUDSHXWLFHFDUHXUPUHVFVSUHYLQ
instalarea nefropatiei sunt:
OLPLWDUHD H[DPHQHORU FX VXEVWDQ GH FRQWUDVW OD
persoanele cu risc crescut;
 ;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
VHSRWUHJVLWRDWHDFHVWH PDQLIHVWULHVWHGHQHIURSDWLLWR[LFH
medicamentoase. Datele epiGHPLRORJLFH UHOHY IDSWXO F -
 GLQ QHIURSDWLL FXQRVF R FDX] WR[LF LDU GLQWUH DFHVWHD
VXQWPHGLFDPHQWRDVHGLQLQVXILFLHQHOHUHQDOHDFXWH
GLDOL]DWHVXQWGHFDX]WR[LF-PHGLFDPHQWRDV
Q SUDFWLFD QHIURORJLF SRVLELOLWDWHD XQHL HWLRORJLL toxic-
PHGLFDPHQWRDVH VH GLVFXW vQ FRQWH[WXO DSDULLHL FHORU GRX
PDULVLQGURDPHQHIURORJLFHUHVSHFWLY,5$L,5&
$QWLELRWLFHOH L VXEVWDQHOH GH FRQWUDVW GHWHUPLQ ,5$
prin mecanisme diferite, toxice directe, imunologice, ischemice
LREVWUXFLHWXEXODU
$,16 SRW GHWHUPLQD DWkW ,5$ FkW L ,5& DFHDVWD GLQ
XUP DSUkQG GXS XWLOL]DUHD PDL DOHV DVRFLDW D
analgezicelor sau la asocierea acestora cu diuretice la bolnavi
FX KHSDWRSDWLL FURQLFH QHIURSDWLL FURQLFH LQVXILFLHQ FDUGLDF
FRQJHVWLY 0HULW UHLQXW L IDSWXO F QHRSOD]LLOH UHQDOH DSDU
PXOW PDL IUHFYHQW OD SDFLHQLL FX QHIURSDWLL DQDOJH]LFH GHFkW vQ
SRSXODLDJHQHUDO
Utilizarea foarte frecvent a antibioticelor impune n
YHGHUHD DSOLFULL XQRU PVXUL FXQRDWHUHD FODVLILFULL
antibioticelor GXSFDOHDGHHOLPLQDUHLGXSQHIURWR[LFLWDWH
'LQWUH DQWLELRWLFHOH FX HOLPLQDUH UHQDO IU UHDFLL
WR[LFH UHLQHP SHQLFLOLQD * SHQLFOLQHOH GH VHPLVLQWH]
9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
$FHDVW PDQHYU H[HFXWDW FX EOkQGHH SHUPLWH
FLVWRVFRSXOXLVSURJUHVH]HvQYH]LF, XQGHYDILH[DPLQDW
- MUCOASA VEZICAL SH WRDW VXSUDIDD HL XUPULQGX-se
eventuale tumori vezicale, aspectul lor (vegetant sau infiltrativ),
ED]D GH LPSODQWDUH QXPUXO SR]LLD ORU UDSRUWDW OD SHUHL FRO
RULILFLLOHXUHWHUDOH6HYRUFRQVHPQDLDOWHPRGLILFULDOHDVSHFWXOXL
mucoasei: edHPSHWHLLSODFDUGHFDOFLILFULHWF
- CALCULI VEZICALI sau fragmente litiazice, notndu-se
QXPUXOIRUPDDVSHFWXOFXORDUHDLGLPHQVLXQLOH
- eventualele cheaguri, fragmente tumorale, FRUSLVWULQL
- ORIFICIILE URETERALE YRU IL DWHQW XUPULWH QRWkQGX-se o
HYHQWXDO SUH]HQ D IUDJPHQWHORU GH FDOFXOL WXPRUL XUHWHUDOH FH
SURHPLQ SULQ OXPHQXO RULILFLXOXL %RPEDUHD H[WUHPLWLL GLVWDOH D
XUHWHUXOXLvQOXPHQXOYH]LFDOVHPQDOHD]SUH]HQDXQXLXUHWHURFHO
9RPXUPULFXDWHQLHLHOLPLQULOHGHXULQGHODQLYHOXORULILFLLORU
ureterale n ncercarea de a stabili sursa unei hematurii. Evacuarea
XQHL PXOH SXUXOHQWH SULQ RULILFLXO XUHWHUDO VHPQDOL]HD] XQ SURFHV
VXSXUDWLY UHQDO FRPXQLFDQW FX FDOHD H[FUHWRULH 3UH]HQD XQXL
oriILFLXXUHWHUDOEHDQWODUJVXJHUHD]H[LVWHQDXQXLUHIOX[YH]LFR-
XUHWHUDOSHSDUWHDUHVSHFWLY
- COLUL VEZICAL YDILH[DPLQDWFXDWHQLHODIHOFDLFHOHODOWH
]RQH XUPULQGX-VH H[LVWHQD ORELORU SURVWDWLFL DVSHFWXO ORU L
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,
clindamicina.
'LQWUH DQWLELRWLFHOH FX HOLPLQDUH UHQDO UHDFLL WR[LFH
frecvente dau: toate aminogicozidele, cefaloridina, meticilina,
ULIDPSLFLQD FLFORVHULQD L VXOIDPLGHOH Q XOWLPLL  GH DQL V-au
GHVFULV LQVXILFLHQH UHQDOH DFXWH JUDYH GXS DGPLQLVWUDUHD vQ

GHVFKLVODSURVWDW
UretrocistoscopLD HVWH R SURFHGXU LQYD]LY L poate fi
DVRFLDW FX LQIHFLL VkQJHUUL UHWHQLH GH XULQ VDX SHUIRUDLH
YH]LFDO 2 LQIRUPDUH FRUHFW D SDFLHQWXOXL FX SULYLUH OD
FRPSOLFDLLOHSRVLELOHHVWHREOLJDWRULH


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Avantajele principale ale cistoscopiei flexibile sunt : $FLXQHWHUDSHXWLF: analog de hormon antidiuretic.
- tolerabilitatea superioDU
- SRVLELOLWDWHDHIHFWXULLvQGHFXELWGRUVDO
- XXULQDDYDQVULLLQVWUXPHQWXOXLvQFRQGLLLOHXQXLFROYH]LFDOvQDOW
- capacitatea de flectare a vrfului endoscopului fapt care permite
YL]XDOL]DUHDvQWUHJLLYH]LFLXULQDUHLLQVSHFLDFROXOXLYH]ical.
Video-uretrocistoscopia permite imaginilor att din
HQGRVFRSLD ULJLG FkW L GLQ FHD IOH[LELO V ILH SURLHFWDWH SH XQ
monitor. Beneficiile acestei tehnici sunt reprezentate de evitarea
FRQWDFWXOXL FX IOXLGH ELRORJLFH vPEXQDWLUHD FRQGLLLORU GH
meQLQHUH D FkPSXOXL RSHUDWRU VWHULO IDFLOLWDUHD GRFXPHQWULL
SURFHGXULL L D SURJUDPHORU GH vQYPkQW SUHFXP L DPHOiorarea
egonomiei chirurgului.
III. ELECTRORE=(&,$75$1685(75$/
5H]HFLDWXPRULLYH]LFDOH sau TUR-9UHSUH]LQWRLQWHUYHQLH
,QGLFDLL HQXUHVLVQLFWXULHGLDEHWLQVLSLGFROLFDUHQDO"
Mod de administrare: VHDGPLQLVWUHD]GHSUHIHUDWODDFHHDL
RU vQDLQWH GH PHVH FRPSULPDWXO QX VH LQJKLWH FL VH WRSHWH
sub limb.
Contraindicatii: $OHUJLH VSHFLILF cardiopatia LVFKHPLF
epilepsia IHPHL JUDYLGH KLSRQDWUHPLH DOWH DIHFLXQL FH
QHFHVLWWUDWDPHQWGLXUHWLFSROLGLSVLDKDELWXDOVDXSVLKRJHQ
LQVXILFLHQDUHQDOVHYHUERDODYRQ:LOOHEUDQG,LE
5HDFLL DGYHUVH IULWDLD mucoasei nazale, cefalee,
FRQMXQFWLYLW
'XS DFHDVW SUH]HQWDUH D DUVHQDOXOXL WHUDSHXWLF FHO
PDLIUHFYHQWXWLOL]DWGHFWUHXURORJDUWUHEXLDGXJDWIDSWXOF
SHQWUX PHGLFDPHQWHOH FX HOLPLQDUH UHQDO PHGLFXO WUHEXLH V
DLEvQYHGHUHDVSHFWH
Nefrotoxicitatea pentru a evita instalarea sau
SUHFLSLWDUHDXQHLGLVIXQFLLUHQDOH
1HFHVLWDWHD DGDSWULL SRVRORJLHL vQ IXQFLH GH
FKLUXUJLFDOHQGRVFRSLFHVWHR continuare a cistoscopiei (pe care YDORDUHDILOWUDWXOXLJORPHUXODUJUDGXOLQVXILFHQHLUHQDOH
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]LFDOILJ9,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*,&
2. DOXORUBICIN
$FLXQHWHUDSHXWLFchimioterapic antineoplazic.
,QGLFDLL WXPRUL YH]LFDOH GXS UH]HFLD HQGRVFRSLF a
acestora.
Mod de administrare: LQVWLODLLLQWUDYH]LFDOH cu 50 mg n 50 ml
VHURLQVWLODLHVSWPkQVSWPkQLGXS785-V.
5HDFLL DGYHUVH locale: polakiurie, hematurie (fenomene de
9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
UH]HFWRVFRSXOXL &KLDU GDF ED]D WXPRULL HVWH vQJXVW OD FHOH
papLODUH QX QH OFRPLP V R WLHP GH OD vQFHSXW ILLQF WXPRUD
HOLEHUDW QX YD SXWHD IL H[WUDV 1X VH IDFH KHPRVWD] GXS
ILHFDUHIUDJPHQWWLDWFLQXPDLFkQGVHvQWkOQHWHXQYDVPDLDFWLY
SH PVXU FH QH DSURSLHP GH ED] /D SHUHWHOH YH]LFDO
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


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

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

acetat.
2DOWVLWXDLHcare poate determina DSDULLDXQHLSHUIRUDLL
Actiune terapeutica: inhibitor puternic al citocromului steroidal
VHvQWkPSOFkQGWXPRUDVHDIOSHSHUHWHOHODWHUDO LODUH]HFLH
VDUH REWXUDWRUXO 'DF DFHVW OXFUX HVWH FXQRVFXW vQDLQWH GH
RSHUDLHVDXUHFXQRVFXWvQFXUVXOFLVRVFRSLHLSRDWHILSUHYHQLWSULQ
3&<3LQKLEkQGDVWIHOHQ]LPDFDUHGHWHUPLQVLQWH]D
WHVWRVWHURQXOXLDWkWvQJODQGHOHVXSUDUHQDOFkWLvQWHVWLFXO
,QGLFDLL WUDWDPHQWXO FDQFHUXOXL GH SURVWDW PHWDVWDWLF
rezistent la castrare n asociere cu analogi de LH-RH.
modificarea formei de anestezie, excitarea obturatorului putnd
ILSUHYHQLWSULQDQHVWH]LHJHQHUDOFXLQWXEDLHRUR-traheaO
5H]HFLDDGHQRPXOXLGHSURVWDW sau TUR-P.
Se SUDFWLFvQJHQHUDOSHQWUXDGHQRDPHGHSkQOD-60
Mod de administrareGR]DUHFRPDQGDWHGHPJFS
FD GR] XQLF ]LOQLF 7UHEXLH DGPLQLVWUDW FX GR]H PLFL GH
prednisol sau prednisolol ( 10 mg/zi).
&RQWUDLQGLFDLL KLSHUVHQVLELOLWDWH OD VXEVWDQD DFWLY
iQVXILFLHQDKHSDWLFVHYHUFODVD&&KLOG-Pugh)
5HDFLL DGYHUVH DQHPLH GLVIXQFLH VH[XDO KLSHUWHQVLXQH
DUWHULDOKLSRSRWDVHPLHUHWHQLHGHOLFKLGHHGHPHSHULIHULFH
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
ntr-o cavitate. )UDJPHQWHOH GH HVXW UH]HFDW VH vQGHSUWHD] FX
DFHHDLVHULQJ*X\RQ'DFUPkQIUDJPHQWHGHHVXWvQYH]LF
ele pot dHWHUPLQDFRPSOLFDLLUHWHQLHGHXULQODVFRDWHUHDVRQGHL
LQIHFLLSHUVLVWHQWHIRUPDUHGHFDOFXOL
Fig.VI.5 5H]HFLD HVXWXOXLSURVWDWLF

 
*XHULQ YLL 0\FREDFWHULXP ERYLV OLRILOL]DW 7 mg
imunostimulent BCG liofilizat; solvent (lichid de suspensionare
Sautan diluat 3 ml).
$FLXQHWHUDSHXWLFimunomodulator.
,QGLFDLL LPXQRVWLPXOHQW GXS LQWHUYHQLL FKLUXUJLFDOH SHQWUX
WXPRUL PDOLJQH GH YH]LFL XULQDUH GH VkQ GLJHVWLYH EURQLFH
laringiene, melanom malign, tratamentul leucemiilor.
Mod de administrare: recomandat la 7- ]LOH GXS UH]HFLH
HQGRVFRSLF FX VXVSHQVLD UHFRQVWLWXLW GLQ FRQLQXWXO D  ILROH
(2 ml) care se dLOXHD] FX  PO VHU IL]LRORJLF VWHULO
LPXQRVWLPXOHQWXO WUHEXLH PHQLQXW vQ YH]LF WLPS GH  K
SURJUDPXOGHHIHFWXDUHDLQVWLODLLORUVSWPkQDOvQSULPHOH
VSWPkQL DSRL OXQDU SkQ OD  OXQL GXS FDUH VH IDFH R
LQVWLODLHSHDQ
&RQWUDLQGLFDLLdeficit imun congenital sau dobndit, serologie
+,9 SR]LWLY WXEHUFXOR] VDX KHSDWLW DFWLY VDX vQ
DQWHFHGHQWH LQIHFLL DOH WUDFWXOXL XULQDU SkQ OD QHJDWLYDUHD
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5HDFLLDGYHUVH loco-regionale: polakiurie, disurie, hematurie,
SURVWDWLWJUDQXORPDWRDVHSLGLGLPLW
,QWHUDFLXQLPHGLFDPHQWRDVHtratament cu corticosteroizi sau
LPXQRVXSUHVRDUH LQIOXHQHD] UVSXQVXO OD LPXQRVWLPXOHQW
BCG - ULVFLQIHFLL%&*JHQHUDOL]DWHWUDWDPHQWFRQFRPLWHQWVDX
n antecendente cu un imunomodelator poate avea efecte
negative asupra imunostimulului BCG.
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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
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&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
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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.
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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.
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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 $GLF HVWH GH SUHIHUDW R
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0DMRULWDWHD SDFLHQLORU FX DGHQRFDUFLQRP GH SURVWDW VH
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,QGLFDLL FDQFHU GH SURVWDW PHWDVWD]DW FDQFHU GH SURVWDW
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stadiul local avansat.
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LQWHUYHQLHL UDGLFDOH HVWH GHSLW ILLQG QHFHVDU LQWHUYHQLD
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SURVWDW GDU HVWH PDL SXWLQ VkQJHUkQG VL IU SUHWHQLH GH D
DMXQJHODFDSVXO6HLQVWDOHD]RVRQG)ROH\HYHQWXDOFXGXEOX
FXUHQWFDUHVHPHQLQH]LOH
,QFL]LD WUDQVXUHWUDO GH SURVWDW (ITUP) sau incizia
2.ELIGARD /HXSURUHOLQ
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LQMHFWDELOPJPJPJ
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hormonodependent, n stadiu avansat.
Mod de administrare: (OLJDUGVHDGPLQLVWUHD] sub forma unei
sinJXUH LQMHFLL VXEFXWDQDWH 6ROXLD LQMHFWDW IRUPHD] XQ
GHSR]LW VROLG FX HOLEHUDUH SUHOXQJLW FDUH YD HOLEHUD FRQWLQXX
DFHWDWGHOHXSURUHOLQ
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GnRH, Eligard nu scade valorile plasmatice de testosteron mai
colului vezical LPSOLF VHFLRQDUHD SULQ SURVWDWD REVWUXFWLY FX XQ
FXUHQWHOHFWULFGHvQDOWIUHFYHQIRORVLQGRDQV special.
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R FRQVHFLQ D VFGHULL FRQFHQWUDLHL SODVPDWLFH D
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FROXO YH]LFDO SkQ OD  FP SUR[LPDO GH YHUXPRQWDQXP (VWH
SRVLELO R VkJHUDUH SRVWRSHUDWRULH YDULDELO FD LQWHQVLWDWH PRWLY
SHQWUX FDUH LQWHUYHQLD HVWH XUPDW GH LQVHULD XQXL FDWHWHU
uretrovezical dotat cu sLVWHPGHLULJDLHYH]LFDOSHQWUXRSHULRDG
testosteronului HGHPH SHULIHULFH HPEROLH SXOPRQDU
SDOSLWDLL PLDOJLL KLSRWRQLH PXVFXODU IULVRDQH GLVSQHH YHUWLM
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pielii.
,,,$QWDJRQLti LH-RH
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
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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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este de 5 mg de 2-3 ori pe zi
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nivel.
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activarea receptorilor beta-DGUHQHUJLFL GLQ PXVFXODWXUD QHWHG
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receptorilor beta 3-adrenergici determinnd relaxarea
musculaturii netede la nivelul vezicii urinare.
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IUHFYHQHL PLFLRQDOH FUHVFXWH LVDX DO LQFRWLQHQHL SULQ
LPSHULR]LWDWHPLFLRQDO
Mod de administrare: 'R]D UHFRPDQGDW HVWH GH  PJ R
GDWSH]LFXVDXIUDOLPHQWH
x Calcul bazinetal voluminos (peste 2-3cm) VDX OLWLD]
PXOWLSOORFDOL]DWvQED]LQHW
x Calcul coraliform (NLP singur sau NLP + ESWL);
x &DOFXODQFODYDWvQMRQFLXQHDSLHOR-XUHWHUDOFXULQLFKLPXW
urografic;
x /LWLD] UHQDO XQLF VDX PXOWLSO VHFXQGDU VWHQR]HL
FRQJHQLWDOHVDXFkWLJDWHDMRQFLXQLLSLHOR-uretrale.
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a) Absolute: WXOEXUULGHFRDJXODUHFHSUHGLVSXQODVkQJHUUL
JUDYHFRQWUROXOSHUDPHWULORUFRDJXOULLHVWHREOLJDWRULXFD
&RQWUDLQGLFDLL KLSHUVHQVLELOLWDWHODVXEVWDQDDFWLY LSHQWUX(6:/856VDXWUDWDPHQWFKLUXUJLFDO
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urticarie.
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1. ZOLADEX *RVHUHOLQ
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plasmatice ale testosteronului ating valori similare cu cele UHJXOL DIHFLXQLOH FDUGLR-vasculare aflate sub tratament cu
LQGXVHGHFDVWUDUHDFKLUXUJLFDO anticoagulante (Trombostop), pot beneficia de tratament
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 DH]DUHDSDFLHQWXOXL vQSR]LLHJLQHFRORJLF
 uretrocistoscopia care va vizualiza orificiul ureteral de
SDUWHD FDOFXOXOXL GDU VH YRU XUPUL L DOWH SRVLELOH OH]LXQL
asociate - ex: tumori vezicale);
VHYHUEROQDYLVXEKHPRGLDOL]
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WXOEXUULRFXODUH
2. Tolterodina
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mg tolterodina
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IDGHFHLGHODQLYHOXOJODQGHORUVDOLYDUH
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DOEDVWUX GH PHWLOHQ SHQWUX YL]XDOL]DUHD L GHVWLQGHUHD
sistemului pielo-caliceal;
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FX SDUWHD SH FDUH VH DIO FDOFXOXO VSUH RSHUDWRU 6H
foloseste si pozitia de decubit dorsal in anumite situatii.
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peste pacient sunt urPWRULLSDL YUVWXUL
 SXQFLD FDOLFHDO (VWH SXQFLRQDW GH RELFHL XQ FDOLFH
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polakiurie si PLFLXQL LPSHULRDVHLQVRLWHGHLQFRQWLQHQ
Mod de administrare: 'R]D UHFRPDQGDW HVWH GH  PJ GH 
RUL SH ]L FX H[FHSLD SDFLHQLORU FX GLVIXQFLL KHSatice, la care
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UHWHQLHXULQDU; forme necontrolate de glaucom cu unghi nchis;
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megacolon toxic.
5HDFii adverse: XVFFLXQHD JXULL GLVSHSVLH  VFGHUHD
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3. Oxibutinina
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aceasta se umple.
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 LQWURGXFHUHDILUXOXLJKLGSULQDFXOGHSXQFLH. Firul ghid
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2. Avanafil
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Prezentare farmaceutica: coprimate cu 50 mg substanta
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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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 9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9( ;0(',&$0(17()2/26,7(135$&7,&$852/2*,&

FRQLQkQGHWDPVLODWJFXWLLFXEXF
$FLXQHWHUDSHXWLF$QWLKHPRUDJLFSULQPHQLQHUHDLQWHJULWLL
FDSLODUHORU UHGXFH WLPSXO GH VkQJHUDUH IU V DIHFWH]H
coagularea.
,QGLFDLL Profilaxia si tratamentul hemoragiilor prin ruptura de
vase mici vQSkQ]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
NLP supine :
n YDULDQWD FODVLF SHQWUX SUDFWLFDUHD 1/3 SDFLHQWXO HVWH
plasat n decubit ventral.
Q XOWLPLL DQL D FkWLJDW WHUHQ YDULDQWD GH DERUGDUH
SHUFXWDQDW D ULQLFKLXOXL OD SDFLHQWXO SODVDW vQ GHFXELW GRUVDO
(tehnica Valdivia), ce s-a dovedit a fi la fel de siguULHILFLHQWFD
YDULDQWDFODVLF
$YDQWDMHOH SR]LLHL GH GHFXELW GRUVDO VXQW WLPSXO RSHUDWRU
PDL VFXUW SRVLELOLWDWHD HIHFWXULL VLPXOWDQH D XUHWHURVFRSLHL
UHWURJUDGH VDX D XQHL LQWHUYHQLL ODSDURVFRSLFH L FRQIRUWXO VSRULW
SHQWUXSDFLHQWRSHUDWRULanestezist.
Prezentare farmaceutica: GLVSRQLELOVXEIRUPGHFRPSULPDWH
filmate de 2,5 PJPJPJLPJ
Actiune terapeutica: inhibitor selectiv, reversibil al
fosfodiesterazei tip 5 (PDE5) cu specificitate pentru guanozin
monofosfatul ciclic (cGMP).
Indicatii: 7UDWDPHQWXO GLVIXQFLHL HUHFWLOH OD EUEDLL DGXOL
Pentru ca tadalafil V ILH HILFDFH HVWH QHFHVDU SUH]HQD
VWLPXOULLVH[XDOH
Mod de administrare: IQ JHQHUDO GR]D UHFRPDQGDW HVWH GH
PJDGPLQLVWUDWvQDLQWHGHDFWLYLWDWHDVH[XDODQWLFLSDWL
LQGLIHUHQW GH LQJHVWLD GH DOLPHQWH /D SDFLHQLL OD FDUH WDGDODILO
10 mg nu produce un efect adecvat, se poate ncerca
administrarea a 20 mg. Medicamentul se poate administra cu
FHOSXLQPLQXWHvQDLQWHGHDFWLYLWDWHDVH[XDO
Contraindicatii: $OHUJLH OD WDGDODILO SDFLHQLL FX LQIDUFW
miocardic in ultimile 90 de zile, SDFLHQLL FXDQJLQLQVWDELOVDX
FX DQJLQ FDUH DSDUH vQ WLPSXO DFWXOXL VH[XDO paciHQLL cu
LQVXILFLHQ FDUGLDF &ODVD  1HZ <RUN +HDUW $VVRFLDWLRQ
1<+$ VDX PDL PDUH DSUXW vQ XOWLPHOH  OXQL SDFLHQLL cu


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

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]LvQIXQFLHGHJUDYLWDWHvQXUJHQHLQWUDYHQRV
foarte lent, 2-PJ]LvQLQWR[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-PJvQERDODKHPRUDJLF'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


! 
 9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
ORPEDU 3RDWH DYHD FDUDFWHU WHPSRUDU VDX GHILQLWLY L vQ
majoritatea cazurilor se H[HFXWvQFRQGLLLGHXUJHQ.
,QGLFDLL.
163WHPSRUDU VHLQGLFvQXUPWRDUHOHVLWXDLLSDWRORJLFH
- n LQVXILFLHQD UHQDO DFXW REVWUXFWLY atunci cnd
cateterismul ureteral nu este posibil;
- n FROLFD UHQDO KLSHUDOJLF UHIUDFWDU OD WUDWDPHQWXO
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
$FLXQHWHUDSHXWLFLQKLEDUHPDUFDW a factorului X ; DFLXQHD
GHLQKLEDUHDWURPELQHLHVWHVODEVDXQXO; efect inhibitor mai
VODEDVXSUDDFWLYULLLDJUHJULLSODFKHWHORU
,QGLFDLL profilaxia trombozelor venoase L D HPEROLLORU GH
FDX] PHGLFDO VDX FKLUXUJLFDO WUDWDPHQWXO WURPER]HL
YHQRDVH SURIXQGH DFXWH L D HPEROLHL SXOPRQDUH SUHYHQLUHD
FRDJXOULL n circuitul extracorporeal n timpul hemodializei n
LQVXILFLHQD UHQDO DFXW VDX FURQLF DQJLQD LQVWDELO L
infarctul miocardic non Q.
Mod de administrare: GR] SURILODFWLF VH DGPLQLVWUHD]
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
LPSRUWDQWHKLSHUSRWDVHPLHDFLGR]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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 ;0(',&$0(17()2/26,7(135$&7,&$852/2*,& 9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(

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.,
DQJLRFDUGLRJUDILLDRUWRJUDILLDUWHULRJUDILHFHUHEUDO
Mod de administrare: 'R]D DGPLQLVWUDW HVWH LQ IXQFLH GH
WLSXO GH H[DPLQDUH YkUVW JUHXWDWH GHELWXO FDUGLDF L VWDUHD
JHQHUDO D SDFLHQWXOXL FkW L GH WHKQLFD XWLOL]DW DVWIHO SHQWUX
- FX XQ DF  * PP L VXE FRQWURO IOXRURVFRSLF VH
SXQFLRQHD]JUXSXOFDOLFHDOLQIHULRUSRVWHULRU
- GXSVFRDWHUHDPDQGUHQXOXLDFXOXLVHH[WHULRUL]HD]XULQDFX
urografie 270/320 mgI/ml 40-80 ml, flebografie 270 mgI/ml 50-
150 ml/mb. inf., CT corp 270/320 mgI/ml 75-150 ml . Doza de
270 mg I/ml este recomandata in cele mai multe cazuri.
&RQWUDLQGLFDLL 7LUHRWR[LFR] PDQLIHVW LQVXILFLHQ FDUGLDF
GHFRPSHQVDW
5HDFLL DGYHUVH VHQ]DLH GH FDOGXU GH UHFH VDX GXUHUH OD
ORFXO LQMHFWULL WXOEXUUL GH YHGHUH FHIDOHH JUHDD YUVWXUL L
WXOEXUUL GH JXVW 3RW DSUHD GH DVHPHQHD UHDFLL FXWDQDWH
prurit, parosmie, angioedem si simptome respiratorii.
XI. ANTICOAGULANTE
1. HEPARINE FXPDVPROHFXODUPLF SR]LLRQDUHDFRUHFWDQHIURVWRPLHL
3UH]HQWDUH IDUPDFHXWLF VHULQJL SUHvQFUFDWH FX R GR] de
FRORUDQWGHFLDYHPRSXQFLHFRUHFWLVHLQVHUSHDFXQILUJKLG
SkQvQVLVWHPXOSLHORFDOLFHDOVDXXUHWHU
- VXE FRQWURO IOXRURVFRSLF L SH ILUXO JKLG VH SUDFWLF GLODWDLD
traiectului cu dilatatoare flexibile de teflon 5-7-9-11 Ch;
- VH LQVHU VRQGD GH QHIURVWRPLH  &K vQ VLVWHPXO
pielocaliceal, se extrage firul ghid;
- H[WHULRUL]DUHD GH XULQ-contrast-FRORUDQW SH VRQG  L
HYLGHQLHUHD IOXRURVFRSLF D EXFOHL VRQGHL vQ VLVWHP FRQILUP

- IL[DUHDVRQGHLFXILUHGHDODSLHOH
DQWLFRDJXODQW(12;,3$5,1 POPJ)5$;,3$5,1
0,3 ml 36 mg sau 2850 UI; CLIVARIN 0,25 ml 13,8 mg,
sau 1750 UI; INNOHEP 0,3 ml 20,83 mg 3500UI.

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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,POILROHIODFRDQH
- GHSR]LLRQDUHDQHIURVWRmiei. DPOPOPOVDXPOVROLQMFRLQkQG
ngrijirea nefrostomiei6XSUDYHJKHUHDLPHGLDWDSDFLHQWXOXL FRUHVSXQ]kQGDPJ,POILROHIODFRDQH 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
drenajul urinar constituit ne asteptam la o tendinta de normalizare
a functiei renale.
6HLPSXQLFkWHYDPVXULGHPRQLWRUL]DUHORFDO KLSRWHQVLXQH RUWRVWDWLF VHQ]DLH GH FDOG UHDFLL DOHUJLFH
- FRQWUROXO SOJLL RSHUDWRULL D DQFRUDMXOXL VRQGHL L D
pansamentului, existind posibilitatea infiltrarii pansamentului cu
urina in cazul depozitionarii/infundarii sondei.
- FRQWUROXODVSHFWXOXLXULQLLGHRELFHLVHOLPSH]HWHvQ-
XURORJLHLODPLHORJUDILH
0RG GH DFLXQH SHQWUX XURJUDILL VH SRW IRORVL ILROH  L
-100 ml, maxim 200 ml pentru adult administrat i.v.
5HDFLL DGYHUVH FHIDOHH JUHD YUVWXUL GLVSQHH
&RQWUDLQGLFDLL SUXGHQ VDX HYLWDUHD XWLOL]ULL OD SDFLHQLL FX
UHDFLL QHGRUite la iod n antecendente, la alergici, astmatici; la
SDFLHQLL FX LQVXILFLHQ KHSDWR-UHQDO JUDY SUXGHQ vQ
LQVXILFLHQ KHSDWLF VHYHU LQVXILFLHQ UHQDO PRGHUDW
VHYHU LQVXILFLHQ FDUGLDF EROL VLVWHPLFH GLDEHW PLHORP
multiplu; dezechilibrele hidroelectolitice trebuie corectate;
RUHGXSPDQHYU LQWHUIHUFXWHVWXOFXLRGUDGLRDFWLY-3 luni.

- FRQWUROXOGLXUH]HLSHVRQGH[LVWLQGULVFXOXQHLHYHQWXDOH 3. ULTRAVIST:
FROPDWDULFXFKHDJXULVDXGRSXULGHSXURL 3UH]HQWDUH IDUPDFHXWLF  IODFRDQH  PO VRO LQM DSRDV
FRQLQkQG ,RSUDPLG  JPO 8OWUDYLVW ; Iopramid 0,623
 g/ml (Ultravist 300); Iopramid 0,769 g/ml (Ultravist 370); timpul
 !
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dismenoree. Sonda de QHIURVWRPLHWHPSRUDUVHVXSULPvQPRPHQWXOvQFDUH

Mod de administrare: oral 1 cpx3-]L LQM  ILRO x 2-3 / zi la
tractul urinar este permeabil. n cazul nefrostomiei definitive sonda
nevoie
&RQWUDLQGLFDLL hipersensibilitate la Ketorolac, ulcer gastro- )ROH\ VH VFKLPE SHULRGLF OD OXQL VDX PDL GHYUHPH GDF VH
GXRGHQDO DFWLY WXOEXUUL DOH KHPDWRSRH]HL GH HWLRORJLH FROPDWHD]
QHFXQRVFXW ,5 VHYHU FRSLL VXE  DQL WULPHVWUXO DO ,,,-lea
GH VDUFLQ WUDYDOLX DOptare; SUHFDXLL DVWP EURQLF
antecendente de ulcere gastroduodenale, Boala Crohn, VI. URETEROSCOPIA
KLSHUWHQVLXQH DUWHULDO GLVFUD]LL VDQJXLQH GLDEHW ]DKDUDW
5HDFLL DGYHUVH JUHD YUVWXUL GLDUHH HSLJDVWUDOJLL 8UHWHURVFRSLD UHSUH]LQW R LQWHUYHQLH HQGRVFRSLF FH
VkQJHUULGLJHVWLYHHUXSLLFXWDQDWHGHUPDWLWH[IROLDWLY SUHVXSXQHLQVSHFWDUHDXUHWHUXOXLFXDMXWRUXOXUHWHURVFRSXOXLGDUL
FHIDOHHYHUWLMVRPQROHQQHIULWLQWHUVWLLDOWURPERFLWRSHQLH
anemie, hiperglicemie. tratamentul afecLXQLORU DVWIHO GLDJQRVWLFDWH calculi, tumori,
,QWHUDFLXQL PHGLFDPHQWRDVH asocierea cu alte AINS sau stenoze) situate la acest nivel.
glucocorticoizi ULVF GH VkQJHUDUH GLJHVWLY  DVRFLHUHD FX
DQWLFRDJXODQWH L DQWLDJUHJDQWH FUHWH ULVFXO GH VkQJHUDUH ,QGLFDLLOHXUHWHURVFRSLHL
DVRFLHUHD FX ,(&$ ULVF GH LQVXILFLHQ UHQDO DFXW FUHWH $ ,QGLFDLL GLDJQRVWLFH evaluarea unui "defect de
FRQFHQWUDLDSODVPDWLFDGLJR[LQHLLULVFXOHIHFWHORUWR[LF
3.DICLOFENAC:
3UH]HQWDUHIDUPDFHXWLFdrajeuri 50 mg; sup 100 mg.
$FLXQH WHUDSHXWLF antiinflamator, antalgic L DQWLSLUHWLF GLQ
clasa AINS nesteroidiene.
,QGLFDLL SROLDUWULWD UHXPDWRLG VSRQGLODUWULWD DQFKLORSRHWLF
XPSOHUH LPDJLQH ODFXQDU vQFRQMXUDW GH VXEVWDQ GH FRQWUDVW
OD QLYHOXO XUHWHUXOXL SH XURJUDILHXUHWHURSLHORJUDILH UHWURJUDG
evaluarea unei hematurii macroscopice unilaterale; identificarea
XQHLWXPRULXURWHOLDOHvQFD]GHFLWRORJLHXULQDUVHOHFWLYSR]LWLY
DIHFLXQL UHXPDWLFH H[WUDDUWLFXODUH FROLFL QHIUHWLFH VWUL FX XURJUDILH QRUPDO  ELRSVLD IRUPDLXQLL WXPRUDOH OD YHGHUH
LQIODPDWRULL GXUHURDVH SRVWRSHUDWRU SRVWWUDXPDWLFH LQIODPDLL VXSUDYHJKHUHD HQGRVFRSLF GXS XQ WUDWDPHQW FRQVHUYDWRU
dureroase vQVIHUDSHOYLQ
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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
SUXULWVHQ]DLHGHDUVXUWHQHVPH  vQGHSUWDUHD FDOFXOLORU XUHWHUDOL vQ VSHFLDO FHL XUHWHUDOL
&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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FUHWH ULVFXO GH VkQJHUDUH GLJHVWLY L D XOFHUXOXL FUHWH
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IXURVHPLGXOXLLDPHGLFDLHLDQWLKLSHUWHQVLYH
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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
XUHWHUDOFHV-a rupt n ureter).
&RQWUDLQGLFDLLOH85(7(526&23,(,856 1. VIMOVO
3UH]HQWDUH IDUPDFHXWLF: comprimate cu eliberare PRGLILFDW
Sunt similare cu cele ale nefrolitotomiei percutane, pe FHFRQLQQDSUR[HQPJVLHVRPHSUD]ROPJ
care le reamintim succint: $FLXQH WHUDSHXWLF naproxenul este un antiiflamator
QHVWHURLGLDQ FH UHGXFH GXUHUHD VL LQIODPDLD vQ WLPS FH
&RQWUDLQGLFDLL DEVROXWH WXOEXUUL GH FUD] VDQJXLQ SDFLHQW HVRPHSUD]ROXO UHGXFH VHFUHLD DFLG JDVWULF DVWIHO DMXW OD
FRPDWRVQHFRRSHUDQWVDUFLQ reducerea riscului de aSDULLH D XOFHUXOXL OD SDFLHQLL OD FDUH VH
administreaza AINS.
&RQWUDLQGLFDLL UHODWLYH 7%& DFWLY LQIHFLL nespecifice netratate, Indicatii FROLFD QHIUHWLF DUWUR]D SROLDUWULWD UHXPDWRLG
tratament prelungit cu anticoagulante, diabet zaharat VSRQGLOLWDDQFKLOR]DQW
Mod de administrare: Un comprimat la 12 ore
GHFRPSHQVDW DIHFLXQL FDUGLR-respiratorii decompensate, ulcer Contraindicatii: alergie la naproxen sau esomeprazol,
GXRGHQDO vQ ID]D DFWLY +7$ QHFRQWURODW UHLPSODQWDUH XUHWHUR- WUDWDPHQW FX DWD]DQDYLU VL QHOILQDYLU IHPHL JUDYLGH SDFLHQL
FXQRVFXLFXXOFHUJDVWULF
YH]LFDOvQDQWHFHGHQWHOREPHGLDPSURVWDWLFYROXPLQRVFDUHIDFH 5HDFLL DGYHUVH FHIDOHH IDWLJDELOLWDWH VHQ]DLH GH VHWH
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).
5HDFLL DGYHUVH HUXSLL FXWDQDWH IHEU DOHUJLF DWUDOJLL
-protezarea ureterului cu sonda "JJ". 'DF SUHOXFUDUHD VDXL
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.
SURWURPELQHL 1X VH DVRFLD] FX XULFR]XULFH SHQWUX F FUHVF
HOLPLQDUHDGHDOORSXULQRO1XVHDVRFLD]FXDPSLFLOLQD risc de
UHDFLL FXWDQDWH $VRFLHUHD FX FORUSURSDPLGH SRDWH IDYRUL]D
UHDFLLKLSRJOLFHPLFHSUHOXQJLWHPDLDOHVODSDFLHQLLFX,5
Asocieri medicamentoase: cu alcalinizante urinare n
tratamentul litiazei urice.

VIII. ALCANIZANTE URINARE

URALYT U:
3UH]HQWDUHIDUPDFHXWLFflacoane JFRQLQkQGJUDQXOH
RUDOH GH KLGURJHQRFLWUDW GH SRWDVLX L VRGLX  OLQJXUL
dozatoare + calendar de control + hrtie indicator).
$FLXQH WHUDSHXWLF : alcanizarea urinii, favoriznd dizolvarea
FDOFXOLORUGHDFLGXULFLSUHYHQLUHDUHIDFHULLORU Fig.VI.7 Introducerea ureteroscopului n ureter
,QGLFDLL OLWLD]D XULF; tratament adjuvant al litiazei urinare


 
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;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
,QGLFDLL: tratamemtul simptomelor moderate pna la severe ale
+%3UHGXFHUHDULVFXOXLGHUHWHQLHDFXWGHXULQLDQHFHVLWLL
LQWHUYHQLHLFKLUXUJLFDOHODSDFLHQLLFX+%3
Mod de administrare: RUDORFDSVXOSH]L
&RQWUDLQGLFDLL IHPHL FRSLL DGROHVFHQL SDFLHQL FX
FRQWUDLQGLFDLLOH8565
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SULQ WUHFHUHD XUHWHURVFRSXOXL OD YHGHUH SH JKLG (HFXO DFHVWHL
YDULDQWHLPSXQHQHIURVWRPLDSHUFXWDQ
-0LJUDUHD FDOFXOXOXL vQDSRL SH XUHWHU GDWRULW PDQHYUHORU VDX
fluxului de lichid). DDF QX SRDWH IL JVLW L UH]ROYDW SULQ
XUHWHURVFRSLH WUHEXLH V DYHP vQ YHGHUH FHOHODOWH RSLXQL
terapeutice.
-/H]LXQL DOH PXFRDVHL XUHWHUDOH SHUIRUDUHD XUHWHUXOXL L FKLDU
LHLUHDFDOFXOXOXLGLQXUHWHUSULQEUHDFUHDW
-5XSHUHD L GH]LQVHULD XUHWHUXOXL QXPLW L VWULSSLQJ XUHWHUDO
KLSHUVHQVLELOLWDWH OD GXWDVWHULG WDPVXORVLQ VDX RULFDUH GLQ
H[FLSLHQL SDFLHQL FX DQWHFHGHQWH GH KLSRWHQVLXQH RUWRVWDWLF
VDX FHL FX LQVXILFLHQD KHSDWLF VHYHU SDFLHQL OD FDUH VH
SUHFRQL]HD]RLQWHUYHQLHFKLUXUJLFDOSWFDWDUDFW
5HDFLL DGYHUVH HMDFXODUH UHWURJUDG DIHFWH] caracteristicele
VSHUPHLODEUEDLLVQWRLVFGHUHDOLELGRXOXLDPHHOLPULUHD
LVHQVLELOLWDWHODQLYHOXOVkQLORU
VI. ANTISPASTICE
1. PAPAVERINA:
3UH]HQWDUH IDUPDFHXWLF cp 100 mg; fiole - 1 ml = 40 mg
SDSDYHULQ; PO PJSDSDYHULQ
$FLXQH WHUDSHXWLF: vasodilatator L DQWLVSDVWLF SULQ DFLXQH
SULQDFLXQHGLUHFWSHPXVFXODWXUDQHWHG
,QGLFDLL FROLFL ELOLDUH LQWHVWLQDOH FROLFL QHIUHWLFH WXOEXUUL
GXS LQWHUYHQLD FODVLF SHQWUX YDULFHOH PHPEUHORU LQIHULRDUH
DSDUH PDL DOHV GDF VH IRUHD] H[WUDJHUHD XQHL VRQGH 'RUPLD
vQFUFDWFXXQFDOFXOYROXPLQRV
-&RPSOLFDLL VHSWLFH GDF XULQD GH GHDVXSUD REVWDFROXOXi era
LQIHFWDWLSURWHFLDDQWLELRWLFQXV-DIFXW
-Dureri lombare, hematurie, sunt probleme ce apar mai ales
postoperator. Postoperator tardiv s-DX GHVFULV FRPSOLFDLL GH FDUH
WUHEXLHVLQHPVHDPDreflux vezico-ureteral; stenoze ureterale.
,QGLFDLLOHLFRQWUDLQGLFDLLOH856
FLUFXODWRULL LQWHVWLQDOH GH QDWXU VSDVWLF VGU 0HQLHUH VGU
DQJLQRVVSDVPSLORULFFRQVWLSDLHVSDVWLF
Mod de administrare: oral 1 cp x 3-5 / zi la nevoie; i.m., i.v. 1-2
fiole(ml) x 2-3/zi la nevoie.
5HDFLL DGYHUVH n administrare i.v. aritmii L EORF
atrioventricular, colaps, deprimare respiratorie; la doze mari:
VRPQFRQVWLSDLLDPHHOLFHIDOHHVXGRUDLH
&RQWUDLQGLFDLLforma inj. cu bloc atrioventricular, hipertensiune
intracranianSUXGHQvQJODXFRPLDGHQRPGHSURVWDW
,QWHUDFLXQL PHGLFDPHQWRDVH QX VH DVRFLD] cu -DJRQLWL
ULVF FUHVFXW GH DULWPLL SDSDYHULQD FUHWH HIHFWXO KLSRWHQVLY DO
medicamentelor antihipertensive.
2.NO-SPA: VXEVWDQD DFWLY clorhidrat de GRWUDYHULQ
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
 
 ;0(',&$0(17()2/26,7(135$&7,&$852/2*,& 9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(

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
SDOSLWDLL
Mod de administrare: 6H DGPLQLVWUHD] FkWH R FDSVXO pe zi
GXSPLFXOGHMXQ
,QWHUDFLXQLFXDOWHPHGLFDPHQWH administrarea FRQFRPLWHQW
ORPEDULUH]ROYDVLWXDLDDVWIHO vQFkWXUHWHURVFRSLDDQWHURJUDGL-
a restrns mult aria de aplicare.
$FHDVW SURFHGXU IRORVHWH XQ WUDLHFW SHUFXWDQ OD IHO
FD L QHIUROLWRWRPLD SHUFXWDQDW 1/3 Q FRQVHFLQ se
FX DOL DOID-EORFDQL SRDWH FRQGXFH OD DSDULLD HIHFWHORU
hipotensive. SVWUHD] DFHOHDL FRQWUDLQGLFDLL FD OD 1/3 FX PHQLXQHD F
DERUGXOVHIDFHSULQFDOLFHOHPLMORFLXLDUFDOFXOXOWUHEXLHVILHPDL
,9,1+,%,725,'($/)$5('8&7$=
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$= 
ALFABLOCANT -GLODWDLDWUDLHFWXOXLODIHOFDOD1/3
-LQWURGXFHUHD QHIURVFRSXOXL L HIHFWXDUHD QHIURVFRSLHL FDUH
DUODART
LGHQWLILF HYHQWXDOD OLWLD] DVRFLDW ED]LQHWDO L MRQFLXQHD SLHOR-
Prezentare IDUPDFHXWLFCapsule FRQLQkQG 0,5mg
dutasterida si 0,4 mg tamsulosin. 
! 
 9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
XUHWHUDO
-LQWURGXFHUHD XUHWHURVFRSXOXL SULQ WHDFD QHIURVFRSXOXL L DFFHVXO
acestuia pe ureter (fig.VI.8);
Fig.VI.8 Introducereanefroscopului prin teaca nefroscopului
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
$FLXQH WHUDSHXWLF analgezic prin metamizol; antispastic
muscXORWURS L DWURSLQLF SULQ SLWRIHQRQ L IHQLSLSUDPLG
,QGLFDLLFROLF QHIUHWLFFROLF ELOLDUGLVNLQH]LHELOLDUFROLWH
FLVWDOJLLGLVPHQRUHHPLJUHQHLDOWHIRUPHGHFHIDOHH
Mod de administrare: - oral 2 cp de 1-3 ori / zi; intrarectal 1-3
sup/zi; i.m, i.v. 1-3 fiole/zi.
&RQWUDLQGLFDLLalergici la metamizol LDOLSLURVROL antecedente
GH DJUDQXORFLWR] OD DPLQRIHQD]RQ L FRPSXL vQUXGLL GHILFLW
de G-6-3'+KHSDWLFDFXWJODXFRPFXXQJKLvQFKLVDGHQRP
GHSURVWDWFXWHQGLQDUHWHQLHGHXULQFRODSVLQVXILFLHQ
FDUGLDFJUDYDQJLQSHFWRUDO
5HDFLL DGYHUVH UHDFLL DOHUJLFH OD PHWDPL]RO HUXSLL FXWDQDWH
IRDUWHUDURFDQDILODFWLFDQHPLHDJUDQXORFLWR]GR]HPDULSRW
SURYRFD IHQRPHQH DWURSLQLFH XVFFLXQHD JXULL WXOEXUUL Ge
vedere, tahicardie, disurie.
,QWHUDFLXQL PHGLFDPHQWRDVH SUXGHQ n asocierea cu
DPDQWDGLQD FKLQLGLQ DQWLGHSUHVLYH WULFLFOLFH FUHVF HIHFWHOH
atropinice).
-YL]XDOL]DUHDLHYHQWXDOH[WUDJHUHDFDOFXOXOXLVXEFPFXDMXWRUXO
SHQVHORU 3HQWUX FDOFXOL PDL PDUL VH LPSXQH GLVWUXFLD
LQWUDFRUSRUHDODFDOFXOXOXLLXOWHULRUH[WUDJHUHDGHIUDJPHQWH
-YHULILFDUHDSHUPHDELOLWLLXUHWHUDOHSULQLQMHFWDUHDDQWHURJUDGGH
VXEVWDQ GH FRQWUDVW 'DF H[LVW VDX VH EQXLHVF OH]LXQL
XUHWHUDOH GDWRUDWH FDOFXOXOXL VDX PDL DOHV PDQHYUULL VH
UHFRPDQG LQVWDODUHD XQHL VRQGH -- DQWHURJUDG SHQWUX D
preveni stHQR]DUHDXUHWHUXOXLLVDXH[WUDYD]DUHDGHXULQ
&RPSOLFDLLOH 856$ $ERUGXO SHUFXWDQ ILH F HVWH SHQWUX
QHIURVFRSLH VDX XUHWHURVFRSLH VH SRDWH vQVRL GH DFHOHDL
incidente pe care le-DPPHQionat n capitolul dedicat NLP.
VII. LAPAROSCOPIA
Unul din domeniile n care tehnicile minim invazive (mai
FRUHFW WHKQLFL FX DFFHV PLQLP GHRDUHFH LQWHUYHQLD SURSULX-]LV
poate fi de amploare) au avansat spectaculos n ultimii ani este cel
al chirurgiei laparoscopice, acest domeniu al urologiei fiind unul din


 
III. ALFABLOCANTE
1. UROREC: (Silodosin)
3UH]HQWDUHIDUPDFHXWLFcapsule de 8 mg.
$FLXQHWHUDSHXWLF blocarea receptorilor alfa1A
adrenoreceptori din prostata, vezica urinara si uretra.
,QGLFDLL tratamentul simptomelor de hiperplazie prostatica
benigna.
Mod de administrare: Doza recomandata este de o capsula de
8 mg o data pe zi. Pentru barbatii cu probleme renale moderate,
doza initiala trebuie sa fie de 4 mg o data pe zi. Dupa o
VSWPkQDFHDVWDSRDWHILPULWDODPJRGDWDSH]L
&RQWUDLQGLFDLL hipersensibilitate (alergie) la silodosin sau la
oricare dintre celelalte componente ale medicamentului.
Sindromul de iris flasc intraoperator (SIFI) apare la unii pacienti
tratati cu antagonisti de alfa-adrenoreceptori si poate cauza
complicatii in timpul operatiei de cataracta.
5HDFLL DGYHUVH: ejaculare retrograda, hipotensiune ortostatica,
cefalee.
2.OMNIC 0,4: (Tamsulosinum HCl)
3UH]HQWDUHIDUPDFHXWLFcapsule 0,4mg.
$FLXQL WHDSHXWLFH 2PQLF  FUHWH YDORDUHD GHELWXOXL XULQDU
PD[LP SULQ UHGXFHUHD WHQVLXQLL PXVFXODWXULL QHWHGH GLQ SURVWDW
L XUHWU GHWHUPLQkQG GLPLQXDUHD REVWUXFLHL $PHOLRUHD]
 ;0(',&$0(17()2/26,7(135$&7,&$852/2*,& 9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(

,QGLFDLL ,QIHFLLDOHFLORUUHVSLUDWRULLEURQLWDFURQLFVLQX]LWD 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
toxic mare).
2. PIAFEN:
3UH]HQWDUH IDUPDFHXWLF: cps: 500 mg metamizol sodic, 5 mg
SLWRIHQRQFORUKLGUDWLPJIHQSLSUDPLGEURPRPHWLODW; sup.
 J PHWDPL]RO VRGLF  PJ SLWRIHQRQ FORUKLGUDW L  PJ
IHQSLSUDPLG EURPRPHWLODW ILROH PO 2,5 g metamizol sodic,
 PJ SLWRIHQRQ FORUKLGUDW L  PJ IHQSLSUDPLG
bromometilat.

INSTRUMENTAR NECESAR:
3ULQFLSDOD GLIHUHQ vQWUH LQWHUYHQLLOH FKLUXUJLFDOH FODVLFH VL
cele laparoscopice este modul de abordare al regiunii anatomice
DVXSUD FUHLD LQWHUYHQLP DFHDVWD ILLQG DFFHVDW SULQ LQWHUPHGLXO
FkWRUYD PLFL LQFL]LL LQWHUYHQLD FKLUXUJLFDO ILLQG YL]XDOL]DW SH XQ
PRQLWRU XQGH LPDJLQLOH DMXQJ GDWRULW XQXL sistem video ce este


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

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
QXPLWD FDPHU GH OXFUX ODSDURVFRSLF SQHXPRSHULWRQHX
pneumoretroperitoneu sau pneumoproperitoneu) acestea fiind
create VL PHQLQXWH FX DMXWRUXO XQXL sistem de insuflare cu CO2
IRUPDWGLQDFXOGHLQVXIODUHLQVXIODWRUXOL JD]XO LQVXIODW&2DUH
DYDQWDMXO XQHL VROXELOLWL YDVFXODUH IRDUWH EXQH L D XQHL HOLPLQUL
Streptococus pyogenes, Streptococus pneumoniae,
Streptococus agalactiae, enterococi, peptococi, Bacteroides
spp., E. coli, Haemophilus influenzae, Neisseria gonorheae,
Neisseria meningitides, Klebsiella spp, Proteus mirabilis,
YXOJDULV 3VHXGRPRQDV DHUXJLQRVD 3URYLGHQLD (QWHUREDFWHU
&LWREDFWHU 6HUDLD 6DOPRQHOD 6KLJHOOD $FLQHWREDFWHU
Bordetela pertusis,
Yersinia enterocolitica.
,QGLFDLL LQIHFLL DOH WUDFWXOXL XULQDU vQDOWH L MRDVH LQIHFii
pulmonare rapide ce scad semnificativ riscul de ebolie gazoasa
fiind din acest motiv cel mai frecvent gaz folosit. Cel mai cunoscut
ac insuflator este acul Veress al carui mecanism permite att
VWUDSXQJHUHD SHUHWHOXL DEGRPLQDO FkW L SURWHMDUHD RUJDQHORU
DEGRPLQDOH WURFDUXO DFXOXL DFRSHULQG YDUIXO DVFXLW DO WHFLL RGDW
JHQLWDOH XUHWULW FX JRQRFRF LQIHFLL UHVSLUDWRULL LQIHFLL DOH
SLHOLL RVWHRPLHOLW LQIHFLL DOH 61& FROHFLVWLWH DEFHVH
abdominale.
Mod de administrare: DGXOL -4 g/zi n 2 prize.
&RQWUDLQGLFDLL: hipersensibilitate la peniciline, sulbactam,
FHIRSHUD]RQVDXDOWHFHIDORVSRULQHVHUHFRPDQGSUXGHQvQ
VDUFLQ
SHQHWUDW SHUHWHOH DEGRPLQDO ,QVXIODWRUXO HVWH GH IDSW R SRPS
FRQWURODW DXWRPDW FH UHDOL]HD] L PHQLQH SUHVLXQHD &2 vQ
FDPHUDGHOXFUX$FHDVWSUHVLXQHVHVLWXHD]vQJHQHUDOvQWUH-
PP+JFXRSUHVLXQHPD[LPGHPP+J
FIG. VI.9. - ,QWHUYHQLHODSDURVFRSLF

 $
5HDFLL DGYHUVH GLDUHH JUHD YUVWXUL FROLW pseudo-
PHPEUDQRDV HUXSLL FXWDQDWH VGU 6WHYHQV -RKQVRQ
leucopenie, neutropenie, hipoprotrombinemie, eozinofilie,
cefalee, KLSRWHQVLXQHDUWHULDOIHEUIULVRDQH
,QWHUDFLXQL PHGLFDPHQWRDVH QX VH DPHVWHF cu AG n
DFHODL UHFLSLHQW QX VH YD UHFRQVWLWXL FX VRO 5LQJHU VDX VROXLL
GH/LGRFDLQ
F. SULFAMETOXAZOLTRIMETOPRIM (Biseptol)
3UH]HQWDUH IDUPDFHXWLF Comprimate 120, 480. Compozitia
chimica: Trimetoprim 20 mg, 80 mg; Sulfametoxazol 100 mg,
400 mg.
$FLXQH WHUDSHXWLF bacteriostatic, este o asociere de
WULPHWRSULP L VXOIDPHWR[D]RO DPEHOH FRPSRQHQWH DFLRQkQG
VLQHUJLFLSUH]HQWkQGRLQKLEDUHDFUHWHULLEDFWHULLORU inhibarea
VLQWH]HLFRPSXLORUSXULQLFLGLQFHOXOHOH EDFWHULLORUSULQLQIOXHQD
DVXSUD GLIHULWHORU ID]H GLQ IRUPDUHD L WUDQVIRUPDUHD DFLGXOXL
IROLF LQKLE VLQWH]D DFLGXOXL GH]R[LULERQXFOHLF DO EDFWHULLORU
DFLRQHD] DVXSUD DJHQLORU JUDP SR]LWLYL L JUDm negativi,
PLFUREDFWHULLYLUXLLIXQJL
 ;0(',&$0(17()2/26,7(135$&7,&$852/2*,& 9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,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.
C. 7,&$5&,/,1
 ACID CLAVULANIC (Timentin)
3UH]HQWDUHIDUPDFHXWLFflacon 1,6 g LJ
0RG GH DFLXQH L LQGLFDLL LQIHFLL JUDYH DOH DSDUDWXOXL
XURJHQLWDO UHVSLUDWRU VIHUD 25/ VHSWLFHPLL LQIHFLL
SRVWFKLUXUJLFDOHSHULWRQLWHLQIHFLLRVWHRDUWLFXODUHLQIHFLLVHYHUH
ODSDFLHQLLLPXQRGHSULPDL
Mod de administrare: uzual 1 f (3,2 g) OD RUHvQLQVXILFLHQ
UHQDO - FOHDUDQFH FUHDWLQLQ !  POPLQ  J x 3 / zi;
FOHDUDQFH FUHDWLQLQ -30 ml/min, 1,6 g x 3/zi; clearance
FUHDWLQLQ
ml/min, 1,6 g la 12 ore.
&RQWUDLQGLFDLL KLSHUVHQVLELOLWDWH OD SHQLFLOLQ SUXGHQ la
SDFLHQLLFXGLVIXQFLLKHSDWLFHVDUFLQDOSWDUHVDXWXOEXUULGH
coagulare.
5HDFLLDGYHUVHVXQWUDUHLFRPXQHSHQLFLOLQHORULQMHFWDELOH
D. $03,&,/,1SULBACTAM (Ampiplus)
3UH]HQWDUH IDUPDFHXWLF IODFRDQH FH FRQLQ DPSLFLOLQ  J 
sulbactam 0,5 g.
AFLXQH WHUDSHXWLF sulbactamul este un inhibitor de beta
ODFWDPD] GHWHUPLQkQG vQ DVRFLHUH FX DPSLFLOLQD R OUJLUH D
spectrului acesteia (stafilococul rezistent la peniciline, E. Coli,
.OHEVLHOOD SURWHXV YXOJDULV L PLUDELOLV WXOSLQL GH JRQRFRF L
QHFHVLWL FRDJXODUH VDX WLHUH H[LVWkQG FD vQ FKLUXUJLD FODVLF
posibilitatea folosirii DWkWDFXUHQWXOXLPRQRSRODUFkWLELSRODU
6LVWHPXO GH LULJDUHDVSLUDLH permite realizarea att a
LULJULL XQHL ]RQH DFRSHULWH GH XQ FKHDJ FkW L D DVSLUULL IOXLGHORU
GLQ FDPHUD GH OXFUX ODSDURVFRSLF vQ VHQVXO IDFLOLWULL XQHL
YL]XDOL]ULRSWLPH.
Instrumentarul laparoscopic operator este format din
trocarele laparoscopice ce permit introducerea instrumentelor de
OXFUXGHODH[WHULRULQFDPHUDODSDURVFRSLFLVXQWIRUPDWHGLQWU-o
WHDF PHWDOLF VDX GLQ PDWHULDO SODVWLF FH SUH]LQW L R YDOY FH
poate fi FRQHFWDW OD LQVXIODWRU L XQ WURFDU FH IDFLOLWHD]
SDWUXQGHUHD WHFLL SULQ SHUHWHOH DEGRPLQDO GDWRULW YkUIXOXL VX
ascuLW&DLLQVWUXPHQWHRSHUDWRULLODSDURVFRSLFHH[LVWSHQVHGH
diferite tipuri, foarfeci, port-ace, aplicatoare de clipuri, staplere,
departatoare, etc., toate adaptate nevoii de a fi introduse prin
FDQXOFXSDUWHDDFWLYvQLQWHULRUXOFDPHUHLGHOXFUXODSDURVFRSLFH
LFX]RQDGHPDQHYUDUHODH[WHULRU
(FKLSD RSHUDWRULH HVWH IRUPDW GLQ FKLUXUJXO RSHUDWRU
hemofLOXVSURGXFWRDUHGHEHWDODFWDPD]H
,QGLFDLL LQIHFLL XULQDUH L XURJHQLWDOH UHVSLUDWRULL 25/
GLJHVWLYH ELOLDUH DYRUW VHSWLF LQIHFLL SXHUSHUDOH JLQHFRORJLFH
gastrointestinale, dentare, cutanate, osteoarticulare.
Mod de administrare: JGHGRX RULSH]LvQLQIHFLLOHVHYHUH
SkQ OD  J]L IU D VH GHSLL  J GH VXOEDFWDP UHGXFHUHD
GR]HORUvQFD]GHLQVXILFLHQUHQDO
&RQWDLQGLFDLL DOHUJLH OD SHQLFLOLQH PRQRQXFOHR]D LQIHFLRDV
KHUSHV OHXFHPLH LQIHFLL VHQVLELOH QXPDL OD DPSLFLOLQ
PRQRWHUDSLHvQLQIHFLLOHJUDYH
5HDFLL DGYHUVH anemie, trombocitopenie, eozinofilie,
OHXFRSHQLHWXOEXUULGLJHVWLYHPLQRUHFRQGLGR]HGXUHULOD locul
GHLQMHFWDUHIOHELWHGXSDGPLQLVWUDUHDLY

operatorul camerei video, o asLVWHQW LQVWUXPHQWLVW L vQ DQXPLWH
cazuri un chirurg asistent.
3ULQFLSDOHOH PRPHQWH DOH XQHL LQWHUYHQLL FKLUXUJLFDOH
laparoscopice sunt:
1. pregatirea pacientului ce cuprinde: a. pregatirea
SHUHWHOXL DEGRPLQDO SULQ vQGHSUWDUHD SUXOXL YHULILFDUHD IDStului
F QX H[LVW IRFDUH LQIHFLRDVH FXWDQDWH L DVHSWL]DUHD FX VROXLL
VSHFLILFH D ]RQHL FH YD IL IRORVLW SHQWUX SODVDUHD WURFDUHORU GH
lucru; b. plasarea unei sonde de aspiratie naso-JDVWULFFHSHUPLWH


 9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
GHFRPSULPDUHD VWRPDFXOXL SHQWUX D HYLWD SUH]HQD acestuia n
]RQD GH SXQFLRQDUH D DFXOXL 9HUHVV VDX D WURFDUHORU L D IDFLOLWD
vizualizarea organelor din etajul supramezocolic; c. plasarea unui
cateter vezical; d. antibioticoprofilaxie pre- sau intra-operatorie,
IXQFLHGHSDUWLFXODULWDWHDFD]XOXLHSXUWDUHDGHFWUHSDFLHQWGH
ciorapi elastici n scopul prevenirii incidentelor tromboembolice.
2. plasarea n pozitia operatorie: functie de calea de abord
LRUJDQXOGHRSHUDWSDFLHQWXOHVWHDezat fie n decubit dorsal fie
n decubit lateral. In cazul oSHUDLLORUSHQWUXRUJDQHVXSUDRPELOLFDOH
(glanda suprarenal, rinichiul, ureterul lombar) monitorul este
SODVDWvQIDDRSHUDWRUXOXL, DFHVWDvPSUHXQFXFDPHUDPDQXOILLQG
SODVDLSHSDUWHDRSXVOH]LXQLLGHRSHUDW3HQWUXDIRORVLJUDYLWDLD
n scopul de a UHWUDFWDLQWHVWLQHOHPDVDRSHUDWRULHWUHEXLHvQFOLQDW
VSUH SDUWHD RSXV RUJDQXOXL GH RSHUDW Q FD]XO RUJDQHORU
VXERPELOLFDOH YH]LFD XULQDU SURVWDWD XUHWHU SHOYLQ VDX LOLDF
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
Mod de administrare: PJ]LvQGR]]LOQLFXQLFvQXUHWULWH
VH DGPLQLVWUHD] R VLQJXU GR] GH J vQ WUDWDPHQWXO LQIHFLHL
JHQLWDOH FX FKODP\GLD Q LQIHFLLOH JDVWUR-dudenale se
DGPLQLVWUHD]J]LWLPSGH]LOH
&RQWUDLQGLFDLL LQVXILFLHQKHSDWLFVHYHU
5HDFLL adverse: GLDUHH JUHD YUVWXUL GXUHUL DEGRPLQDOH
DPHHOLFHIDOHH
15. &20%,1$,,'($17,%,27,&(
 ACID CLAVULANIC (Augmentin)
A. AMOXICILINA
3UH]HQWDUHIDUPDFHXWLFcp 375 mg, 625 mg, 1000 mg; fl: 600
mg, 1200 mg, 2200 mg; pulbere suspensie: 62,5 mg/5 ml, 156
mg/5 ml, 312 mg/ 5 ml;
$FLXQH WHUDSHXWLF LQKLE sinteza peretelui bacterian. Activ
pe: streptococ, pneumococ, meningococ, gonococ, listeria,
6WDILORFRFXO DXULX VHFUHWRU GH SHQLFLOLQD] L EDFLOOL *UDP-
QHJDWLYL VHFUHWRUL GH -lactamaze: Haemophilus influenzae, E.
coli,
Klebsiella, Proteus mirabilis, Shigella, Bacteroides fragillis.
,QGLFDLL LQIHFLL XULQDUH FX JHUPHQL VHQVLELOL OD $XJPHQWLQ
YDULFRFHO PRQLWRUXO VH SODVHD] OD SLFLRDUHOH SDFLHQWXOXL SR]Lia
operatorXOXL ILLQG SH SDUWHD GUHDSW D SDFLHQWXOXL L D
FDPHUDPDQXOXLSHSDUWHDVWDQJ
3. creerea camerei de lucru presupunerea insuflarea CO2
ILHvQFDYLWDWHDSHULWRQHDOILHLQVSDii anterior create prin disecie
LQIHFLLUHVSLUDWRULL25/SRVWFKLUXUJLFDOH
Mod de administrare: $GXOL- oral 1 cp (625 mg; 1000 mg) x
]LvQLQIHFLLJUDYHx 4 / zi; parenteral: 1,2 g x ]LvQLQIHFLL
grave x 3 / zi.
5HDFLL DGYHUVH GLDUHH JUHD YUVWXUL FDQGLGR] HULWHP
FXWDQDWIHEUDDOHUJLF
&RQWUDLQGLFDLL DOHUJLL OD 3HQLFLOLQ SUXGHQ n I.H. doze mai
mici n I.R.
oarb GLJLWDOLFXDMXWRUXOXQRUEDORDQHVSHFLDOHEDORQXO*DXUvQ
DULDSURSHULWRQHDOVDXUHWURSHULWRQHDO
 LQWURGXFHUHD WURFDUHORU GH OXFUX WUHEXLH IFXW FX JULM
pentru a evita leziunile de organe intraabdominale, primul introdus
fiind trocarul folosit pentru laparoscop, celelalte trocare fiind
plasate sub control vizual direct.
5. timpul operator propriu-]LV GLIHU IXQFLH GH RUJDQXO
B. 3,3(5$&,/,1TAZOBACTAM (Perasin)
3UH]HQWDUH IDUPDFHXWLF IODFRDQH FX SXOEHUH SHQWUX VROXLH
LQMHFWDELOSHUIX]DELO FH FRQLQ  J SLSHUDFLOLQD J
WD]REDFWDPVDXJSLSHUDFLOLQJWD]REDFWDP
$FLXQH WHUDSHXWLF este mai activ pe pseudomonas,
NOHEVLHOOOD L HQWHURFRF GHFkW FDUEHQLFLOLQD (VWH GHRVHELW GH
XWLODVRFLHUHDFXXQDPLQRJOLFR]LGvQLQIHFLLOHVHYHUH
,QGLFDLL LQIHFLL PHGLL L VHYHUH DOH WUDFWXOXL XULQDU LQFOXVLY
RSHUDWGHOH]LXQHLGHFDOHDGHDERUGDOHDV SLHORQHIULWD JLQHFRORJLFH LQIHFLL LQWUDDEGRPLQDOH LQIHFLL
FXWDQDWH L DOH HVXWXULORU PRL SQHXPRQLH QRVRFRPLDO
HQGRFDUGLWRVWHRPLHOLW
 Mod de administrare: 1 fl. 4,5 g la 8 ore sau 1 fl. la 6 ore.
 
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,QGLFDLLLQIHFLLXULQDUHFXJHUPHQLVHQVLOELOL &RPSOLFDLLOH FH SRW VXUYHQL vQ FXUVXO XQHL LQWHUYHQLL

Mod de administrare: vQLQIHFLLOHDFXWH 100 mg de 3 ori pe zi.
chirurgicale laSDURVFRSLFH SH OkQJ FHOH VSHFLILFH LQWHUYHQLLORU
QLQIHFLLOHFRUQLFHGR]HOHVHvQMXPWHVF
&RQWUDLQGLFDLL DQXULH ROLJXULH LQVXILFLHQ UHQDO VDUFLQ FKLUXUJLFDOHFODVLFHVHUHIHUODLQFLGHQWHSURGXVHODLQVHULDDFXOXL
DOSWDUHGHILFLWGH*-6-PDH.
9HUHVV OD LQVHULD WURFDUHORU VDX FHOH GHWHUPLQDWH GH JD]XO GH
5HDFLL DGYHUVH JUHXUL YUVWXUL DOHUJLH OHXFRSHQLH
SDUHVWH]LLKHPROL]SULQGHILFLWGe G-6-3'+ILEUR]SXOPRQDU lucru.
SQHXPRQLHLQWHUVWLLDO
 /D LQVHULD DFXOXL 9HUHVV VH SRW SURGXFH LQVXIODUH GH
14. MACROLIDELE CO2 vQ DOW UHJLXQH GHFDW LQWUDSHULWRQHDO DVWIHO DSUkQG ILH
prepneumoperitoneu, fie pneumoepipORQVDXLQVXIODUHVXEFXWDQDW
5HSUH]HQWDQLFRPSXLGHELRVLQWH]HULWURPLFLQDVSLUDPLFLQD
MRVDPLFLQD GHULYDL VHPLVLQWHWLFL UR[LWURPLFLQD FODULWURPLFLQD
diritromicina, azitromicina, rakitamicina, telitromicina).
A. ERITROMICINA
3H]HQWDUHIDUPDFHXWLFcomprimate de 200 mg.
$FLXQH WHUDSHXWLF efect bacteriostatic pe germeni gram
pozitivi, stafilococi penicilinazo-secretori, streptocici,
pneumococi,
unele bacterii gram negative din genul neisseria, haemophilus,
micoplasme.
,QGLFDLL LQIHFLL GLQ VIHUD 25/ L UHVSLUDWRULL LQIHFLL FXWDQDWH
VWDILORFRFLFH DQWLELRWLF GH vQORFXLUH OD SDFLHQLL FX DOHUJLH OD
peniciline.
Mod de administrare: 250-500 mg la 6 ore, sau 0,5 g - 1 g la 12
RUH SkQ OD PD[LP  J]L 'R]HOH SRW IL GXEODWH vQ LQIHFLLOH
severe.
&RQWUDLQGLFDLL DOHUJLHDIHFLXQLKHSDWLFH
5HDFLLDGYHUVH JUHXULYUVWXULUDUDOHUJLHGLDUHHGLVIXQFLH
KHSDWLF
B. AZITROMICINA
3H]HQWDUH IDUPDFHXWLF comprimate de 250 mg, 500 mg,
SXOEHUHSHQWUXVXVSHQVLHRUDOPJPOPJPO
$FLXQH WHUDSHXWLF SUH]LQ VSHFWUX EDFWHULDQ VLPLODU
HULWURPLFLQHL vQ SOXV ILLQG DFWLY L DVXSUD XQRU EDFWHULL JUDP
negative.
,QGLFDLL LQIHFLL DOH FDLORU UHVSLUDWRULL SLHOLL HVXWXULORU PRL
XUHWULWH QHFRPSOLFDWH FHUYLFLWH LQIHFLL JDVWUR-duodenale cu
Helicobacter pylori.

FDUH vQ FD] GH YROXP PDUH L IX]DUHD JD]XOXL SkQ vQ UHJLXQHD
WRUDFLF SRDWH GXFH FKLDU OD SQHXPRPHGLDVWLQ VDX SQHXPRWRUD[
PneumomediDVWLQXOSRDWHDSDUHDLvQFD]GHSURGXFHUHGHOH]LXQL
LDWURJHQHGHGLDIUDJPvQDFHVWHVLWXDLLSODVDUHDXQXLWXEGHGUHQ
SOHXUDOFXSUHVLXQHQHJDWLYILLQGREOLJDWRULX
2. La plasarea trocarelor de fapt vorbim de plasarea
primului trocar (cel folosit pentru laparoscop), restul fiind introduse
VXEFRQWURORSWLFVLLQDFHVWIHODYDQGRUDWDLQFLGHQWHORUPXOWPDL
PLF $X IRVW GHVFULVH OH]LXQL LQWHVWLQDOH GH DRUW YHQ FDY
OH]LXQL JDVWULFH VDX YH]LFDOH vQ PRPHQWXO LQVHULHL SULPXOXL WURFDU
Pentru a SUHYHQL DFHVW OXFUX LQVHULD WURFDUXOXL RSWLF VH IDFH SULQ
SURJUHVLD VD SHUSHQGLFXODU SH SHUHWHOH PXVFXODU FX SDUWHD
ERDQW D WURFaUXOXL VSULMLQLW vQ SRGXO SDOPHL vQ WLPS FH LQGH[XO
minii este extins n lungul canulei pentru a preveni penetrarea
exageraWDYkUIXOXLDVFXLWvQDEGRPHQQFD]GHH[LVWHQDDXQRU
DGHUHQH YLVFHUR-SDULHWDOH ULVFXO GH OH]LXQH LQWHVWLQDO DWkW OD
LQVHULDDFXOXL9HUHVVFkWLODLQVHULDWURFDUXOXLRSWLFHVWHDWkWGH
PDUHvQFkWVHUHFRPDQGUHQXQDUHD OD DERUGXOFXDMXWRUXO acului
9HUHVV L SODVDUHD WURFDUXOXL RSWLF SULQWU-o mini-incizie ce se
VXWXUHD] XOWHULRU vQ MXUXO FDQXOHL SHQWUX D SUHYHQL SLHUGHULOH GH
gaz. De asemenea la plasarea trocarelor se pot produce leziuni ale
$

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vaselor din peretele abdominal acestea pot fi evitate prin
SODVDUHD WURFDUHORU vQ FRQGLLLOH IRORVLULL WUDQVLOXPLQULL FX DMXWRUXO
laparoscopului plasat intraabdominal, n acest fel evitndu-se
vasele importante de la acest nivel.
 &RPSOLFDLLOH GHWHUPLQDWH GH JD]XO GH OXFUX SUHVXSXQ
hipercarbia n cazXO LQWHUYHQLLORU GH OXQJ GXUDW 3HQWUX D
FRPSHQVD DFHDVWD FRPSOLFDLH DQHVWH]LVWXO WUHEXLH V FUHDVF
YHQWLODUHDSDFLHQWXOXL2FRPSOLFDLHPXOWPDLJUDYGDUGLQIHULFLUH
H[WUHP GH UDU HVWH HPEROLD JD]RDV DFHDVWD SXWkQG IL IDWDO Q
marea majoritate D FD]XULORU vQ FDUH DFHDVWD DSDUH VH GDWRUHD]
asocierii unei alte complicatii OH]LXQHYDVFXODUFXDFXO9HUHVV
XUPDW GH LQVXIODUHD GH JD] GLUHFW LQWUDYDVFXODU 6ROXLD
WHUDSHXWLF vQ DFHVW FD] HVWH HYDFXDUHD UDSLG D JD]XOXL GLQ
camera de lucru si plasarea pacientului ntr-R SR]LLH GH GHFXELW
lateral stng combinat cu Trendelemburg pentru a preveni
SWUXQGHUHDJD]XOXLvQDUWHUDSXOPRQDU(YDFXDUHDJD]XOXLSRDWH
ILIDFLOLWDWSULQSODVDUHDXQXLFDWHWHUYHQRVFHQWUDO
2 SDUWLFXODULWDWH D LQWHUYHQLLORU ODSDURVFRSLFH VH UHIHU OD
PRGXO vQ FDUH R PLF VDX FKLDU PHGLH VkQJHUDUH GLQ VXUVH
YHQRDVH SRDWH IL FRQWURODW SULQ FUHVWHUHD WHPSRUDU D SUHVLXQLL
JD]XOXLvQFDPHUDGHOXFUXSHQWUXDVFDGHDGHELWXOVkQJHUULLLD
SXWHDUHSDUDOH]LXQHD DSDUXW $FHVWD este si motivul pentru care
OD ILQDOXO RSHUDLHL SUHVLXQHD WUHEXLH VFD]XW SDQD OD  PP +J
SHQWUXDLQVSHFWDDSDULLDGHHYHQWXDOHVkQJHUULLQDFWLYHvQFXUVXO
LQWHUYHQLHLGDWRULWHIHFWXOXLGHEDURKHPRVWD]GHVFULVDQWHULRUQ
FD]XO XQRU FRPSOLFDLL KHmoragice ce nu pot fi controlate prin
PDQHYUH ODSDURVFRSLFH VH LPSXQH FRQYHUVLD LQWHUYHQLHL
ODSDURVFRSLFH vQ XQD FODVLF L HIHFWXDUHD KHPRVWD]HL SULQ
PHWRGHOHFKLUXUJLFDOHRELQXLWH

 
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
$FLXQHWHUDSHXWLFinhibarea sintezei proteice prin legarea de
subunitatea 50S, avnd efect bacteriostatic.
,QGLFDLL PLFURRUJDQLVPH JUDP SR]LWLYH DHUREH L DQDHUREH
LQGLIHUHQW GH UH]LVWHQD ID GH DOWH FODVH GH PHGLFDPHQWH
SQHXPRQLL LQIHFLL FXWDQDWH L DOH HVXWXULORU PRL LQIHFLL
enterococice, rezistente la alte clase de medicamete.
Mod de administare: p.o. sau i.v. lent n 30-120 minute, 600
mgX2/zi.
&RQWUDLQGLFDLL alergie.
5HDFLLDGYHUVH FHIDOHHJUHDYUVWXULFUHWHUHDHQ]LPHORU
KHSDWLFHFDQGLGR]HYDJLQDOHQHXURSDWLHSHULIHULF
12. FOSFOMICINA
3UH]HQWDUHIDUPDFHXWLF plicuri de 3 g, comprimate de supt de
3 g pentru utilizarea n sfera ORL.
$FLXQH WHUDSHXWLF inhibarea piruvil-transferazei, intervenind
ntr-R ID] SUHFRFH D VLQWH]HL SHSWLGRJOLFDQXOXL HIHFW EDFWHULFLG
SH EDFWHULL JUDP SR]LWLYH L JUDP QHJDWLYH LQFOXVLv
pseudomonas aeruginosa, enterococci, proteus, klebsiella,
enterobacter, serratia.
,QGLFDLL LQIHFLL FX JHUPHQL VHQVLELOL GLQ VIHUD 25/ LQIHFLL
urinare necomplicate.
Mod de administrare: vQ LQIHFLLOH WUDFWXOXL XULQDU VH
DGPLQLVWUHD]vQGR]XQLFGH JvQDLQWHGHPDVLFXYH]LFD
XULQDU JRDO Q SURILOD[LD LQIHFLLORU WUDFWXOXL XULQDU VH
DGPLQLVWUHD] vQ GR] XQLF  J vQDLQWH GH LQWHUYHQLD
FKLUXUJLFDOLvQFJODRUHGXSLQWHUYHQLDFKLUXUJLFDO
&RQWUDLQGLFDLL hipersensibilitate lD IRVIRPLFLQ DOSWDUH
LQVXILFLHQUHQDO
5HDFLL DGYHUVH RFD]LRQDO SRW DSUHD WXOEXUUL JDVWUR-
LQWHVWLQDOHUDUSRDWHDSUHDUXVKFXWDQDW
13. NITROFURANI
5HSUH]HQWDQL nitrofurantoin, furazoldon.
NITROFURANTOIN
3UH]HQWDUHIDUPDFHXWLFcomprimate de 100 mg.
$FLXQH WHUDSHXWLF bacteriostatic sau bactericid cu spectru
larg, active pe E. Coli, coci piogeni, Shighela, Samonella,
Aerobacer, Trihomonas vaginalis.
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9. MONOBACTAMI (YROXLD WHKQLFLORU ODSDURVFRSLFH D GXV OD GLYHUVLILFDUHD

PRGDOLWLORU de abord aparnd astfel laparoscopia single port, mini
5HSUH]HQWDQLazotreonam.
3UH]HQWDUHIDUPDFHXWLF IODFRDQHGHPJLJ ODSDURVFRSLD ODSDUVRFRSLD FX YL]XDOL]DUH WULGLPHQVLRQDO L ELQH
$FLXQHWHUDSHXWLF activvi pe bacilli garm negative din familia
nteles cel mai avansat sistem laparoscopic de la acest moment
(QWHUREDFWHULDFHDHL3VHXGRPRQDVDHUXJLQRVDFKLDUvQFRQGLLL
GHDQDHURELR] ODSDURVFRSLDURERWLFDVLVWDW
,QGLFDLL LQIHFLL SXOPRQDUH VDX XURORJLFH FX PLFURRUJDQLVPH
Supravegherea postoperatorie D SDFLHLORU FX LQWHUYHQLL
sensibile, gonoree.
Mod de administrare: i.m. sau i.v. 2g la 6-8 ore vQ LQIHFLLOH ODSDURVFRSLFH DUH FD SDUWLFXODULWDWH PDMRU UDSLGLWDWHD FX FDUH
severe, 1-2 g la 8- RUH vQ LQIHFLLOH VLVWHPLFH -1 g la 8-12
SDFLHQWXO vL UHFDSW PRELOLWDWHD OD  RUH GH OD LQWHUYHQLD
RUH vQ LQIHFLLOH XURORJLFH $MXVWDUHD GR]HORU vQ IXQFLH GH
clearance-XOGHFUHDWLQLQVDXvQFD]GHLQVXILFLHQKHSDWLF FKLUXUJLFDOFKLDULvQFD]XOXQRULQWHUYHQWLLGHPDUHDPSORDUHFD
&RQWUDLQGLFDLL DOHUJLHGHPRQVWUDWODSURGXV
nefrectomia sau pieloplastia. n rest suprimarea sondei
5HDFLL DGYHUVH UHDFLL ORFDOH UXVK JUHD GLDUHH HR]LQRILOLH
FUHWHULWUDQ]LWRULLDOHQ]LPHORUKHSDWLFHWURPERIOHELWHODORFXOGH XUHWURYH]LFDOHvQSULPHOHRUHLDWXEXOXLGHGUHQvQSULPHOH-3
injectare.
]LOH vQ FD]XO vQ FDUH SODVDUHD XQXLD D IRVW QHFHVDU
10. '(5,9$,'(,0,'$=2/ VXSUDYHJKHUHD UHOXULL WUDQ]LWXOXL LQWHVWLQDO L HYLWDUHD DSDULLHL GH
FRPSOLFDLL LQIHFLRDVH QRVRFRPLDOH XUPH] Srincipiile chirurgiei
5HSUH]HQWDQL metronidazol, tinidazol.
3UH]HQWDUH IDUPDFHXWLF comprimate 250 mg, 500 mg, clasice.
VXVSHQVLHRUDOGHPJPOVROXLHSHUIX]DELOGHPJPO
VIII. /,72752,$(;75$&25325($/
flacon 100 ml.
$FLXQH WHUDSHXWLF EDFWHULFLG SULQ DFWLYDUHD vQ FRQGLLL (6:/ D DMXQV V ILH SURFHGXUD QXPDUXO  vQ OLWLD]D UHQR-
anaerobe a nitrat-UHGXFWD]HL EDFWHULHQH FH LQWHUDFLRQHD] FX
XUHWHUDOGLQPDLPXOWHPRWLYH
AND microorganismelor.
,QGLFDLL active pe protR]RDUH EDFWHULL DQDHUREH L VSHFLL -(VWH IU vQGRLDO FHD PDL SXLQ DJUHVLY GLQWUH WRDWH PHWRGHOH
microaerofile, antiparazitar, active pe Giardia, Trihomonas
eficace.
vaginalis, Entameoba histoyitica.
Mod de administrare: p.o. 1-1,5 g/zi, chemoprofilaxia -6LQJXU VDX FX DMXWRUXO VRQGHL XUHWHUDOH DXWRVWDWLFH UH]ROY
FKLUXUJLFDOPJ[]LFXRUHvQDLQWHGHLQWHUYHQLHLYvQ
peste 80- GLQ WRDWH FD]XULOH GH OLWLD] UHQR-XUHWHUDO FDUH
perIX]LHOHQW-1,5 g/zi.
&RQWUDLQGLFDLL WXOEXUUL DOH PGXYHL KHPDWRIRUPDWRDUH impun un tratament agresiv.
LQVXILFLHQ KHSDWLFDVDXFDUGLDF3UHFDXLL vQFD] GHDJUDYDUH
-6H SRDWH IDFH IU DQHVWH]LH OD PDMRULWDWHD OLWRWULWRDUHORU
DWXOEXUULORUQHXURORJLFHFHQWUDOHLSHULIHULFH
5HDFLL DGYHUVH DWD[LH FRQYXOVLL WXOEXUUL JDVWUR-intestinale, moderne).
leucopenie.
-0XOL GLQWUH SDFLHQLL FX calculi mici sau mijlocii (sub 1 cm) pot fi
11. OXAZOLIDINONE H[WHUQDL OD -12- RUH GXS SURFHGXU GDF HYROXLD HVWH
QRUPDO
5HSUH]HQWDQL: linezolid.
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SHUIX]DELOPOPJGHVXEVWDQDFWLYSHPO


 
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COORDONATE TEHNICE ALE ESWL
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LQIHFLLORU VXVSHFWDWH OD SDFLHQLL QHXWURSHQLFL L VHSWLFHPLHL Q
PHQLQJLWGR]DUHFRPDQGDWHVWHGHJOD 8 ore.
&RQWUDLQGLFDLL SDFLHQLL FX DQWHFHGHQWH GH UHDFLL GH
hipersensibilitate la acest produs.
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WURPERIOHELW GXUHUH OD ORFXO LQMHFWDULL 5HDFLL FXWDQDWH UDVK
prurit, urticarie. GasWURLQWHVWLQDOH GXUHUL DEGRPLQDOH JUHXUL
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PHGLXOOLFKLGLDQXULQLFDOFXO,QGLIHUHQWGHPRGXOGHSURGXFHUH
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fragmentabile (marea majoritate a calculilor renali).
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B. IMIPENEM/CILASTATIN (Tienam)
3UH]HQWDUH IDUPDFHXWLF IODFRDQH FX SXOEHUH SHQWUX VROXLH
SHUIX]DELO FX FDSDFLWDWHD GH  PO ce contin
Imipenem/Cilastatin 500 mg/500 mg sau 250 mg/250 mg
$FWLXQHWHUDSHXWLF bactericid, intervenind la nivelul procesului
RUJDQL]DUHFRQLFDDFXPUH]XOWGLQILJXUDXUPWRDUHILJ9, 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
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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,
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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
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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
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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
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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,
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&RQWUDLQGLFDLL DOHUJLH VH DGPLQLVWUHD] FX SUXGHQ vQ DFLGXOXULFLDUvQXOWLPDFDWHJRULHDFDOFXOLORUXRUGHIUDJPHQWDW
VDUFLQLvQSULPHOHOXQLGHDOSWDUH
5HDFLL DGYHUVH DOHUJLH WXOEXUUL GLJHVWLYH HR]LQRILOLH
neutrofilie, tombocitopenie, nefrotoxicitate la doze mari,
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duritatea lui, vis--vis de ESWL dar cele mai corcte estimari se
fac prin CT pre ESWL, stabilindu-se i densitatea calculului (UH) i
5HSUH]HQWDQLertapenem, doripenem, imipenem, meropenem.
A. MEROPENEM (Meronem)
3UH]HQWDUHIDUPDFHXWLF )ODFRQSHQWUXLQMHFLLLYVDXSHUIX]LL
ce FRQLQPJVDXJ PHURSHQHPVXEIRUPGHWULKLGUDWvQ
amestec cu carbonat de sodiu anhidru pentru constituire.
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YLWDO DO VLQWH]HL SHUHWHOXL FHOXOHL EDFWHULHQH 8XULQD FX FDUH
penetreaz SHUHWHOH EDFWHULDQ QLYHOXO VX ULGLFDW GH VWDELOLWDWH
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APARATELE DE ESWL
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componente:
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EDFWHULFLG SXWHUQLF D PHURSHQHP vPSRWULYD XQXL VSHFWUX ODUJ
de bacterii aerobe si anaerobe.
,QGLFDLL 3QHXPRQLLLQFOXVLYSQHXPRQLLQRVRFRPLDOHLQIHFLLDOH
WUDFWXOXLXULQDULQIHFLLLQWUD-DEGRPLQDOHLQIHFLLJLQHFRORJLFHGH
H[HQGRPHWULWDLERDODLQIODPDWRULHSHOYLDQLQIHFLLFXWDQDWHL
ale tesuturilor moi; meningite; septicemii.
Mod de administrare: injectabil i.v. n bolus lent sau n perfuzie
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UHFRPDQGDW HVWH  PJ LY OD ILHFDUH  RUH vQ WUDWDPHQWXO
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x PDVDPRELOFXSODWVXUVHLGHXQGHGHRF
x SXSLWUXOGHFRPDQG
a) 6XUVHGHXQGHGHRF
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energia ntr-XQ VSDLX OLPLWDW SURGXFkQG XQGH GH RF DFXVWLFH L
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
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2. (PLWRDUHOH FX DPSOLWXGLQH ILQLW crea] unde acustice
SXOVDWLOH SULQ GHSODVDUHD XQHL VXSUDIHH DFWLYDWH SULQ GHVFUFUL
HOHFWULFH([LVWGRXWLSXULGHDVWIHOGHHPLWRDUH $FLXQHWHUDSHXWLF efect bactericid, cu activitate pe specii de
-(PLWRDUHHOHFWURPDJQHWLFH
-(PLWRDUHSLH]RHOHFWULFH
b) 6LVWHPXOGHIRFDOL]DUHDOXQGHORUGHRF
n diagrama de mai jos, VH SRDWH XRU UHPDUFD IDSWXO F
SXQFWXOVSUHFDUHVHvQGUHDSWXQGHOHGHRFSURGXVHvQFXYSULQ
GHVFUFDUHD HOHFWULF UHSHWDW GH -19kV, coincide cu calculul
ED]LQHWDO UHSHUDW UDGLRORJLF ELGLPHQVLRQDO L YL]XDOL]DW SH FHOH
H. CEFTAZIDIM (Ceftamil)
3UH]HQWDUH IDUPDFHXWLF SXOEHUH SHQWUX VROXLH LQMHQFWDELO
500 mg, 1 g, 2 g.
Proteus, Enterobacter, E. Coli, citrobacter, Salmonella,
Pseudomonas, Haemophilus,Nisseria, Bordetella, Yersinia;
Stafilococul auriu.
,QGLFDLL LQIHFLJUDYHFXVSHFLLVHQVLELOHVHSWLFHPLLPHQLQJLWH
Mod de administrare: J]LvQSUL]H'R]HOHVHDMXVWHD]vQ
IXQFLHGHFOHDUHQFH-XOGHFUHDWLQLQ
&RQWUDLQGLFDLL aOHUJLH VH DGPLQLVWUHD] FX SUXGHQ vQ
VDUFLQLvQSULPHOHOXQLGHDOSWDUH
5HDFLL DGYHUVH DOHUJLH WXOEXUUL GLJHVWLYH HR]LQRILOLH
neutrofilie, trombocitopenie, nefrotoxicitate la doze mari,
IHQRPHQHQHXURWR[LFHFDQGLGR]GXUHULORFDOHGXSDLQjectare.
douPRQLWRDUHILJ9,6UHPDUFPGHDVHPHQHDIDSWXOF
pacientul este imersat ntr-R FDG FX DS GHJD]HLILFDW FDUH
SHUPLWHXQGHORUGHRF VDMXQJODLQWHUIDDGLQWUHFDOFXO LXULQD
FRQLQXWvQbasinet
Fig.VI.11.Diagrama litotritorului DornierHM-3
GXSMARSHALL LSTOLLER)
I. CEFPIROM (Cefrom)
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$FLXQH WHUDSHXWLF L LQGLFDLL FHIDORVSRULQ GH JHQHUDLD D
IV-D LQKLE VLQWH]D SHUHWHOXL EDFWHULDQ LQIHFLL DOH DSDUDWXOXL
XULQDU UHVSLUDWRU DOH SLHOLL L HVXWXULORU PRL EDFWHULHPLL
septicemii produse de germeni sensibili la cefrom.
Mod de administrare: i.v. 1-2 g la 12 ore; doza se reduce la
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&RQWUDLQGLFDLL KLSHUVHQVLELOLWDWH OD FHIDORVSRULQH VDUFLQ
DOSWDUHSUXGHQ- ODSDFLHQLLDOHUJLFLODDQWLELRWLFH-lactamice;
vQQHXWURSHQLHVHDMXVWHD]GR]HOH
5HDFLL DGYHUVH angioedem, bronhospasm, RF DQDILODFWLF
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&RQWUDLQGLFDLL - DOHUJLH OD FHIDORVSRULQH SUXGHQ la cei cu SDFLHQWXOXL D IRVW vQORFXLW FX R SXQJ VSHFLDO GH FDXFLXF
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DYDQWDMRDVDVRFLHUHDFXXQ$*
F. CEFIXIM (Eficef)
3UH]HQWDUHIDUPDFHXWLF capsule de 200 mg.
$FLXQH WHUDSHXWLF LQKLE sinteza peretelui bacterian; stabil
IDGH-ODFWDPD]
,QGLFDLL LQIHFLL DOH FLORU UHVSLUDWRULL 25/ DOH FLORU XULQDUH
FLORU biliare produse de streptococ, pneumococ, Moraxella,
Haemophilus, Nisseria, Serratia.
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GHVFUFULOH HOHFWULFH /LWRWULWRDUHOH HOHFWURPDJQHWLFH L
SLH]RHOHFWULFH DX VXUVD GH XQGH GH RF DFRSHULW FX DFHODL WLS
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vQGLDJQRVWLFXOOLWLD]HLIOXRURVFRSLDLHFRJUDILD
Reperajul radiologic vQ GRX SODQXUL DUH FHUWH DYDQWUDMH
majoritatea calculilor urinari sunt radioopaci; amplificatoarele de
LPDJLQHRIHUR EXQUH]ROXLHLQIRUPkQGFXPXOWSUHFL]LHGHVSUH
HYROXLDFDOFXOXOXLVXEWLUXOXQGHORUGHRFVHSRWORFDOL]DGHVLJXU
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.

 
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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
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YL]XDOL]HD] FDOFXOXO ,QGLIHUHQW GH WLSXO GH DSDUDW GH DLFL HVWH
UHJODW NLORYROWDMXO XQGHORU GH RF IUHFYHQD ORU L VXQW GHFODQDWH
PDL PXOW VDX PDL SXLQ ]JRPRWRDVHOH XQGH GH RF Q FD]XO
DSDUDWHORU FX UHSHUDM UDGLRORJLF SXSLWUXO GH FRPDQG HVWH ILH
instalat ntr-RvQFSHUHDOWXUDWILHSURWHMDWGHXQHFUDQGHVWLFO
UHVSLUDWRULLLQIHFLLFXWDQDWHFXJHUPHQLVHQVLELOLOD&HIDFORU
Mod de administrare: RUDO X]XDO  PJ OD  K vQ LQIHFLL
severe 500 mg la 8 h (doza max. 4 g/zi).
5HDFLL DGYHUVH HUXSLL FXWDQDWH SUXULW XUWLFDULH JUHD,
YUVWXUL UDU KHSDWLW WUDQ]LWRULH L LFWHU FROLVWDWLF
&RQWUDLQGLFDLL ODEROQDYLLDOHUJLFLODFHIDORVSRULQHSUXGHQ la
cei alergici la peniciline.
Asocieri medicamentoase: Aminoglicozide Metronidazol n
LQIHFLLVHYHUHDQDEROLL
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,9DFHIHSLPFHISLURP
A. CEFALEXIN
3UH]HQWDUH IDUPDFHXWLF capsule 250 mg, 500 mg si de 1 g,
SXOEHUHSHQWUXVXVSHQVLHRUDOPOPOPO
$FLXQH WHUDSHXWLF bactericid pe bacterii JUDP SR]LWLYH L SH
unele specii de bacili gram negativi.
,QGLFDLL LQIHFLL 25/ LQIHFLL UHVSLUDWRULL LQIHFLL XULQDUH L
cutanate cu germeni sensibili, n special gram pozitivi.
Mod de administrare: p.o. 0,5-1g, n 4 prize.
5HDFLLDGYHUVH JUHXULYUVWXULFUHWHULDOHWUDQVDPLQD]HORU
icter colestatic.
&RQWUDLQGLFDLLDOHUJLHLQIHFLLVHYHUHVHSWLFHPLL
B. CEFUROXIM (Zinnat)
3UH]HQWDUH IDUPDFHXWLF cps film 125 mg, 250 mg, 500 mg;
suspensie 125 mg/5 ml.
$FLXQH WHUDSHXWLF - spectru: Coci Gram-pozitivi: pneumococ,
Streptococ piogen, Stafilococul omini, Stafilococul epidermidis;
Bacili Gram-pozitivi: N. Pneumoni; E. coli, Proteus mirabilis,
Citobacter, Providentia, N. Influenzae.
,QGLFDLL LQIHFLL XULQDUH SQHXPRQLL PHQLQJLWH sinuzite cu
germeni sensibili.
Mod de administrare: LQIHFLL XULQDUH  PJx2/zi; pneumonii,
EURQLWHPJx2/zi.
&RQWUDLQGLFDLL- KLSHUVHQVLELOLWDWHODFHIDORVSRULQHSUXGHQ la
SDFLHQLLDOHUJLFLODSHQLFLOLQH
5HDFLLDGYHUVH - HUXSLL FXWDQDWH XUWLFDULHVWULIHEULOHIRDUWH
UDUUHDFLLDQDILODFWLFHJUHDYUVWXULGLDUHH
Asocieri medicamentoase: se pot asocia cu AG sau
PHWURQLGD]ROvQLQIHFLLVHYHUH
C. CEFACLOR (Ceclor)
o
de 70 XQJKLXO IRUPDW vQWUH GLUHFLD XUHWHUXOXL L GLUHFLD
calicelui inferior); lungimea calicelui inferior < 3cm.
x calculi bazinetali mai mici de 2 cm n diametru.
x calculi ureterali lombari SkQ vQFPDFURU aspect
radiologic VXJHUHD] SRVLELOD IUDJPHQWDUH calculi
semiopaci;
x calculi ureterali iliaci GDF DSDUDWXO GH OLWRWULLH DUH
DFHDVWIDFLOLWDWH
x calculi ureterali pelvini SHQWUX PXOL DXWRUL (6:/ fiind
SULPDRSLXQHvQDLQWHDXUHWHURVFRSLHL
&DOHD XULQDU VXEMDFHQW FDOFXOXOXL WUHEXLH V ILH
SHUPHDELO $FHDVWD HVWH XQD GLQ FRQGLLLOH GH ED] ce trebuie
YHULILFDW vQDLQWH GH RULFH WHQWDWLY GH OLWRWULLH 8URJUDILD LY vL
JVHWH L DLFL XWLOLWDWea de necontestat, preciznd att locul
REVWDFROXOXLFkWLJUDGXOGHSHUPHDELOLWDWHDFLLXULQDUH
&RH[LVWHQD LQIHFLHL XULQDUH FX OLWLD]D a constituit L
FRQVWLWXLHRSUREOHPIRDUWHVHULRDVGLQSHUVSHFWLYDWUDWDPHQWXOXL
L D HYHQWXDOHORU FRPSOLFDLL 7UDWDUHD HQHUJLF FRQIRUP
DQWLELRJUDPHL D HYHQWXDOHL LQIHFLL vQDLQWH GH OLWRWULLH HVWH
obligatorie.
&2175$,1',&$,,/((6:/
 Absolute: sDUFLQDLQGLIHUHQWGHEXQDHYROXLH tXOEXUULGH
FUD]VDQJXLQQHFRQWURODELOHREVWDFROGLVWDOFDOFXOXOXLGH
3UH]HQWDUH IDUPDFHXWLF: cps: 250 mg; 500 mg; suspensie
pentru DGPLQLVWUDUHRUDOPJPOPJPO
$FLXQHWHUDSHXWLFLLQGLFDLL FHIDORVSRULQ gen. III - LQIHFLL
cu stafilococi coagulazo-SR]LWLYL L QHJDWLYL L SHQWUX FHL
SURGXFWRUL GH SHQLFLOLQD] 6WUHSWRFRF S\RJHQHV VWUHSWRFRF
pneumonie, Moraxella catarrhalis, Haemophillus influenzae
WUDWDW VWHQR] XUHWHUDO DOW FDOFXO HWF SDFLHQW FRPDWRV
QHFRRSHUDQW +7$ QHFRQWURODELO SDFLHQL OD FDUH FDOFXOXO
QX SRDWH IL DGXV vQ IRFDU REH]LWDWH JU ,,, GHIRUPUL DOH
coloanei vertebrale).
 Relative: +7$ LQIHFLD XULQDU SDFLHQLL DIODL VXE
LQFOXV VHFUHWRUL GH -ODFWDPD] ( FROL 3URWHXV PLUDELOLV

 
 9,(;3/255,/((1'2852/2*,&(,0,1,0,19$=,9(
WUDWDPHQW FX PHGLFDLH DQWLFRDJXODQW REH]LWDWHD
DQHYULVPHDRUWLFHLVDXDOHDUWHUHLUHQDOHVDXFHLFXSDFH
maker cardiac.
35(*7,5($3$&,(178/8,3(1758(6:/
3HQWUX SDFLHQLL FDUH vor urma ESWL pe un litotritor cu
UHSHUDM UDGLRORJLF WUHEXLH V VH HIHFWXH]H R SUHJWLUH
preoperatorie. 9RP DYHD vQ YHGHUH R EXQ SUHJWLUH D WXEXOXL
GLJHVWLYSHQWUXFDDHURFROLDLVDXPDWHULLOHIHFDOHVQXDFRSHUH
calculul vizat.
&RQVLGHUPFsunt EHQHILFHXUPWRDUHOHUHFRPDQGUL XURJHQLWDO DQWLELRWLF GH SULP DOHJHUH vQ LQIHFLLOH SURYRFDWH GH
 evitarea cu 12-24 ore nainte de ESWL a consumului de
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
&RQVWUDLQGLFDLLHipersensibilitate la Colistin in antecedente.
6. CICLINELE
5HSUH]HQWDQLtetraciclina, doxiciclina,minociclina.
A. DOXICICLINA : (doxycylinum)
Forma de prezentare: &DSVXOH FRQLQkQG  PJ GR[LFLFOLQD
sub forma de clorhidrat.
$FLXQH WHUDSHXWLF Doxiciclina este un antibiotic DSDULQkQG
JHQHUDLHLDGRXDGHWHWUDFLFOLQH
,QGLFDLL ,QIHFLL DOH DSDUDWXOXL UHVSLUDWRU LQIHFLL DOH DSDUDWXOXL
Chlamydia, Calymmatobacterium granulomatis (granulom
inghinal), UreaplaVPDXUHDO\WLFXP&DDOWHUQDWLYODWUDWDPHQWXO
PkQFUXUL L EXWXUL FH SURYRDF IODWXOHQ EDORQDUH FX SHQLFLOLQ vQ LQIHFLLOH SURYRFDWH GH JRQRFRFFL JRQRUHH
IDVROHFDUWRILGXOFLXULIUXFWHEXWXULFDUERJD]RDVHFXVDX
IU]DKU
 HYLWDUHD IXPDWXOXL L D FRQVXPXOXL Ge cafea nainte de
XUHWULWH +DHPRSKLOXV GXFUH\ VDQFUXO PRDOH L 7UHSRQHPD
SDOOLGXP DJHQWXO HWLRORJLF DO VLILOLVXOXL LQIHFLL JDVWURLQWHVWLQDOH
LQIHFLLRFXODUHDOHSLHOLLLHVXWXULORUPRL
Mod de administrare: 'R]D RELQXLW la adult este de 200 mg
doxiciclina n prima zi (intr-R VLQJXUD SUL] VDX vQ GRXD SUL]H
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
ILDUW SDVWUDP XQF EUkQ] GH YDFL RX WDUL SkLQH
XVFDWLVDXSUMLW
 VH RSUHWH FX FHO SXLQ -10 zile nainte de ESWL
WUDWDPHQWXO FX $VSLULQ VDX 7URPERVWRS SHQWUX D HYLWD
VkQJHUDUHD SRVWSURFHGXU ,QYHVWLJDUHD SDUDPHWULORU
sifilisul secundar:  PJ]L IUDFLRQDW vQ PDL PXOWH SUL]H FHO
SXLQ]LOHUretrita cu Chlamydia: 2 x 100 mg/zi timp de 7 zile.
Trahoma: 200 mg/zi timp de 40 de zile.
&RQWUDLQGLFDLL HipeUVHQVLELOLWDWH OD GR[LFLFOLQ VDUFLQD L
SHULRDGDGHDOSWDUH
5HDFLL DGYHUVH DQRUH[LH JUHD YUVWXUL GLDUHH JORVLW
HQWHURFROLWH VDX FROLW SVHXGRPHPEUDQRDV UHDFLL DOHUJLFH
3UHFDXLL Se va evita administrarea capsulelor de Doxiciclina la
EROQDYLLSUH]HQWkQGDOWHUULIXQFLRQDOHDOHHVRIDJXOXL
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.
VDXIXQFLRQDOHQHXURORJLFH(VWHQHFHVDUSHQWUXDvQORFXLVDXD
XQWDRSRULXQHVHYHUDIHFWDWDWUDFWXOXLXULQDULscopul este de a
FRQVHUYDIXQFLDUHQDO
'HULYDLLOHXULQDUHSRWILcontinente sau incontinente.
&HOH PDL FXQRVFXWH IRUPH GH GHULYDLH XULQDU LQFRQWLQHQW
sunt ureterostomiile cutanate directe, transileale sau transcolice.
Ureterostomiile cutanate directe presupun deconectarea
XQXLD VDX DPEHORU XUHWHUH GH YH]LFD XULQDU L DGXFHUHD ORU OD
VXSUDIDD SHUHWHOXL DEGRPLQDO FX IRUPDUHD XQHL VWRPH SULQ FDUH
GUHQHD]FRQWLQXXXULQD
n cazul ureterostomiilor cutanate transileale
transcolice XUHWHUHOH VXQW GHFRQHFWDWH GH YH]LFD XULQDU L
DQDVWRPR]DWH OD H[WUHPLWDWHD SUR[LPDO D XQXL VHJPHQW
4. GLICOPEPTIDELE
5HSUH]HQWDQL teicolpanina, vancomicina, televancin.
A. TEICOLPLANINA (targocid)
3UH]HQWDUHIDUPDFHXWLF: flacoane 200 mg, 400 mg.
$FLXQH WHUDSHXWLF L LQGLFDLL LQIHFLL JUDYH FX JHUPHQL
Gram-pozitivi: urinare, respiratori, digestive, endocardite,
RVWHRPLHOLWH SURILOD[LH SUHRSHUDWRULH ID GH JHUPHQLL *UDP-
pozitivi.
Mod de administrare: i.m., i.v. 400 mg x 1-]LvQLQVXILFLHQ
UHQDO GR]HOHQXVHDMXVWHD]vQSULPHOH]LOHGHWUDWDPHQWOD
sau un clearance al creatininei de 40-60 ml/min doza se va reduce la
MXPWDWH
&RQWUDLQGLFDLLKLSHUVHQVLELOLWDWHODVXEVWDQDDFWLYVDUFLQ
DOSWDUHSUXGHQ QXVHHOLPLQSULQGLDOL]KLSHUVHQVLELOLWDWH
vQFUXFLDW FX YDQFRPLFLQD WHVWDUHD IXQFLHL UHQDOH L KHSDWLFH
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 LQILOWUDWLYHGXSFLVWHFWRPLDUDGLFDO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*,&
5HDFLLDGYHUVHJUHDGLDUHHGXUHULDEGRPLQDOHLFWHU arsuri,
HUXSii cutanate, urticarie, fotosensibilitate, sdr. Stevens
-RKQVRQ QHIULW LQWHUVWLLDO DUWUDOJLL KDOXFLQDLL WURPERFLWR]
anemie.
$VRFLDLLPHGLFDPHQWRDVHPeniciline, Metronidazol.
B. OFLOXACIN:
3UH]HQWDUH IDUPDFHXWLF cps filmate 200 mg, 400 mg; sol
9,,'(5,9$,$85,1$5(;7(51,1&217,1(17
([LVW R JDP ODUJ GH VLVWHPH GH FROHFWDUH SHQWUX
SDFLHQLL FX XURVWRPLH GDU WRDWH SRW IL vPSULWH vQ GRX FDWHJRULL
principale: QSLHVXQLFVDXFXGRXSLHVH
6LVWHPXOvQSLHVXQLFFXSULQGHDWkWSXQJDFROHFWRDUHFkW
LIROLDDGH]LYHVWHIOH[LELOLRFXSXQYROXPPDLPLF
6LVWHPXOFXGRXSLHVHFXSULQGHIROLDDGH]LYODFDUHHVWH
SHUIX]DELOIO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]DELOPJPJPJPO
LQIHULRDUHFRDSVVDXJDPE
$FLXQHIDUPDFHXWLFLGHPFLSURIOR[DFLQ
,QGLFDLLLQIHFLLDOHDSDUDWXOXLXURJHQLWDOUHVSLUDWRU25/ 1*5,-,5($3$&,(178/8,&8'(5,9$,(85,1$5
Mod de administrare: RUDOPJ]LSUL] XQLFSHUIX]LHLY (;7(518526TOMIE)
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
HYROXLHL SRVWRSHUDWRULL L SH WHUPHQ OXQJ D SDFLHQWXOXL FX
XURVWRPLH LQFRQWLQHQW &RQVLOLHUHD VH SRDWH H[WLQGH FX HIHFWH
EHQHILFH SHQWUX SDFLHQW L DVXSUD PHPEULORU DSURSLDL DL IDPLOLHL
acestuia.
,QIRUPDLLOH WUHEXLH V LQFOXG HOHPHQWH OHJDWH GH
inteUYHQLD FKLUXUJLFDO XURVWRPLD L UROXO DFHVWHLD vQJULMLUHD
VWRPHLLGLVSR]LWLYHOHXWLOL]DWHSDFLHQLLSRWILvQYDLSUHRSHUDWRU
V-L vQJULMHDVF VWRPD L V-L VFKLPEH GLVSR]LWLYXO FROHFWRU
6WDELOLUHD SUHRSHUDWRULH D ORFXOXL vQ FDUH YD IL SODVDW stoma este
XQHOHPHQWLPSRUWDQWSHQWUXDVLJXUDUHDHWDQHLWLLLDVFKLPEULL
facile a sistemului colector.
ngrijirea postoperatorie
,PHGLDW GXS LQWHUYHQLD FKLUXUJLFDO VWRPD WUHEXLH V ILH
DFRSHULW FX XQ GLVSR]LWLY GH FROHFWDUH WUDQVSDUHQW SHQWru a
SHUPLWH VXSUDYHJKHUHD IDFLO D DFHVWHLD ,QVSHFLD VWRPHL vQ
SHULRDGD SRVWRSHUDWRULH LPHGLDW WUHEXLH V ILH HIHFWXDW FX R
IUHFYHVLPLODUVXSUDYHJKHULLFDUGLRYDVFXODUH
!
 $
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
B. AMIKACIN:
3UH]HQWDUHIDUPDFHXWLFflacoane 2 ml, 4 ml (350 mg/ml); fiole
2 ml, 50 mg/ml, 125 mg/ml, 250 mg/ml.
$FLXQHWHUDSHXWLFLGHPJHQWDPLFLQ
,QGLFDLL LQIHFLL DOH DSDUDWXOXL XURJHQLWDO UHVSLUDWRU VLVWHPXOXL
RVWHRDUWLFXODU 61& DOH SLHOLL L HVXWXULORU PRL LQIHFLL
LQWUDDEGRPLQDOHFXJHUPHQLVHQVLELOLODDPLNDFLQ
Mod de administrare: i.m., i.v., - GXS HYDOXDUHDIXQFLHL renale
LDFOHDUDQFH-ul creatininei; 15 mg/kgc/zi GR]XQLFVDXvQ-
3 doze administrate la intervale de timp egale vQ LQVXILFLHQ
UHQDOVHUHFRPDQGDMXVWDUHDGR]HORUvQIXQFLHGHFOHDUDQFH-ul
GHFUHDWLQLQ
&RQWUDLQGLFDLLKLSHUVHQVLELOLWDWHODDPLNDFLQ n antecendente;
SUXGHQODSDFLHQLLFXPLDVWHQLHJUDYLVVDX%RDO3DUNLQVRQ
5HDFLL DGYHUVH ototoxicitate, nefrotoxicitate, bloc
QHXURPXVFXODU HUXSLL FXWDQDWH IHEU SDUHVWH]LL DQHPLL
DUWUDOJLL JUHD YUVWXUL KLSRWHQVLXQH DUWHULDO FUL]H GH DVWP
EURQLF
,QWHUDFLXQL PHGLFDPHQWRDVH QX VH UHFRPDQG asocierea cu
alte medicamente ototoxice sau nefrotoxice.
Asocieri medicamentoase: efect sinergic n asociere cu
peniciline.
3. CHINOLONE
5HSUH]HQWDQL: ciprofloxacin, ofloxacin, levofloxacin, norfloxacin,
pefloxacin, enoxacin, moxifloxacin, lomefloxacin, gemifloxacin,
gatifloxacin, sparfloxacin, trovafloxacin.
A. &,352)/2;$&,1
3UH]HQWDUH IDUPDFHXWLF cps 250 mg, 500 mg, 750 mg; fiole
POPJILRO; flacoane 50 ml, 100 ml (100 mg/50 ml, 200
mg/100 ml).
$FLXQH WHUDSHXWLF LQKLE ADN JLUD]D EDFWHULDQ sau
WRSRL]RPHUD],,EORFkQGGLYL]LXQHDFHOXODU
,QGLFDLL LQIHFLL JHQLWDOH SLHORQHIULWH FLVWLWH SURVWDWLWH LQIHFLL
UHVSLUDWRULL 25/ RFXODUH ELOLDUH D RDVHORU L DUWLFXODLLORU
spectru Coci Gram-SR]LWLYLLEDFLOL*UDP-negativi.
Mod de administrare: oral 250-500 mg x 1-2 ori/zi; sol
SHUIX]DELO-400 mg de 1-RUL]LODSDFLHQLLYkUVWQLFLVDXFX
LQVXILFLHQUHQDOVHDMXVWHD]GR]HOHvQIXQFLHGHFOHDUDQFH-ul
FUHWLQLQHLLJUDYLWDWHDEROLL
 ;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
C. OXACILINA
3UH]HQWDUH IDUPDFHXWLF capsule 250 mg, 500 mg, 1000 mg,
LSXOEHUHLQMHFWDELOIODFRQGHPJPJLPJ
$FLXQH WHUDSHXWLF EDFWHULFLG LQKLE VLQWH]D SHSWLGRJOLFDQL
DQWUHQkQGOL]DLPRDUWHDFHOXODU
,QGLFDLLLQIHFLLVWDILORFRFLFHORFDOL]DWHVDXJHQHUDOL]DWH
Mod de administrare: 2-3 g/zi n 4- SUL]H VROXLLOH LQMHFWabile
VHSUHSDULPHGLDWvQDLQWHGHLQMHFWDUHVHDGPLQLVWUHD]LYOHQW
VDXLPSURIXQGvQDFHOHDLGR]H
&RQWUDLQGLFDLLDOHUJLHLQIHFLLVHQVLELOHODSHQLFLOLQD*VDXDOWH
peniciline.
5HDFLL DGYHUVH DOHUJLH vQFUXFLDW FX DOWH SHQLFLOLQH UDUHRUL
9,,'(5,9$,$85,1$5(;7(51,1&217,1(17
'UHQDMXO XULQDU WUHEXLH V ILH FRQWLQXX LDU VLVWHPXO GH
colectare trebuie s ILH JROLW UHJXODW SHQWUX D DVLJXUD FRQIRUWXO
SDFLHQWXOXLLDUHGXFHSUHVLXQHDDVXSUDVWRPHL
,QVSHFLD VWRPHL WUHEXLH V GHFHOH]H RULFH VHPQ GH
LVFKHPLH 6WRPD QRUPDO DUH FXORDUHD UR] VDX URX VLPLODU
PXFRDVHL EXFDOH DVSHFWXO HGHPDWRV LQLLDO YD GLVpare n
XUPWRDUHOH - OXQL LDU vQ XULQ L vQ MXUXO VWRPHL VH REVHUY
acumulare de mucus.
,PHGLDWFHVWDUHDFOLQLFRSHUPLWHSDFLHQWXOYDILLPSOLFDW
WXOEXUUL UHQDOH DOEXPLQXULD KHPDWXULD SRDWH GHWHUPLQD
FUHWHUHD7*2
2. AMINOGLICOZIDE
5HSUH]HQWDQL: SURGXLGHELRVLQWH]VWUHSWRPLFLQQHRPLFLQ
NDQDPLFLQ WREUDPLFLQ VSHFWLQRPLFLQ SDURPRPLFLQ
vQ VFKLPEDUHD VLVWHPXOXL FROHFWRU QDLQWH GH GHFODQDUHD DFHVWHL
SURFHGXUL HVWH LPSRUWDQW asigurarea tuturor materialelor
necesare.
7LPSLLSULQFLSDOLDLVFKLPEULLVLVWHPXOXLGHXURVWRPLHVXQW
VXSULPDUHDFXEOkQGHHDSXQJLLLDIROLHLDGH]LYH
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
WUHSWDW YROXPXO FHO SXLQ  OXQL GXS LQWHUYHQLH DVWIHO vQFkW L
GHFXSDMXO IROLHL WUHEXLH V ILH PRGLILFDW FRUHVSXQ]WRU 3LOR]LWDWHD
SHULVWRPDO SRDWH UHGXFH DGHUHQD dispozitivului colector sau
poate determina dureri la desprinderea foliei, motiv pentru care
PDMRULWDWHD SDFLHQLORU SUHIHU V UDG VSWPkQDO WHJXPHQWXO
respectiv.
$YvQG vQ YHGHUH IDSWXO F vQ XULQD GUHQDW SULQ XURVWRPLH
VH HYLGHQLD] vQ PRG RELQXLW un numar semnificativ de bacterii
(bacteriurie), tratamentul antibiotic nu este recomandat la
SDFLHQLLDVLPSWRPDWLFLFKLDUGDF SUH]LQW uroculturi pozitive.
$SRUWXODGHFYDWGHOLFKLGHIUDFLRQDWSHSHULRDGD]LOHLHVWH
HVHQLDOSHQWUXDUHGXFHULVFXOGHLQIHFLLXULQDUH1XHVWHQHFHVDU
HYLWDUHDYUHXQXLDOLPHQWODSDFLHQLLFXXURVWRPLH
&RPSOLFDLL
&RPSOLFDLLOH GHULYDLLORU XULQDUH H[WHUQH LQFOXG stenoza
stomei, KHUQLD SDUDVWRPDO, LQIHFLD tractului urinar superior,
formarea de calculi si deteriorarea IXQFLRQDO UHQDO. n plus
SRW DSDUH FRPSOLFDLL OHJDWH GH IRORVLUHD LOHRQXOXL WHUPLQDO vQ
GHULYDLDXULQDUDFLGR]PHWDEROLFKLSHUFORUHPLFKLSRNDOLHPLH
KLSRYLWDPLQR]%GHPLQHUDOL]DUHRVRDVSURGXFLHH[FHVLYGH
mucus, anomalii de metabolizare a medicamentelor.
,ULWDLD WHJXPHQWXOXL SHULVWRPDO SRDWH IL JHQHUDW GH
contactul prelungit cu urina, leziuni mecanice (produse la
;0(',&$0(17()2/26,7(135$&7,&$852/2*,&
9,,0(',&$0(17()2/26,7(135$&7,&$852/2*,&
I. ANTIBIOTICE
1. PENICILINE ( lactamice)
5HSUH]HQWDQL: peniciline naturale (penicilina G, penicilina V,
procain penicilina, benzathil penicilina), peniciline rezistente la
betalactamaze (meticilina, nafcilina, oxacilina, cloxacilina,
dicloxacilina, flucoxacilina), aminopenicilinele (ampicilina,
amoxicilina), carboxipenicilinele (carbenicilina, ticarcilina),
ureidopenicilinele (azlocilina, mezlocilina, piperacilina).
A. AMPICILINA
3UH]HQWDUH IDUPDFHXWLF capsule 250 mg, 500 mg, 1000 mg,
LIODFRDQHGHPJPJLPJ
$FLXQHWHUDSHXWLFLQKLEVLQWH]DSHUHWHOXLEDFWHULDQ
,QGLFDLL LQIHFLLXRDUHL PHGLLGHWUDFWUHVSLUDWRUWUDFWXULQDU
ELOLDU IHEU WLIRLG WXVH FRQYXOVLYH OHSWRVSLUR]H LQIHFLL
SRVWFKLUXUJLFDOH GLYHUVH WHUDSLD LQLLDO D PHQLQJLWHORU FX
JHUPHQL QHLGHQWLILFDL LQIHFLL JUDYH VHSWLFHPLD HQGRFDUGite,
meningite, peritonite.
Mod de administrare: vQLQIHFLLOHXRDUHLPHGLLSR-4 g/zi la
KvQLQIHFLLOHVHYHUHLY-12 g/zi n 4 prize.
&RQWUDLQGLFDLL DOHUJLH LQIHFLL FX SLRFianic, anaerobi,
eterobacter.
5HDFLLDGYHUVHHUXSLLFXWDQDWH
Asocieri medicamentoase: DPSLFLOLQVXlbactam (ampiplus).
B. $02;,&,/,1
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
FRQFHQWUDWGHPHULRUFUDQEHUU\
$OWHUDUHD IXQFLHL UHQDOH UHSUH]LQW R FRPSOLFDLH PDMRU
JHQHUDW GH SLHORQHIULWD UHFLGLYDQW DVRFLDW FX REVWUXFLH
SRVWUHQDOVWULFWXULDQDVWRPRWLFHVWHQR]DVWRPHLVDXXUROLWLD]
,QWHUYHQLLOHFKLUXUJLFDOHUDGLFDOHSHOYLQHSRWDIHFWDIXQFLDVH[XDO
D SDFLHQLORU LDU DFHVW OXFUX SRDWH IL DJravat de impactul
SVLKRORJLF7UDWDPHQWXOGLVIXQFLHLHUHFWLOHDUHODED]DGPLQLVWDUHD
LQKLELWRULORUGHIRVIRGLHVWHUD]VLOGHQDILOHWF
6XSUDYHJKHUHDSHWHUPHQOXQJDSDFLHQLORUFXXURVWRPLH

$ 
 
 9,,'(5,9$,$85,1$5(;7(51,1&217,1(17
HIHFWXDW GH FDGUH VSHFLDOL]DWH WUHEXLH FRQWLQXDW vQ DPEXODWRU
prin controale la intervale prestabilite de timp, cu posibilitatea
HYDOXULL GH XUJHQ vQ FD]XO DSDULLHL XQRU FRPSOLFDLL

 
,;35267$7(&720,$5$',&$/
IX. 35267$7(&720,$5$',&$/
3URVWDWHFWRPLD UDGLFDO SUHVXSXQH DEODLD vQWUHJLL
SURVWDWH vPSUHXQ FX YH]LFXOHOH VHPLQDOH XUPDW GH
UHFRQVWUXFLDFROXOXLYH]LFDOLDQDVWRPR]DYH]LFR-XUHWUDO
35 SRDWH IL HIHFWXDW GHVFKLV SH FDOH UHWURSXELDQ VDX
SHULQHDO VDX ODSDURVFRSLF vQ YDULDQWHOH FODVLF VDX DVLVWDW
robotic.
35 HVWH LQGLFDW FD tratament curativ OD SDFLHQLL FX
ERDOSURVWDWLFPDOLJQvQVWDGLXORFDOL]DWODFDUHVSHUDQDGH
YLD GHSHWH  DQL ([LVW R WHQGLQ GH H[WLQGHUH D
LQGLFDLLORU35ODSDFLHQLLFXULVFFUHVFXWGHSURJUHVLHWXPRUDO
(PSA > 20 ng/mL sau scor Gleason > 8 sau stadiu cT3), la care
HVWH QHFHVDU L HIHFWXDUHD OLPIDGHQHFWRPLHL SHOYLQH H[WLQVH
bilateral, pentru a asigura un control superior al cancerului de
SURVWDWSHWHUPHQOXQJQDFHVWVHQVXURORJXOWUHEXLHVIDF
parte dintr-R HFKLS PXOWLGLVFLSOLQDU FDUH DQDOL]HD] ILHFDUH
FD]  LDU SDFLHQWXO WUHEXLH V FXQRDVF WRDWH RSLXQLOH
WHUDSHXWLFHLVILHLQIRUPDWGHFRPSOLFDLLOH35
0RUELGLWDWHDDVRFLDWFX35SRDWHILVHPQLILFDWLYLHVWH
Q PDUH SDUWH GHSHQGHQW GH H[SHULHQD HFKLSHL FKLUXUJLFDOH
&RPSOLFDLLOH LQWUDRSHUDWRULLLPHGLDWHLQFOXGKHPRUDJLDOH]DUHD
UHFWXOXLVDXDXUHWHUHORU+HPRUDJLDLQWUDRSHUDWRULHVHYHUHVWH
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imunosupresiv.
I. '(),1,,(
Transplantul renal este un proces compex prin care un rinichi
RELQXWSULQUHFROtare chirurgLFDOGHODXQdonator este implantat la
un receptor FDUH QHFHVLWD R IRUP GH VXSOeHUH D IXQFLHL UHQDOH
ILLQGvQVWDGLXOILQDOGHERDOUHQDOFURQLF
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compatibil din punct de vedere imunologic cu primitorul sau un
GRQDWRU vQ PRDUWH FHUHEUDO FkQG VH SUDFWLF GH RELFHL UHFROWri
multiorgan. Odat FX ULQLFKLL VH SRW UHFROWD L FRUGXO SOPkQLL
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etc.
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FURQLF FDUH QHFHVLW R IRUP GH VXSOeHUH D IXQFLHL UHQDOH FDUH
VXQW OXDL vQ HYLGHQ L WHVWDL GLQ SXQFW GH YHGHUH LPXQRORJLF
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II. (9$/85,35(23(5$725,,
A. EVALUAREA DONATORILOR VII
'RQWRULL YLL UHSUH]QW VXUVD PDMRU GH RUDJH vQ PXOWH UL
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x 'HWHUPLQDUHDFRPSDWLELOLWLLvQVLVWHPXO$%2
x Crossmatch,
x Determinarea gradului de matching HLA.
(YDOXDUHD VWDWXVXOXL GH VQWDWDWH VH UHDOL]HD] SULQ WHVWH
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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
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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
SXOPRQDUYHQWLODWRULLLVDXUHVSLUDWRULL XULQDU QHIURWR[LFLWDWHD imunosupresoarelor,
x EKG, optional ecocardiografie pielonefrLWD DFXW PLFURDQJLRSDWLD WURPERWLF
x ([DPHQ VXPDU GH XULQ VHGLPHQW XURFXOWXU hipovolemia, hipotensiunea).
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probe de concentrare, microalbuminurie, transplantare, (boli renale intrinseci QHIURSDWLDFURQLF
x (FRJUDILHDEGRPLQDO DJUHIHLQHIURWR[LFLWDWHDFURQLFDLPXQRVXSUHVRDUHORU

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x 6FLQWLJUDPUHQDOSHQWUXHYDOXDUHDUDWHLGHILOWUDUH DUWHUUHQDOREVWUXFLLGHWUact urinar, stricturi uretrale,

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

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LPXQRVXSUHVLYLDIXQFLRQDOLWDLLJUHIHLUHQDOH Antibioterapia  Diabet zaharat,

este obligatorie timp de 10 zile postoperator, ideal fiind ca  ,QIHFLLGRYHGLWH+,99+&9+%
polnavul (la externare) sDLERXURFXOWXUQHJDWLY
B. IMUNOSUPRESIE
Tratamentul imunosupresiv n transplantul de organe
DUH UROXO GH D PHQLQH XQ HFKLOLEUX vQWUH SUH]HQD JUHIHL L
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ale imunosupresiei:
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autoimune, neurologice,
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 7XOEXUULGHFRDJXODUH
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PLQRU FKLVW VROLWDU UHQDO KLGURQHIUR] FRQJHQLWDO SLHORQ
GH D VFGHD ULVFXO GH UHMHW DFXW vQ SULPHOH OXQL GXEOX XUHWHU UHWURFDY UHJXOD QH REOLJ V ODVP DFHVWXLD
posttransplant, ULQLFKLXOFDUHDUHRIXQFLRQDOLWDWHPDLEXQ
 3HULRDGD GH PHQLQHUH SUHFRFH FDUDFWHUL]DW SULQ 'HRDUHFH GXUDWD PHGLH GH IXQFLRQDUH D XQXL ULQLFKL
stabilirea unor regimuri imunosupresive individuale transplantat este de 10-DQLPD[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:
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antilimfocitari monoclonali (OKT3, anti-Tac,OKT4) sau organe.
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de apnee,

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 VIII. TRANSPLANTUL RENAL VIII. TRANSPLANTUL RENAL

x 'RX WUDVHH ((* HIIHFWXDWH OD LQWHUYDO GH  RUH GHVXERUHGHODUHFROWDUHLDUHFKLSDFKLUXUJLFDOWUHEXLHV
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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,(
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x Teste de laborator (grup sangvin, Rh, tipizare HLA, LQWHUYHLL FKLUXUJLFDOH GHVFKLVH PDMRUH WUHEXLH IFXW GH FDWUH
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(hemoculturi, uroculturi, culturi din sput), de suport KHPRGLQDPLFPRQLWRUL]DUHDGLXUH]HLLFRPSHQVDUHD

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

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 VIII. TRANSPLANTUL RENAL VIII. TRANSPLANTUL RENAL

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cel mai mult .
IV. PREZERVARE
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UHFROWULL L PRPHQWXO LPSODQWULL DUH XQ URO LPSRUWDQW vQ
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EDFWHULHPLHVDXIXQJHPLHVHURORJLH+&9SR]LWLYGDF
receptorul are srRORJLH+&9SR]LWLY
fuQFLRQDOLWDWHDXOWHULRUDJUHIHLUHQDOH  ,VWRULFGHPDUHLYHFKLIXPWRUULVFGHDWHURVFOHUR]
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
racire pentru rinichi este de 31 de ore. Q SUDFWLF OD vQFHSXW
rinichiL VXQW VSODWL GH VkQJH FX R VROXLH UHFH LDU XOWHULRU
vPSDFKHWDL L VFXIXQGDL vQWU-R VROXLH UHFH KLSHURVPRODU FX
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IXQFLDUHQDO
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50ml/mLQQXHVWHDFFHSWDWSHQWUXWUDQVSODQWDUHDXQXL
singur rinichi).
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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
FKLUXUJLFDO XURORJLF 'H FHOH PDL PXOWH RUL UHFROWDUHD L
transplantarea rinichiului (de la donatorul viu) se face succesiv
vQ GRX VOL GH RSHUDLL GH FWUH GRX HFKLSH FKLUXUJLFDOH
&RQH[LXQHDYDVFXODUVHHIHFWXHD]GHRELFHLODYDVHOHLOLDFH
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LQIHULRDU 5HFRQVWUXFLD WUDFWXOXL XULQDU VH IDFH SULQ uretero-
cistonHRVWRPLHFXGLIHULWHOHVDOHYDULDQWHGHWHKQLFFKLUXUJLFDO
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organe.
C. EVALUAREA RECEPTORILOR
7UDQVSDOQWXO UHQDO HVWH LQGLFDW WXWXURU SDFLHQLORU FX
LQVXILFLHQUHQDOFURQLF vQVWDGLXOFDUHQHFHVLW RIRUP
GH VXSOLHUH D IXQFLHL UHQDOH FDUH QX DX FRQWUDLQGLFDLL
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

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grefei renale. histoFRPSDWLELOLWLL GLQWUH SULPLWRU L GRQDWRU SHQWru un

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 $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
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 ([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,

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