Hôpital de la Pitié Salpétrière Mardi 24 Octobre 2006 Ecole d’infirmier(e)s de bloc opératoire Dominique LELIEVRE COOK®

PERCUTANEE NLPC (Néphrolithotomie Percutanée) COOK®

COOK® Review the diseases of the urinary tract Stones – the most common problem that we will discuss Hydronephrosis Renal Cancer UPJ Obstruction COOK®

STONES The typical patient is male in his 30’s when a stone first presents. Stone formation is typical in warm humid climates. Calcium oxalate most common type of stone. Supersaturation of the urine with certain types of crystals (ie. Uric acid, cystine, Struvite (magnesium ammonium oxide) and calcium phosphate that come out of solution. The saturation level is pH dependent, based on the type of crystal. Calcium oxylate stones are the most common. Calcium and uric acid stones may be related to dietary excess or assorted disease processes While struvite (magnesium ammonium phosphate) are related to infection. Cystine stones are hereditary are secondary to an inborn error of metabolism resulting in abnormal intestinal (small bowel) mucosal absorption and renal tubular absorption of dibasic amino acids, including cystine, ornithine, lysine, and arginine. COOK®

CYSTOGRAM POUR NLPC COOK®

90% percent of stones have some Calcium and are radiopaque 90% percent of stones have some Calcium and are radiopaque. Doctor will assess history of stones. UA, 24 hour urine, diet, IVP, cysto, RGP, CT if cannot see stone. COOK®

Hydronephrosis Dilation of the renal pelvis and parenchyma due to obstruction At first—increased peristalsis in effort to drain the kidney -the parenchyma is initially protected by dilation of the collecting system -after a while the organ tires and losed elasticity and hydronephrosis develops which can become irreversible Once the external part of the collecting system can no longer compensate, pressure is transmitted to the renal parenchyma The parenchyma slowly atrophies and becomes a non-functioning shell around the collecting system. Signs and symptoms Flank pain—radiating down the ureter Hematuria Chills, fever, burning on urination Nausea, vomiting, weight loss COOK®

NLPC COOK®

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PONCTION COOK®

PONCTION DU REIN COOK®

PONCTION RENALE COOK®

PONCTION COOK®

(avec extrémité de Chiba) AIGUILLES DE PONCTION SKINNY NEEDLE (avec extrémité de Chiba) 22 G – 20 cm 090010 & 090010-ET Utilisé pour la ponction. COOK®

AIGUILLES DE PONCTION AIGUILLE TROCART 18 G – 20 cm 090020 & 090020-ET en 2 parties 18 G – 20 cm 090020 & 090020-ET Utilisé pour le passage du guide. COOK®

AIGUILLES COOK® Aiguille « Chiba » 22 G 18 G Aiguille Mitty-Pollack : Introduction Guide COOK®

AIGUILLES Aiguille Trocart Aiguille de ponction COOK®

PONCTION RENALE COOK®

GUIDE d’ AMPLATZ AMPLATZ EXTRA STIFF : THSF-038-145-AUS Utilisé comme guide de travail lors d’une N.L.P.C. COOK®

GUIDE d’ AMPLATZ COOK®

GUIDE DE LUNDERQUIST LUNDERQUIST EXCHANGE : Réf 638448 Utilisé pour une procédure N.L.P.C comme guide de travail. Les dilatateurs d’Amplatz, ou ballons de dilatation du trajet, coulissent sur ce guide très rigide. COOK®

DILATATION COOK®

DILATATEURS DE FASCIAS COOK®

DILATATEURS DE FASCIAS FASCIAL DILATATOR sets: 072XXX Utilisé pour la dilatation des fascias. COOK®

SET D’AMPLATZ POUR N.L.P.C 075000 Set pour dilatation séquentielle du trajet de néphrostomie lors d’une NLPC. COOK®

BALLOON DILATION CATHETERS COOK ULTRA XX Ballon de dilatation pneumatique haute pression du trajet de néphrostomie. COOK®

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ULTRA-XX COOK®

NEPHROSCOPES COOK®

NEPHROSCOPE RIGIDE COOK®

NEPHROSCOPE FLEXIBLE COOK®

Direct Vizualisation of the stones with the Nephroscop. COOK®

COOK® Show scope through sheath. Clear sheath will be more radiolucent providing better visualization of the tract. COOK®

FRAGMENTATION DU CALCUL COOK®

SONOTRODE COOK®

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PERC-NCIRCLE COOK®

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MALECOT NEPHROSTOMY CATHETER Used for nephrostomy drainage in the renal pelvis.The Malecot catheter is placed percutaneously through an existing nephrostomy tract.The radiopaque stripes allow fluoroscopic visualization of the catheter’s position without masking the area behind the catheter. COOK®

MALECOT POSITIONING COOK®

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