Lower urinary tract instruments used in urology

1. Instruments used in lower
urinary tract and their
sterilization
Presenter :
Dr. Gaurav Sharma
1st yr DrNB urology Resident
Pushpanjali Hospital
Agra

2. Cystoscope
• Sheath
• Obturator
• Bridge
• Scope

3. Sheath

4. Sheath
• Length 22cm
• Parts :Beak
Shaft
Inlet and outlet vent
Colour code disc

5. Obturator
• Make tip of sheath smooth

7. Cystoscopic sheath
obturator
VIU sheath
obturator
TURP sheath
obturator
1.Knob Conform to beak of
sheath
Rounded Rounded
2.Groove Groove for
irrigation (19F and
above )
------ -----
3.Length Equal to sheath Projects just
beyond sheath
Projects just
beyond sheath

8. Bridges

10. Advantages of bridge
• Efficacious bladder emptying
• Larger size catheter can be placed after detaching bridge
• Ellik’s evacuator can be attached

11. Types of scopes
• Classified depending upon viewing angle

13. Adapters

16. Meatotomy scissor

17. Meatotomy scissor
• For ureteric meatotomy
• Cutting sutures and meshes migrated into bladder

18. Rigid biopsy forceps

19. Rigid biopsy forceps
• Cup shaped jaws

20. Flexible biopsy forceps

21. Stent removal forceps

22. Stent removal forceps
• Alligator jaw for strong grip
• Can be used for bladder biopsy if biopsy forceps not available

23. Sachse’s optical urethrotome

25. TURP Instruments
• Resectoscope sheath
• Working element
• Cutting loops
• Evacuator

29. Ellik’s evacauator

30. Modification
of bladder
evacuator

31. Toomey’s syringe

32. Semirigid ureteroscopes

34. Semirigid ureteroscopes
• Two sizes mentioned eg.7/8.5Fr
• One straight channel for pneumatic lithotripter

35. Flexible cystourethroscope

37. Parts
• Eye piece and focusing component
• Hand piece: Deflecting lever
Working channel
Light post
• Shaft
• Tip

38. Advantages of flexible cystourethroscope
• “Office cystoscopy” as less painful
• Easy manipulation across difficult curves

44. Cleaning and sterilization
• Cleaning :removal of visible soiling from objects using water with
detergents
• Disinfection :pathogenic microorganisms eliminated except spores
• Sterlization: spores too are eliminated

45. Steps of cleaning and sterilization process
• Pre cleaning: blood,tissue removal at point of use
• Disassembly
• Cleaning
• Packaging :for autoclaving
• Sterilization process
• Storage:shelf life according to porosity of storage
• Monitoring :biological /chemical monitors

46. Semirigid ureteroscope with cleaning brush

47. Flexible cystoscope with accessories for cleaning

49. Instruments of TURP Method of sterlization
Telescope Autoclavable,plasma, ETO,glutaraldehyde
Resectoscope Sheath Autoclavable,plasma
Working element Autoclavable,plasma
Loops Plasma,ETO
Light cable Glutaraldehyde,ETO
High frequency cord Glutaraldehyde,ETO

50. Instrument Method of sterilization
Flexible Ureteroscope Glutaraldehyde,ETO
Flexible cystoscope glutaraldehyde,ETO
Baskets ETO,Plasma
Semrigid ureterosope Autoclavable

51. Important points:
• Instruments should be dried after cleaning and then sterilized.
• Before using , instruments should be rinsed and dried after taking
them out from disinfectant solution.
• Glutaraldehyde : in 20-30 min. disinfection.
:if telescope soaked for 12hr ,fogging occurs.