Iimvavanyo zedayi ye-methylene blue zokuvuza komchamo neefistula: into eqinisekiswa yiswabhu eluhlaza okwesibhakabhaka

Kwiiveki ezimbalwa emva kotyando lwesinqe, isigulana siphawula ukuba umchamo uvuza ngokuqhubekayo. Sicinga ukuba lusulelo lwesinyi, sigqiba ikhosi yamayeza okubulala iintsholongwane, size sidideke xa ukuvuza kuqhubeka kungatshintshanga. Amayeza okubulala iintsholongwane ebengenakusebenza, kuba ingcinga yokuba yintoni ingxaki ibiphosakele. Usulelo kukuhlaselwa kwezicubu ziintsholongwane. Ifistula ngumngxuma: umjelo ongaqhelekanga odibanisa iindawo ezimbini ezifanele zahlukane, kule meko isinyi nelungu lobufazi. Akukho yeza lokubulala iintsholongwane livala umngxuma.

Yile meko kanye eyenzelwe uvavanyo lwedayi ye-methylene blue. Olu vavanyo alunyangi nto, alufumani usulelo, kwaye alwenzi uxilongo ngokwalo. Luphendula umbuzo omnye ocacileyo: ngaba ulwelo olukwilungu lobufazi luvela kwisinyi esizaliswe ngedayi? Yonke into ephathelele kule nkqubo, kuquka iindlela enokungaphumeleli ngazo, isekelwe kuloo njongo inye. Isishwankathelo sethu se-methylene blue kwezonyango sibeka olu setyenziso lokuxilonga ecaleni kweendima zale khompawundi ezigunyazisiweyo nezisaphandwayo.

Ingcinga engundoqo: ulwelo oluluhlaza okwesibhakabhaka olulawulwayo njengomkhondo

Umgaqo wenziwe walula ngabom. Isinyi sizaliswa ngekhathitha, ulwelo lungeniswa ngokuchasene nendlela eqhelekileyo yokuhamba komchamo, kusetyenziswa ulwelo lokuhlamba olungenazintsholongwane oluqulethe i-methylene blue exutywe yathamba. Akufanele kubekho ulwelo oluluhlaza okwesibhakabhaka kwilungu lobufazi. Ukuba olo lwelo luvela kwilungu lobufazi kwindawo engaqhelekanga, kukho umjelo odibanisa isinyi okanye i-urethra nelungu lobufazi. Idayi isebenza njengomkhondo, kwaye uvavanyo yindlela yokufumanisa indawo yokuvuza.

Oku kukhokelela ngoko nangoko kwiziphumo ezimbini. Okokuqala, uvavanyo lunokufumana kuphela ukuvuza okukwindlela yolwelo emva kwendawo efakwe kuyo idayi. Idayi eluhlaza okwesibhakabhaka ekwisinyi ayinakuze iveze ifistula edibanisa i-ureter nelungu lobufazi, kuba umchamo osuka kwi-ureter echaphazelekayo ufika kwilungu lobufazi ungakhange ungene kwisinyi. Okwesibini, isiphumo esibonisa ukuvuza sichaza indawo yako, kodwa asithethi nto ngomgangatho wezicubu, ubukhulu befistula, okanye indlela yokuyilungisa. Yiyo loo nto ucwangciso lotyando neenkqubo zokuxilonga lusoloko ludlulela ngaphaya kovavanyo lwedayi.

Uvavanyo lweziswabhu ezintathu, inyathelo ngenyathelo

Ukuhlolwa kuqala ngaphambi kokuba kusetyenziswe nayiphi na idayi. Ukuhlolwa ngesixhobo se-speculum kukhangela ukuqokelelana komchamo ocacileyo kunye nomngxuma wefistula okwilungu lobufazi, ukuba uyabonakala. Izikhokelo zaseYurophu zonyango lwenkqubo yomchamo zincomela ngamandla ukuthathwa kwembali yesigulana nokuhlolwa okujoliswe kwingxaki xa kukho ifistula yomchamo, kwaye akukho siphumo sedayi esithatha indawo yoko amehlo akubonayo ngokuthe ngqo.

Inkqubo esemthethweni yeziswabhu ezintathu, njengoko ichazwe kwingxelo yesigama ye-ICS/IUGA, ihamba ngolu hlobo. Iziswabhu ezintathu ezomileyo ezenziwe ngesiponji zifakwa ngokulandelelana kwilungu lobufazi: enye phezulu, enye embindini, enye ezantsi. Ezinye iindlela zisebenzisa iipakethi zegauze, iibhola zomqhaphu, okanye itampon, kodwa iziswabhu ezintathu ezahlukeneyo zezona zisetyenziswa kwindlela esemgangathweni. Emva koko isinyi sizaliswa ngekhathitha ngolwelo lokuhlamba olunedayi eluhlaza okwesibhakabhaka exutywe yathamba, kwaye ugqirha ujonga ukuba ulwelo oluluhlaza okwesibhakabhaka luyavela na kumngxuma okwilungu lobufazi ngexesha lokuzaliswa. Kubalulekile ukufaka iziswabhu ngaphambi kokuzalisa: ukufaka itampon emva kokuba idayi ichithekile kufutshane nomnyango welungu lobufazi kuqinisekisa ungcoliseko nesiphumo esingenantsingiselo.

Akukho bungakanani bolwelo, mlinganiselo wedayi, okanye xesha lokuyishiya ngaphakathi elinye elisebenza kuzo zonke iimeko, kwaye inqaku elinyanisekileyo lifanele likuchaze oko. Incwadi yoqeqesho lotyando lwefistula ye-FIGO ichaza i-60 ukuya kwi-100 mL yedayi exutywe yathamba, kulandelwe kukuhlolwa ngoko nangoko; ukuba akukho nto ibonwayo, isigulana siyahamba size sisele kangangemizuzu engama-30 ukuya kwengama-60 idayi isesesinyini. Enye inkqubo yasemva kotyando yasebenzisa i-250 ukuya kwi-300 mL, yaza yalumkisa ngokukodwa ukuba ukuzalisa ngokunganelanga kubangela iziphumo ezingabonisi ukuvuza nangona kukho ifistula encinci. Inkcazelo ye-ICS/IUGA ithi iziswabhu zisuswa emva kwemizuzu eli-10, kodwa ivumela ukuya kwimizuzu engama-30 xa umjelo mncinane kakhulu okanye ujijekile. Umyalelo onokuxhaswa kukuzalisa ngokwaneleyo ngomxube wedayi obuthathaka ngokwenkqubo yasekuhlaleni, hayi ukumisela indlela enye esebenza kuyo yonke indawo.

Ukutolika iziswabhu

Iswabhu nganye isuswa yodwa, kuze kubhalwe ubumanzi nombala wayo. Ukutolikwa okuqhelekileyo, ngokulandela iinkcazelo ze-ICS/IUGA:

Umqolo wesibini ngowona uyingozi kakhulu. Umbala oluhlaza okwesibhakabhaka kwiswabhu esezantsi kuphela sesona siphumo sinokuvela ngokulula kungekho fistula kwaphela, ngenxa yokuvuza komchamo okuqhelekileyo nge-urethra okanye ngenxa yolwelo oluluhlaza okwesibhakabhaka olubuyela umva lusuka kumngxuma we-urethra. Iswabhu esezantsi eluhlaza okwesibhakabhaka yodwa ayize ilugqibe uphando.

Uvavanyo lweedayi ezimbini: ukwahlula isinyi kwi-ureter

Xa umchamo uqhubeka uvela kwilungu lobufazi kodwa idayi yesinyi ingaze ibonakale kuwo, kurhanelwa umthombo ongasentla, kwi-ureter. Uvavanyo lweedayi ezimbini lwenza le mithombo mibini yahluke ngamehlo. Isigulana sithatha i-phenazopyridine ngomlomo de umchamo ube nombala o-orenji oqaqambileyo (inkcazelo esemthethweni isebenzisa i-200 mg kathathu ngemini kangangosuku olunye ukuya kwezimbini, nangona ezinye iinkqubo zasekliniki zisebenzisa idosi enye), kuze emva koko isinyi sizaliswe ngolwelo lokuhlamba oluluhlaza okwesibhakabhaka njengangaphambili.

Ingqiqo yoku isekulandeleni indlela yolwelo. Ukuba idayi eshiyeke kwilungu lobufazi iluhlaza okwesibhakabhaka, ulwelo luvela kwisinyi okanye kwi-urethra. Umbala o-orenji ngaphandle koluhlaza okwesibhakabhaka uthetha ukuba ulwelo luvela kwii-ureter ezingasentla kwesinyi. Ukuba yomibini imibala ikhona, oko kucebisa imijelo edibanisayo kuzo zombini iindawo. Umchamo ocacileyo kwindawo ephezulu yelungu lobufazi nangona isinyi sinedayi eluhlaza okwesibhakabhaka ukhomba kumthombo ongasentla kanye njengombala o-orenji. Le yinkqubo yokuxilonga ekhokelwa ngugqirha, hayi ulingelo lwasekhaya.

Icystoscopy negumbi lotyando

Uvavanyo lwedayi luyasebenza nakwelinye icala. Ngexesha lotyando lwesinqe, isinyi sinokuzaliswa ngokuchasene nendlela eqhelekileyo yokuhamba komchamo ngolwelo lokuhlamba olunedayi eluhlaza okwesibhakabhaka ngoxa kuhlolwa indawo yotyando; ulwelo oluluhlaza okwesibhakabhaka oluphuma luye kule ndawo lubonisa isiphene esisinyini, kwaye inkqubo inokuphindwa emva kokulungiswa ukuze kujongwe ukuba ukuvalwa kubonakala kungavumeli ulwelo ludlule. Enye indlela echaziweyo yasebenzisa ukuya kwi-600 mL ukulungiselela oku, nto leyo efanele iqondwe njengengxelo yotyando, hayi njengomgangatho omele usetyenziswe kwisinyi ngasinye.

Icystoscopy ichaza oko iziswabhu zingenako ukukuchaza: inani, ubukhulu, nendawo yeziphene zesinyi kunye nokunxulumana kwazo ne-trigone nemingxuma yee-ureter. Izikhokelo zaseYurophu zincomela icystoscopy kunye nokuzaliswa ngolwelo olunombala olungeniswa ngokuchasene nendlela eqhelekileyo yomchamo ukuze kuqinisekiswe ifistula, kodwa ziphawula ukuba ubungqina obuxhasayo bunqongophele. Enye inkqubo enxulumene nale kodwa eyahlukileyo ijonga ukuba ii-ureter zivulekile na ngexesha lecystoscopy ngokubukela imisinga yedayi ephuma kwimingxuma yee-ureter. Apha into esetyenziswa njengomkhondo kufuneka ifike ivela ngasentla, ngegazi okanye ngomchamo, kuba idayi efakwe ngaphakathi kwisinyi sele ingaphantsi kwee-ureter kwindlela yokuhamba komchamo kwaye ayinakuzivavanya. Ukubhidanisa ezi ndlela zimbini zedayi luhlobo kanye lwempazamo yokuqonda itheyibhile yeziswabhu ejoliswe ekuyithinteleni. Iinkcukacha zezi ndlela zotyando zikwisikhokelo sethu esihambelana nesi nge-methylene blue kutyando nasekuxilongeni.

Isizathu sokuba uvavanyo luphosise kuzo zombini iindlela

Isiphumo esingabonisi ukuvuza nangona kukho ifistula sinezizathu eziqhelekileyo ezimbalwa: ukuzaliswa kwesinyi okuncinane kakhulu, umjelo omncinane okanye ojijekileyo obufuna ngaphezu kwemizuzu elishumi, ukuvuza okwenzeka ngamaxesha athile okanye okuxhomekeke kwindlela umzimba omi ngayo, ifistula edibanisa i-ureter nelungu lobufazi engenakufikelelwa yidayi ekwisinyi, okanye ifistula yesibini efihlakele emva kweyokuqala efunyenweyo. Kolunye uphando olujonge emva kwiimeko zezigulana ezingama-56 ezazineefistula emva kotyando, ezili-10 kwezili-13 iimvavanyo zedayi ezenziwa ngaphambi kokuthunyelwa kwingcali zabonisa ukuvuza. Eli nani le-10 kwezili-13 ngamanye amaxesha licatshulwa ngokungathi lilinganisa ukukwazi kovavanyo ukufumana iimeko ezikhoyo. Akunjalo: iqela lezigulana lalikhethwe kakhulu, kwaye uphando aluzange luyilwe njengovavanyo lokuchaneka koxilongo. Uphando lweemeko zasemva kotyando luka-2020 luxhasa uvavanyo lwedayi njengenyathelo lokuqala elikhawulezayo, hayi njengenani elilinganisiweyo lokukwazi kovavanyo ukufumana ifistula.

Iziphumo ezibonisa ukuvuza ngempazamo nezo zilahlekisayo ubukhulu becala zibangelwa lungcoliseko: idayi echithekileyo xa kufakwa itampon, umchamo ofunxeka uhamba kwizinto ezifakiweyo, ukuchama ngexesha lovavanyo, okanye ukungakwazi ukubamba umchamo okuqhelekileyo okubangelwa luxinzelelo okanye ngumnqweno ongxamisekileyo wokuchama, kushiye umbala kwiswabhu esezantsi. Akukho nanye kwezi ebonisa ifistula, nto leyo eyenza ukuba ukubukela ngokuthe ngqo ngexesha lokuzaliswa nokujonga ukubuyela kolwelo kumngxuma we-urethra kube yinxalenye yenkqubo, kungekhona izinto ezongezelelweyo ezingenziwa xa kuthandwa.

Isiphumo sedayi esibonisa ukuvuza asisosiphumo se-UTI, kwaye ngokunjalo nakwelinye icala

Usulelo lwenkqubo yomchamo alwenzi umjelo phakathi kwesinyi nelungu lobufazi, ngoko usulelo lodwa alunakuze lubangele ukuvuza okuluhlaza okwesibhakabhaka ngaphandle komngxuma we-urethra phantsi kweemeko ezilawulwayo. Ezi meko zimbini zineempawu ezifanayo kwaye zinokubakho ngaxeshanye, nto leyo ebangela kanye ukuba zibhidaniswe. Umchamo obangelwa ngumnqweno ongxamisekileyo wokuchama okanye kukungakwazi ukuwubamba ngenxa yosulelo uphuma nge-urethra eqhelekileyo; ukuvuza ngefistula kuyayidlula loo ndlela. Ukuhlalutya umchamo nokuwukhulisa elebhu ukukhangela iintsholongwane kusabalulekile xa kurhanelwa usulelo, kwaye ukulinganisa i-creatinine kulwelo oluqokelelwe kwilungu lobufazi kunokuqinisekisa ukuba olo lwelo ngumchamo, nangona oko kungenako ngokwako ukubonisa indawo yokuvuza. Qaphela enye into enokubhidanisa iziphumo: amanye amayeza axubeneyo enkqubo yomchamo aqulethe i-methylene blue ayawutshintsha ngokwawo umbala womchamo, nto leyo efanele ikhankanywe kugqirha ngaphambi kwalo naluphi na uvavanyo olusebenzisa idayi.

Oko kusafuneka kwenziwe emva kweziswabhu

Uvavanyo lwedayi luqala uphando loxilongo; alulugqibi. Ukuhlolwa kwesinqe kuvavanya umgangatho wezicubu, amanxeba ashiyekileyo, nendawo yefistula. Icystoscopy ne-urethroscopy zibonisa iindawo zemingxuma yangaphakathi ngaphambi kwalo naluphi na ulungiso. Xa kurhanelwa umthombo okwi-ureter okanye izakhiwo zomzimba zingacacanga, i-CT enesixhobo sokubonisa umahluko, enesigaba esisemva sexesha lokukhupha ngomchamo, okanye i-MRI ibonisa inkqubo ephezulu yomchamo, kwaye i-retrograde pyelography inokubonisa ngokuthe ngqo i-ureter engacacanga. Kukho uthelekiso ne-ultrasound: kuphando oluncinane lwezigulana ezilishumi elinesibini lokujonga ukuba indlela inokusetyenziswa na, i-color Doppler ephuculwe ngesixhobo sokubonisa umahluko yahlula ngokuchanekileyo iimeko ezili-11 kwezili-12, kodwa eso siphumo sesendlela ye-ultrasound, hayi uvavanyo lwedayi (uVolkmer noogxa bakhe, 2000).

Uvavanyo lwedayi luyaphinda lusetyenziswe nasemva konyango. Iingcebiso ze-FIGO zenkqubo elungileyo zicebisa ukujongwa ngedayi kwiintsuku ezili-10 ukuya kwezili-14 emva kokulungiswa kwefistula, ngaphambi kokuba kususwe ikhathitha, isigulana sikhohlela ngoxa sibukelwe (uBrowning noogxa bakhe, 2025). Uvavanyo olungabonisi kuvuza kolu tyelelo luthetha ukuba akukho kuvuza ngefistula kubonisiweyo ngelo xesha; aluqinisekisi ukuba ukuvuza kamva ngenxa yokungakwazi ukubamba umchamo, ukugcinakala komchamo, usulelo, okanye umthombo okwi-ureter ongakhange ufunyanwe akunakuze kwenzeke.

I-methylene blue inenye indima yokuxilonga efanele igcinwe yahlukile kuphando lwefistula: ikwasetyenziswa ukujonga ukuba imibhobho yesibeleko ivulekile na, inkqubo echazwe kwisikhokelo sethu sovavanyo lokuchuma nokuhlolwa kokuvuleka kwemibhobho yesibeleko. Idayi iyafana, kodwa umbuzo nezakhiwo zomzimba zahlukile. Ukugcina umbuzo unxulumene nesiphumo sisiseko sonke sovavanyo lwedayi. Iswabhu eluhlaza okwesibhakabhaka iqinisekisa ukuba kukho indlela yokudlula kolwelo. Yonke enye into, ubukhulu, ukuba inokulungiswa na, noko kulindelekileyo kwixesha elizayo, kusafuneka kuhlolwe.