Gynaecology Instruments and Patient Preparation

Equipment and Accessories Required

• Tenaculum: used to pick up small pieces of tissue, such as the anterior lip of the cervix
• Uterine Sound: used to probe the uterus and possibly dilate the cervix

Patient Preparation

• Procedure is done during the proliferative phase of the menstrual cycle (7th-10th day or 8th-12th day)
• Patient must avoid sexual intercourse from the onset of their period to the day of the exam
• ß-HCG test (Beta human chorionic gonadotropin test) should be carried out to rule out pregnancy or for patients with irregular menstrual cycles
• The patient is given 40mg Buscopan an hour prior to the exam
• Mild analgesics and prophylactic antibiotics may be given to reduce pain from cramps and potential infections
• The patient may be asked to empty their bladder to prevent displacement of the uterus and uterine tubes

Procedure

• Informed consent is obtained before the procedure starts
• Patient is placed in lithotomy position with legs bent at the knee or supported with stirrups
• Patient is draped with sterile towels and the perineum is cleaned with antiseptic solution
• Vaginal speculum is inserted and the cervix is localized and cleaned with antiseptic solution
• Cervix is cannulated and dilated with a balloon catheter to occlude the cervix and prevent contrast media from flowing out during the injection phase

Specific Indications

• Repeated infections
• Renal colic
• Flank pain
• Trauma
• Retention and decreased urinary output
• Kidney Stones
• Renal cell carcinoma
• Polycystic Kidneys

Contraindications

• General contraindications to contrast agent
• Hepato-renal syndrome
• Pregnancy
• Blood urea above a certain defined or normal level
• Anuria or absence of urine excretion
• Diabetes, especially diabetes mellitus
• Severe hepatic or renal disease
• Patients taking certain medications (e.g. metformin, Glucophage, Fortamet, Glumetza, Glucovance, Diabex, Riomet, Actoplus Met, Avandamet)

Projections

• Control projection
• Immediate projection
• 5-minute projection
• 10-minute/15-minute projection
• 20-minute projection
• Post-void projection

Hysterosalpingography (HSG)

• Refers to the radiographic examination of the female reproductive system, particularly the uterus and uterine tubes (Fallopian tubes)
• Involves injecting contrast material into the uterus under fluoroscopic guidance
• Patients should carefully wash their vagina with soap and water and change vaginal pads as needed after the procedure

Cystography and Urethrography

• Cystography: imaging the bladder before, during, and after administration of contrast via urethral or cystostomy catheter
• Urethrography: imaging the urethra before, during, and after administration of contrast via urethral or cystostomy catheter
• Goals: detect anatomic and/or functional abnormalities of the lower urinary tract

Indications for Cystography and Urethrography

• Recurrent urinary tract infections

• Vesicoureteral reflux

• Bladder contour

• Bladder diverticula

• Suspected rupture

• Fistulae

• Integrity of postoperative anastomoses or suture lines

• Bladder outlet obstruction

• Incontinence

• Hematuria

• Neoplasia

• Urethral diverticula

• Urethral strictures

• Bladder outlet or urethral obstruction

• Trauma

• Recurrent urinary tract infection

This quiz covers the equipment and accessories required for a gynaecological procedure, including tenaculum and uterine sound, as well as patient preparation beforehand.