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Can you still see me? Yeah, I can see. All right. Great. So that's a slave. I'm just going to give it a couple of minutes, serve on conjoined, and then we can go ahead and stop. Yeah, No problem. Okay, just a second was going to get my charger, just in case. That's fine. No problem. Oh, yeah. Three. All right. Okay. So I think old. Go ahead and start this now. You're okay with that, But you ready? Yeah. Money. Great. Okay. You hear me? All good. Everything. Yeah. Yeah, that's that's brand great. Thank you, everyone for joining us today. Today is going to be the last session of the mind. The belief urology Siris to Thanks for all joining us. Um, today, Doctor, bra is going to give us a shortened sweet, um, syriza session. Basically on, um, some practical tips in urology for junior doctors and juniors in general. And, uh, hopefully you could You can all remember this days to come when you're working on the urology ward. So we'll go ahead and introduce you brought. Go ahead. Hi, Zack. Thanks. And, uh, hello, everyone. Good evening. Thanks, Zack. And thanks Monday. Believe for having me and give me the chance to actually present to everyone here. Uh, my name is, but I'm one of the foundational to doctors and are currently working a hospital for any general hospital, which is in the northwest of England. It is about 40 minutes. Drugs to the lake district. Very small hospital, really? In a very small town. So, um yeah, a lot of response that we have some sort of many more, but yeah, I thought I would get uses chance of actually talk to you guys about my experience in urology. This session is actually not going to be so informative. Well, not so educational. About sort of more off my experience and things that you could sort of maybe hopefully use along Ah, your journey, whether you're doing urology or, um, whether you're just coming across your surgical on cause I might, you know, cross cover urology. Right? So basically is gonna talk to you guys about my urology experience. Talk to you guys about about urologists. Surgical cure the things to look forward to. Junior year old replacements and practical tips that you can hopefully, um hopefully be used for beneficial to you. all. And then a d end. Talk to you guys about some neurologic emergencies just briefly, even before we can cook on with Westchester. Unfortunately, my consulting was supposed to be giving this talk with me, but he's off sick at the moment. Um, so maybe hopefully in the near future, we could probably possibly have ah, session where we can both talk to you guys about some I've experienced basically working a district small district hospital. But the reason why we all basically wanted to give you this talk is that, um, urology in med school was basically just covered as a topical other than the sweetness specialty on did just really was brushing over in medical school. Initially, you, when you come across a urology, when you start working, you might you might get this sort of daunting feeling, daunting experience. Um, and it's normal because because of the limited experience that you have Ah, urology actually isn't expanding specialty. So it's normal for you to feel out of your depth initially. Um, but hopefully that should improve for a limitation. And one thing that I need to tell you guys is that your allergies actually really, really fun. Um, if you make the most out of it, you will actually enjoy, and you never know. That's that's the best thing that I when I first joined this, I wasn't quite sure on. Was was insure off. What expect? Out of the irritation, But at the end of it, I actually have it managed to sort of convinced me to do a, um a security. Really? Um, so I have done urology when I was an F one that was not seeing doing sort of peak orbits, if you see, um, I was actually only junior doctor team. I did have a CT one doctor with me, but she sort of, um, left in January because she had a lot of animal even studied. Leave book together. Um, so as you can, as you can see, can expect I didn't have a lot of time if you eat. Unfortunately, but what I did have is actually a lot of 1 to 1 teaching, which was consulting dead. Um, I did have a lot on a lot. A lot of practice on because you're the only doctor in a team you to get quite a lot of people really simple. Um, the interesting thing is that we didn't have a urology ward. So all of our patients who actually are climbing in the surgical wards, medical wards and just can't get around the hospital and towards the end, you action to become everyone's favorite because you're the only one working day. And what was also really beneficial for me is that we did have some sort of weekly the car mental teaching sessions. And you do get that experience. I did manage to get some experience teaching regionally locally two different sort of healthcare professions throughout. So I thought I would just give you a sort of the grief, um, overview of what My identity basis was on neurology. So I would start urology and my much my shifts doesn't about 88 15. But I would usually used to come early, 7 45 to about eight when and this is when I actually start going through all the patients all the new basis that we have, um, making sure I know where all the patients are. I would also do my own money minute round, making sure that I actually know and I can put a sort of, ah, face to each of the names I have in my list. Um, from 8. 15 and to 11. AM This is this is basically would be used to go on more drones and we would go through the referrals. And this was actually really valuable teaching time because every time we see a patient, we would actually stop for, like, 5 to 10 minutes and actually talk about the patient. Talk about the management. The consultants were really great, as they would actually give me. The question is to sort of being full with the management and be involved with vision, making that on otherwise I know people wouldn't be involved in after that time. From 11 to about 12 30 PM I would be sort of just catching up on my documentation on doing war jobs, including discharge. Summary is making sure that everyone leaves the warden's. It leaves the hospital in time because we were short of bed sometimes, Um, and then after that, after that time you were sort of just go from my lunch and then second coffee break on, then from 11 15. So about 5 10 5 gm is This is what I would be chasing blood streets and scans doing random job such as cannulas catheters and all the other believes from From all the other words, um, if if the world required, I reduce this sort of chance to go on theater in clinics, um, otherwise, I would just sit there and actually work on my audience like here. I have actually had a quite a few on. It's in curious to work on doing my religion, which is which is great. Really? Eso obviously this is not, like a fixed sort of, um, timeline of what I would do about it, just roughly. But I used to do, uh, pretty much apart from your own cause. Obviously, you get you get thrown out here and there sometimes. So, yeah. Um, so urologist surgically, really? Basically what discriminates? Sort of urology from the rest of the others. It's basically because you get the best of more threads. You get a bit of medicine, a bit of surgery combined, which is what I love about, uh, urology. Because too much surgery and too much medicine can be a bit overwhelming. So urology is that perfect mix. Really? Well, you can do a bit of both, Um, you would have relatively short one drones. Obviously, that depends on where you work. Um, you do get a lot of hands on experience. Experience in practice. When it comes to actually theater when it comes to cap, it is when it comes to the sort of blood in Washington the other position will be involved in. Ah, you also get a mix off. Ah, good mix. I would say about off short and long preparations. Uh, again, it depends on where you work. And then as a consultant or as a registrar, he would actually I mean, they would have actually fairly good towards my balance, which is, uh, which is what is sort of, um, the thing that people look forward to the most number. These, um I thought I would talk to you guys about things that you should look sort of look forward to and hopefully enjoy when you were doing urology. So obviously the surgical experience is there. But also, the most important thing is actually the new schools that you would be able to acquire, such as the catheter insertion handling. Cystoscopy is doing other procedures of lather wash out and cetera. And the most important thing is that you can actually try and back about them to your other ones of her F twos or fellow medical students, if anything and and in urology. What when I when I actually realize that you do get that sort of instant feeling of satisfaction reward is to treat patients because you don't have that sort of high turnover rate in urology, and you only use that once we took away. A simple procedure in setting catheter could bring a lot of sort of, uh, relieve to patients. And this is where you sort of get your satisfaction report from and again, you do end up, um, having the chance to work within a really, really big entity. But it's the cancer patients or whether it's our decision making, they do it on a day to day basis. But, um, overseeing urology, you would come across a lot of catheterization. Um, so it is really important for you to sort of know how to do it properly and for you to be able to do it properly. I thought, um, I was sort of give against some sort of tips and tricks on how to do it. So good understanding of the night to me is actually key to for you to be able to do it properly intimately on D, making sure you have sort of have a good grasp of the Penis. And you lift that up about 45 degree angle through super Buddy. This will allow you to straight in the urethra, and it would be sort of more straightforward in sexual. Uh, you're gonna insert the catheter into you sort of fever it combines of the prostate and then once that once you feel that you want to lower it down until you sort of until the Penis is actually almost on the same level of the body. Sometimes I have seen is that if you twist the catheter junkie as soon as you inserted within your between between your index finger and thumb, you can actually help sometimes, Um, so ah, make it easier. And now you will definitely come across this whether you're doing urology or you're doing other sort of specialties. But the two common reasons for and feeling a male can transition would be number one obviously enlarged prostate for you to be able to sort of roughly gauge whether it's the prostate, is not allowing to insert a catheter or not. And the way I think about it is if you have any large prostate and you would be able to solve, advance roughly about half of the country into the urethra before it bounces back and stops going, Ah ah, for me. Ah, what I would suggest is actually trying to use a catheter with sort of a larger diameter. So these things catheters are less less likely to cause any force messages on on sort of steady A to push. If you're unable to do that, then I would suggest using a team in tip or chordee tip catheter and only suggest you doing that only when you're familiar. Comfortable descriptions. Initially, I was just going around speaking to see, and he's speaking to you. Just trust if you're doing urology and making sure that you do know what the differences are between both and how to use, but they're fairly straightforward, but there are some sort of tips and tricks that you would want to use in real life that would make it easier. So here this this is what we call a cognitive catheter. It's almost the same as the normal one. But a Z concede here is that sort of elevated sort of tipped, and this helps you with this helps on the prostate. Every conscripts is through, and it's quite rigid here. It screens to the prostate in it goes in smoother a team, it Timentin catheter is almost the same. But here it's It's made up of the different material, really, and it's quite smaller here. So this whole this whole sort of, um, shape allows you to sort of navigate through the prostate if it's if it's an indoor one. Ah, the second reason is a ureteral stricture. So difference between the urethra stricture and a prostate enlargement is, um, in the urethra stricture, you would be able to you only be able to sort of advance a little way into the ureter before the battery would stop advancing forward. So what I would suggest is actually using a different topic at the which is silicon. Get up and try and use a smaller one, because the stricture might be quite small, as you can see here, this is what I mean by a stricture here, So if you have a smaller sort of catheter, you might be able to navigate through. But the most important thing is you're actually you would wanna not trying to many times. And if you can get it in, then ah, my advice is to call a senior for first on her because they would sort of them up for a flexible cystoscopy got insulation or won't be something. What we call if you refill the irritation or the other option is a super quick after that, which I'll talk to. You guys go right, No bacon gel. This is one of this is this is going to be one of your sort of best friends. When you work in urology, it is very important. You need to sort of use it before any catheterization. The most important thing is actually not rushed through in certain sort of pushing gel in your What you want to do is you would have ordered the Penis up and basically trying push the gel in very slowly. Once that is done, I would also try and recommend that you claim the refugee in Italy because that will sort of give you more time for it to work. And the more time you give for your patient based, the more the more they be relaxing. The easy for you to proceed with the catheterization if you find it difficult or if you know the patient is difficult. But your eyes are with recommend using more than one instead. If if if you have, if you ever face ah, difficult patient. Um, obviously, before doing any procedure you would want to obtain and consent from the patient. So it is very important. Too expensive and what the procedure involves and the potential risks the potential that you might cause pain and all. And, ah, basically all this acute risks of countries issue. We're going to make sure that you're actually going through education so it will obviously cause a bit of bleeding was cause a bit of pain. Sometimes four. Specify is depending on how depending on the anatomy of the patient and how difficult it is for you to insert it. There's always a chance of failure, refill damage, perfect. Morse's new neurological emergency, and it's always sort of risk of infection, Really. So these are the Saudi sort of risk that you were gonna go over with the patients. Um, now, we do have different types of additives again. So we do have the short term cut. It is. These ones can remain in. Sit up for about four weeks. Ah, my advice is before you actually, um, unwrap the catheter. Have a read about that on the right on the back, off the catheter sort of packaging. And it should tell you how many you can use each other before, um, some of them are. Long term category is, which is most of the catheters in the hospital. I would say these are made of silicon, so they can actually mean in in place for about 12 weeks. Now, the sense that you might come across that between 12 to 16 French. Uh, the bigger the bigger the number, the bigger the size. But you would really When you get when when we're talking about to be cancerous, you would not really want to go over 16. Something was 16 would do the job in on dmard. Really? And we do have seven is our, uh, cold three categories. And now these countries, they're sort of a bit wider than the normal two week after that, you would see on a day to day basis. Uh, we usually these usually reserved these catheters for hematuria, um, allow continuous segregation and to do better wash it. But I'll talk to you guys about later. This is our three recapture Looks like so it's essentially the same as, uh, the normal Catholic. But it does have this extra channel here. Right? So this is where the extra glass of the dreams all the u. N. This is where you would inflate your bedroom. And this is the third child where you would sort of, um, use Ah, Teo, do it a Gatien for blood, for hematuria or for you to do a bladder wash up. It comes in different sort of sizes as well. So the best thing to do is actually put the best. The best was are found so far when when I was practicing a size 18, Ah really gets the which I found that it doesn't drop pretty well. This is just another picture of how it looks like, really, and you would come across to the suprapubic catheter tests, and I have to admit, when I came across it the first time. I was quite intimidated because I thought it was sort of, uh, invasive procedure that I have to do. But, um, my advice is not to panic. It is actually easier than your if you consider to insert or three place. But the most important thing is free to never actually attempt, insert. And you want yourself. You need a urologist for that. And if the catheter is, if the Suprapubic catheter is getting place for the first time, I would recommend calling the urologist because, um, there might be some potential complications initially. So make sure that your oldest is informed. Ah, and you could observe them and see how they do it so you can learn from them. This is how it actually looks like, Um, so there's a certain names just it's just a super pubic want. Instead of putting you through the urethra, you go through a super pubic hair, and that's how it looks like I'm on a real patient. This is what it is, really, so it's essentially you go through the abdomen and then you go to the The actual catheter is in the bladder itself, so it has nothing to do with urethra. So I just thought show you is how he looks like, Really. And you would come across a lot of antibiotic administration when you're doing urology. So I'm favorite antibiotics. Two years are gentamicin and super Fluxus in, so knowing when to use for flat take antibiotics really can be useful. So, um, normally we would use it before for patients who have had previous infections from catheterizations or they're at a high risk of infection if they're even suppressed and what not? And if you come across difficult patients when it comes to get authorization and if they're at risk of in the car like this and if you're not sure, always ask. So you were almost after inciting catheter. You would always, always want to make sure that you measure essential the divorce him off the, um, after you inserted So what? I mean, it is after inserted. Stay there for a while, see how much, um, urine has actually been draining, especially when you're dealing with an acute urinary retention and document that, uh, the consultants need to know about this. It's ah, it will sort of, um, change the management based on, uh how much Stay patient, actually. Dreams? No. Um, when you're in stating cattle, you would wanna document how much Ah, born in. How much ml is have you putting into a stare? What happening to balloon? Because he will help you. It will help you or the people who are actually about to take the catheter out because some creepy catheters need to be inflict with more than just an email. But sometimes you have to put 20 sometimes 25 sometimes 30. So we everyone is to know how much you have actually put into the building before deflating it. Um, you would also wanna document the procedure itself, including that you get consent from the patient and findings of anything difficult conizations. Um and what not, and most important thing really here is to replace the foreskin, the original position it means. And this is to avoid having, ah, for a few more cells, which is a urological emergency. Ah, never use a few more comfortable for me. A patient, a lot of human catheters will have a big label in the middle that sees female catheter for female use. Never, ever forced the catheter because you would put the patient at risk of force messages and potentially having a more complicated procedure than I just actually normal. Uh, never inflate the balloon before your urine is draining. I've had instances, incidences where some Ah, some of the patients have had the ah balloon inflated within the prostate area. And of course, a lot of pain for them. So just inflate inflate the balloon when whenever you see you in, because, I mean, you're you're more less in the bladder and bladder wall shots, right? So BP is one really fun procedure that have come to man. I've learned it from the nurses and, uh, planted from the consulting the first time. Really? And we do normally use that to remove clots from the bladder and a block A catheter normally within patients who have had the material and what not so they criticize You were quiet. Is a 15 minute syringe quite a big one. Yes, you need the bladder irrigation through it, which you can get from any surgical ward on, and you need a large role for you to sort of put in in our company. Explain to you guys have to do a bladder wash in a bit, so you would really make sure like that fever catheter is inserted. Initially, you were doing a disconnect irrigation fluid to do it. One of measure the bladder volume using a better scan. What not you don't have a place. The end of the catheter in the ball. That after story. About what? Why, like down the points with an alcohol wipe trying. Squeeze the addition fluid into the irrigation port, which is a very channel of the castor using the syringe. And you need to take no off, how much you put in and how much comes out and what color on the president's off clots. Really, because this is, well, this one. Influence the management. If you feel like that, the catheter is not freely draining urine than what I was just this gym. Just try and gently pull back on the syringe, Um, and do not keep putting more in if nothing comes out because you were put the patient at risk of sort of, ah, being uncomfortable and, uh, if it would be in pain on, especially if the cat is not draining. If you come across any further trouble during that Contact your seniors or the urology team. And if you're not sure, speak to the nurse is on the ward. They're actually quite good at this. The first time I remember did it doing it was when the nurse have actually shown any other do it and just sort of, uh we find my skills When, uh, I've been on a water and I had to do it in front of the consultants. So in doubt, if it ever end up, just just call for help. Pretty. And you would always gonna have one of these bad boys with you on a war drawn. Um, you will pretty much almost always have to do, uh, well, not you. But most of the time, I think when something would have to do a theory on the patients and, um having and the lubricant gel with you, uh, will be in handy because, honestly, I have had trouble sometimes finding it on some of the bone, especially if it's a medical word. They don't know where they put in. It takes a bit of time, So if you have this in your pocket all the time, you will come in handy. Um, so things that urology have sort of help me gain is and I've sort of been nicknamed the catheter in general, my hospital by some of the medical registrar us Some of the ah, the F two is my colleague. Some of the F ones because you you with at the end of your rotation, you would sort of alone to do with different catherization. And you know how to use different types of cancers for different types off sort of patients. Um, I did sort of get the confidence I had. I have more confidence in dealing with the relatively emergencies which otherwise I wouldn't be able to before if if if, using for urology, I've learned to be sort of more regiment independent being so, the more the only doctor in the team. And most importantly, uh, I was able to sort of game become a safer doctor because if if I was ever in doubt, I would always call for her. And that's what that's what they expected to do as an f phone or enough to really And if sort of made me bit more organized because obviously the concepts will um will depend on you a lot for sort of leaving the world runs and knowing what your patients are in for what? You're a patient where your patients are? Um, no. Lastly, I just wanted to sort of a shine some light on the religion emergencies that are important to recognize and act upon or escalate If if you're not sure. Ah, now, as I said, uh, well, I was supposed to get this court. This city is sort of talked with my consulting, unfortunately, is not here. He he had some sort of tips and tricks on how to deal with these emergencies, but it's it's it's good if you sort of good. Uh, um, know what the urologist emergencies are and sort of try and recognize them and act upon them. And And if you ever come across this this presentations, so it includes a culinary attention, it's always it's always an emergency for you. For a neurology hematuria. More or less yes, um, testicular torsion, if you're more contest and a squatter pathologies and a very important one is an obstructed infected kidney as well as renal stones. Very important for you to sort of recognize and trying. Ah, manage if you're able to pretty for more since it's very important for you to recognize and, um not necessary at your old skin regency. But generally a surgical emergency would be a phone is going green. And unfortunately, I would have loved to talk to you guys about all this emergencies. But you need about at least two other sort of talk for you to sort of course across. And this conditions. And yeah, I think that's it. Um, hope that wasn't too quick for for everyone. And I hope you have sort of, um, learn something for me today. Ah, and you have 111. thing I want to say is, if you're doing your old G or if you're doing any any specialty, there is a really important and then sort of Ah ah, really good course that you can do for free. And it's called the National Education Catheter program. If you just go get that, it's it's It's free for all your you condition, the way in your own pace, and you you will get you. We'll give you a certificate in. And if you're looking for ah career in surgery for playing for considerable training. It will help you with your applications, and you can get people in treating and, well, you can take any questions now, if that's all right. Great. Thank you very much. But that was a really useful I'm just gonna have a look here. Would anyone like to ask any questions? If you can pop it on the chat box and I'll be happy to read them out to me but excited Coverdell grounds. But that's good to be, Yeah, No, this is the moment, I think. Yeah, that's fine. So could we need to move onto the next light? If you guys happen to have any questions later on, feel free to send us in the email and the urology in mind that leave dot com he mailed dress targeted towards. But I'll be happy to send it cross to him, and I'm sure we'll be happy to respond to those questions. Um, otherwise, we really appreciate your feedback. Obviously, this is the last session for the urology Siris so grateful for any feedback, so we know how well we did and what sort of things we could have worked on. And so on so forth. So thank you all for joining us again today on, but, uh, hope you have a good evening. Thanks again. But that was a things from people. Thank you very much. Thanks, everyone. You Thank you.