Ukugcinwa Komchamo: Izimpawu, Izimbangela, Ukuxilongwa Nokwelashwa

Ukugcinwa komchamo kubhekisela ekungakwazini ukukhipha ngokuphelele esinyeni ngesikhathi uchama. Kuyi-a ukuphazamiseka kwe-urological lokho kungaba nomthelela omkhulu eqophelweni lempilo yomuntu uma kuyekwa kungalawulwa. Ukugcinwa komchamo kungase kuvele kungazelelwe ezimeni ezibucayi ezethula njengesimo esiphuthumayo sezokwelapha, noma kubonakale kancane kancane njengesimo esingelapheki esidinga ukunakekelwa okuqhubekayo. Lesi sihloko sichaza ukuthi ngempela ukugcinwa komchamo kuhilelani, izimbangela zako ezihlukahlukene, izimpawu zesici, izindlela zokuxilonga emtholampilo, kanye nokwelashwa kokukuxazulula.

Kuyini Ukugcinwa Komchamo?

Isinye siyisitho esinemisipha esingenalutho esiqoqa umchamo okhiqizwa izinso kuze kube yilapho umzimba usulungele ukuwukhipha. Umchamo ngokwawo uwuketshezi olulahlwayo oluhluzwa egazini ngezinso, oluhlanganisa ikakhulukazi amanzi amaningi, usawoti, kanye ne-nitrogenous ngemikhiqizo efana ne-urea.

• Ukugcinwa komchamo kubhekisela ikakhulukazi ekuphumeni okungaphelele kwesinye ngesikhathi sokuchama.
• Ukugcinwa komchamo okubukhali kuhilela ukungakwazi ukuchama ngokuzenzakalelayo futhi okuqhubekayo ngokushesha naphezu kokuba esinyeni esigcwele.
• Ukugcinwa komchamo okungamahlalakhona kubangela ukugcwala ngokweqile kwesinye isikhathi ngokuhamba kwesikhathi ngenxa yokungavuleki ngokwanele.
• Kokubili ukugcinwa komchamo okubuhlungu nokungapheli ekugcineni kubangela ukucindezeleka izimpawu eziphansi zomgudu womchamo.

Yini Ebangela Ukugcinwa Komchamo?

Ukugcinwa komchamo kubangelwa izimo ezithinta ukuthuthwa komchamo usuka ezinso uye esinyeni (ukugcinwa komchamo) kanye/noma ukuphuma komchamo esinyeni ngaphandle komzimba (ukuvaleka komchamo). Isizathu esijwayelekile sokugcina umchamo sihlanganisa:

• Ukwandiswa Kwendlala Yesinye
  • Isizathu esivame kakhulu sokugcinwa komchamo okungapheli emadodeni angaphezu kweminyaka engama-50 i-benign prostatic hyperplasia (BPH). 
  • Njengoba i-prostate ikhula, icindezela i-urethra evimbela ukugeleza komchamo. 
  • Ukugcinwa okunamandla kungase kwenzeke uma indlala ekhulisiwe ivimbela ngokuphelele umchamo.
• I-Urethral Stricture
  • Izibazi zomgudu womchamo ngenxa yokulimala, ukuhlinzwa noma ukutheleleka kuholela ekuncipheni (umcu). 
  • Lokhu kudala ukumelana nokugeleza komchamo.
• Ukwehluleka Kwemisipha Yesinye
  • Ukungasebenzi kahle kwe-Detrusor kusho ukufinyela kwesinye okubuthakathaka okuhluleka ukukhiqiza ingcindezi eyanele yokukhipha umchamo ongenalutho. 
  • Kujwayeleke kakhulu uma usukhulile.
• Imithi
  • Izidakamizwa ezifana nama-antimuscarin, ama-antidepressants, ama-antipsychotics, ama-opioid, nama-alpha-blockers angaphazamisa ukusebenza okuvamile kwe-detrusor okuholela ekukhishweni kwesinye okungaphelele.
• Ukukhulelwa nokubeletha
  • Ukushintsha kwamahomoni, ukukhuliswa kwesibeletho, nokulimala kokuzalwa okubandakanya imisipha/imizwa yezinzwa kwandisa ingozi yokugcinwa komchamo ngemva kokubeletha.

Yiziphi Izimpawu Zokugcina Umchamo?

Ukugcinwa komchamo okungamahlalakhona kuqhubeka kancane, okuvumela isinye ukuba sande futhi ngokuvamile sintula izimpawu ezisobala ekuqaleni. Ukugcinwa okunamandla kuhilela ukuqala okungazelelwe kokungakwazi ukuchama futhi kubangela izimpawu eziqine kakhulu.

Izimpawu ezijwayelekile zokugcinwa komchamo zihlanganisa:

• Ubunzima bokuqalisa ukuchama
• Ukugeleza komchamo obuthakathaka
• Ukucindezela noma ukusunduza ukuze uphume
• Umchamo ogelezayo
• Ukuchama isikhathi eside
• Ukuvuthwa njalo, ikakhulukazi ebusuku
• Ubuhlungu besinye
• Ubuhlungu besisu
• Umuzwa wokungapheleli kwesinye isinye
• Ukuvuza komchamo ngokuzenzakalelayo phakathi kohambo lokuya endlini yokugezela

Sifo

Odokotela basebenzisa ukubuyekezwa komlando wezokwelapha, ukuhlolwa ngokomzimba, ukuhlolwa kwe-imaging kanye nezifundo ze-urodynamic ukuze bahlole ukugcinwa komchamo. Nakhu ukubuka konke kwenqubo yokuxilonga yokugcina umchamo: 

• Umlando Wezokwelapha
  • Udokotela ubuza ngezimpawu zesiguli, ukuqala kwazo kanye nobude besikhathi. Ulwazi olumayelana nezinkinga zesikhathi esidlule zezokwelapha, ukuhlinzwa, ukuhlukumezeka ngesikhathi sokubeletha, imithi ephuzwayo njll. inikeza izinkomba zokuxilonga.
• Ukuhlolwa Komzimba
  • I-palpation yesisu ithola esinyeni esihlakazekile esinwetshwe ngaphezu kwethambo le-pubic, okuqinisekisa ukugcinwa komchamo okubalulekile. 
  • Ukuhlolwa kwe-digital rectal kuhlola usayizi we-prostate ekhulisiwe. 
  • Ukuhlolwa kwezinzwa kukhomba ukulimala kwezinzwa okungenzeka kube yimbangela yezimpawu. 
  • Izikrini zokuhlolwa kwe-gynecological ze-pelvic organ prolapse kwabesifazane.
• Iskena Sesinye
  • Lokhu kuhlolwa kwe-ultrasound okungavamisile kukala ivolumu yomchamo oyinsalela yangemva kokungabi nalutho. 
  • Amanani omchamo angaphezu kuka-100-200 mL abonisa ukuphuma okungavamile nokugcinwa komchamo. 
  • Ukuskena okuphindaphindiwe kuqapha ukuqina kokugcina ngokuhamba kwesikhathi.
• I-Urinalysis
  • I-Microscopic urinalysis kanye nesiko lomchamo kuthola ukutheleleka okuvame ukuhambisana nokugcinwa. 
  • Igazi emchameni lingase libonise amatshe esinyeni noma umdlavuza.
• Ukuhlolwa Kwezithombe
  • I-Ultrasound kanye ne-computed tomography ibona ngeso lengqondo ukungahambi kahle kwesakhiwo njengokukhula kwendlala yesinye, ukuqina, amatshe esinyeni, izimila ezivimbela ukugeleza komchamo emgudwini womchamo. 
  • Ukufanekisa futhi kuqinisekisa usayizi wesinye owandisiwe ngenxa yokusekela komchamo kunoma yikuphi ukuvinjelwa.
• I-cystoscopy
  • I-cystoscope (ishubhu elincanyana elifakwe ikhamera) elifakwe ku-urethra livumela odokotela babone ngokuqondile ngaphakathi komgudu womchamo ongezansi. 
  • Lokhu kukhomba ukuqina, ukuvinjwa i-prostate ekhulisiwe noma okungavamile kwesinye okubangela ukugcinwa. 
  • Iphinde yenze kube lula ukususwa kwanoma yimaphi amatshe/amathumba esinyeni atholakele.
• Ukuhlolwa kwe-Urodynamic
  • Ukuhlola okuningana kuhlola umfutho wesinye kanye namaphethini okugeleza komchamo phakathi nokugcinwa nokukhulula umchamo. 
  • Lokhu kuhlola ukusebenzelana phakathi kwemisipha yesinye kanye ne-sphincter kanye namandla okwanele okufinyeza esinyeni ukuze siphume ngendlela efanele - izici ezibalulekile ekugcinweni komchamo.

Kwelashwa Kanjani Ukugcinwa Komchamo?

Zonke iziguli ezigcina umchamo ziqala ukudonsa amanzi esinyeni ukuze zidambise izimpawu futhi zivikele ukulimala kwezinso ngenxa yokugcinwa komchamo. Ukwelashwa okwengeziwe kugxile kumbangela ethile.

• Ukwehlukaniswa namathebhu
  • Ukufaka ishubhu le-catheter nge-urethra kwesinye kuvumela ukuphuma okuphelele komchamo ogciniwe. 
  • Ukuze kugcinwe ukuqina, lokhu kuqhutshwa kuze kube yilapho ukuchama okujwayelekile kubuyiselwa. 
  • Iziqephu ezibuhlungu eziphindelelayo zingase zidinge ukwelashwa kokugcina umchamo ekhaya ukuzikhipha nge-catheter phakathi nohambo lokugezela.
• Imithi
  • Ekwandiseni i-prostatic encane, ama-alpha blockers (i-tamsulosin, i-alfuzosin) aphumuza imisipha ebushelelezi ethuthukisa ukugeleza komchamo. 
  • Ama-antibiotics elapha izifo eziwumsuka ngenkathi ama-anticholinergics afana ne-oxybutynin angasiza izimo zokugcina ezingapheli ngokuphumuza imisipha yesinye.
• Ukuhlinzwa Kwendlala Yesinye
  • Ngokugcinwa komchamo okungapheli kusuka ku-benign prostatic hyperplasia engaphenduli emithini, i-minimally invasive transurethral resection (TURP) isalokhu iwukwelashwa kwegumbi. 
  • I-TURP ihlinza ngokuhlinzwa izicubu ze-prostate ezicindezela i-urethra isebenzisa i-electrocautery. 
  • Ezinye izinketho ezisebenzayo zihlanganisa i-laser prostatectomy kanye ne-prostate artery embolization.
• Ukuhlinzwa Kwama-Urethral
  • Ukuqina kwe-urethral kudinga i-urethrotomy lapho odokotela abahlinzayo besika izicubu ezibomvu benweba indlela yokudlula. 
  • Ukucutshungulwa okuphelele kwendawo eyakhiwe ngokuxhunywa kabusha kokuphela kuya ekupheleni kwemiphetho ye-urethral enempilo (urethroplasty) kungase kudingeke emikhawulweni emide noma ephindaphindayo.
• Ukukhuthazwa Kwezinzwa
  • Ukuze ugcinwe kusukela ekuphazamisekeni kwezinzwa, ukukhuthazwa kwenzwa ye-sacral kulinganisa nge-elekthronikhi amasignali wezinzwa ukuze kuthuthukiswe ukufinyela kwesinye kanye nokuxhumana kwe-sphincter. 
  • Ukwakha i-sphincter yokwenziwa ezungeze urethra nakho kusiza ekukhipheni esinyeni.
• Ukuhlinzwa Isinye
  • Ukuhluleka kwemisipha yesinye ngokukhuliswa okukhulu kwesinye kungase kudinge ukuhlinzwa kokunciphisa esinyeni, kususwa ingxenye yodonga lwesinye ukuze kwehliswe umthamo futhi kuvumele ukuthululwa okuphelele nokufinyela okubuthakathaka. 
  • Ukuhlinzwa kokukhulisa isinye kungenye indlela, kusetshenziswa izingxenye zamathumbu ukuze kwandiswe umthamo wesinye ezinyeni ezincane ezinenkontileka.

Isiphetho

Ukugcinwa komchamo kuhlanganisa ukungakwazi ukukhipha ngokugcwele esinyeni okuholela ekunqwabelaneni komchamo ngaphakathi. Ukugcinwa okunamandla kubangela ukuhlukana kwesinye okubuhlungu futhi kudinga ukwelashwa okuphuthumayo, kuyilapho izifo ezingelapheki ziqhubeka ngobuqili ngokwengeziwe ngokukhula kwesinye kancane kancane. 

Izimpawu ezijwayelekile wubunzima bokuchama, ukuchama kaningi/ukungapheleli, ukugeleza okubuthakathaka kanye nobuhlungu besinye. Isinye esiphathekayo, izivivinyo ze-imaging kanye nezifundo ze-urodynamic kusiza ukuxilongwa. Ukukhululwa kokuqala kuhilela ukukhishwa kwe-catheter, okulandelwa imithi noma ukuhlinzwa okuqondise izici eziyimbangela. Ukuxilongwa ngokushesha kanye nokwelashwa okufanele kubalulekile ukuze kugwenywe izinkinga ezifana nokutheleleka okuphindelelayo, ukulimala kwesinye kanye nezinkinga zezinso.