RU2185099C2 - Method for determining urethra obliterations - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves pumping 0.25% novocaine solution through external orifice of the urethra canal using puncture needle with syringe under ultrasonic scanning control. When pumping in the novocaine solution, the needle is moved along the urethra in retrograde direction. Obliterated area is punctured. Hypoechogenic strip image being observed on the monitor screen, multiple urethral obliterations are considered to be the case, their disposition and length are determined. EFFECT: high accuracy of the method. 1 dwg

Description

 The invention relates to medicine, namely to urology, and can be used to diagnose the extent and localization of multiple urethral obliterations.

 A known method for the diagnosis of urethral obliteration, including retrography (urethrography) with the introduction of a radiopaque solution through the urethra, is retrograde with the simultaneous installation of a metal bougie in the intact proximal urethra through a cystostomy fistula (A.Ya. Pytel and other X-ray diagnostics of urological diseases. M .: Medicine: 1966, p. 399).

 The disadvantage of this method is that it is not always possible to integrate the bougie into the neck of the bladder and further into the posterior urethra through the cystostomy due to the narrowness of the urethra, deviation of the prostatic urethra, and high standing of the cystostomy.

 The disadvantage is that on the x-ray, only a defect in the filling of the contrast medium between the intact urethra and the end of the bougie is noted. It is not possible to establish whether there is a preserved section of the urethra between the obliterations, or if the filling defect corresponds to the full extent of the obliterations.

 This requires a test operation to establish an accurate diagnosis, which often leads to unjustified injuries.

 There is also a method for determining urethral obliteration, including pumping fluid through the external opening of the urethra under the control of ultrasound scanning (Grinev A.V. Endoscopic surgical treatment of urethral strictures. Abstract of dissertation of Candidate of Medical Sciences. M., 1987, p. 3- 4).

 In this case, the sensor is fed through the outer skin to the area of damage to the urethra. As a liquid, you can use any non-irritating sterile solution. Fluid injection is necessary so that cicatricial narrowing is determined against the background of normal sections of the urethra that look dilated.

 The disadvantage of this method is that in the presence of multiple obliterations during the ultrasound examination, it is not possible to determine their extent and to establish whether there is a preserved section of the urethra between the multiple obliterations.

 In accordance with this task, aimed at expanding the functionality of the method by determining multiple obliterations, their location and extent.

 This problem is achieved by the fact that in the method for determining urethral obliteration, including pumping fluid through an external opening of the urethra under ultrasound scanning, a 0.25% solution of novocaine is used as the fluid, which is injected using a puncture needle with a syringe, while in the process of pumping of the novocaine solution, the needle is advanced along the urethra in the retrograde direction and puncture of the obliterated area is performed, and if there is an image of the hypoechoic cavity on the monitor screen After this area, the presence of multiple obliterations of the urethra, their location and extent is judged.

 The drawing shows a diagram of the method and the image on the screen.

 On the diagram: 1 - urethral obliteration, 2 - preserved section of the urethra, 3 - ultrasound probe, 4 - bladder, 5 - pubic joint, 6 - syringe with a needle.

 The method is as follows.

 An ultrasound probe 2 is fed through the skin to the urethra. A puncture needle with a syringe - 6 is inserted through the external opening of the urethra. During injection of a 0.25% solution of novocaine, the first obliterated area is punctured - 1 and the needle is gradually advanced further in the retrograde direction. As soon as the needle enters the preserved area of urethra 2, the novocaine solution begins to flow into the preserved area, and an image of the hypoechoic cavity appears on the monitor screen, indicating the presence of multiple obliterations. The image on the screen of the monitor judges the location of multiple obliterations, their extent and the length of the preserved portion of the urethra.

 Example. Patient D was admitted to a urological clinic with a diagnosis of Total post-traumatic stricture of the anterior and posterior urethra, cystostomy. Chronic pyelonephritis. Chronic cystitis

 During the preliminary examination, the following data were obtained. With counter cystourethrography - there is a defect in the filling of the urethra, starting 2 cm proximal to the external opening of the urethra and ending with the neck of the bladder.

 To clarify the diagnosis, a puncture needle with a syringe filled with 0.25% novocaine solution was introduced through the external opening of the urethra.

 On the trochanteric side of the penis, a transducer of the ultrasound device is connected. During injection of the novocaine solution, obliteration was punctured and the needle was moved retrograde by 1 cm. After this, the novocaine solution began to be injected under lower pressure, and a cavity formation appeared on the monitor of the ultrasound apparatus, extending to the membrane section of the urethra. When measuring the distal cicatricial obliteration in the hanging section of the urethra was 1.5 cm, and the proximal in the membrane was 0.5 cm. Between the two obliterated sections of the urethra, a 12-cm length of the urethra was revealed.

 Using this method will provide the ability to accurately diagnose multiple obliteration of the urethra, which will allow for appropriate operations with high efficiency.

Claims (1)

 A method for determining urethral obliteration, including pumping fluid through an external opening of the urethra under ultrasound scanning, characterized in that a 0.25% solution of novocaine is used as the fluid, which is injected using a puncture needle with a syringe, while in the process of pumping the solution the novocaine needle is advanced along the urethra in the retrograde direction and puncture of the obliterated area is carried out and if there is an image of a hypoechoic strip on the monitor screen after this the site is judged by the presence of multiple obliterations of the urethra, their location and extent.