RU2801128C1 - Method of endoscopic determination of the length of urethral stricture - Google Patents

Abstract

FIELD: medicine; urology.

SUBSTANCE: optical semi-rigid urethrocystoscopy is performed with the patient placed in an examination chair in the Trendelenburg position. First of all, a cathegel-type gel is introduced into the urethra as a substance. Then, optical retrograde urethroscopy of all the sections of urethra is performed: urethra of the penis balanus, the spongy part of the urethra, the bulbous, membranous and prostatic sections of urethra, as well as the region of the bladder neck, using a polymer two-channel urethral catheter with semi-rigid optics, on the outer surface of the body of which ring marks are made with a uniform step followed by fixing the study on an electronic medium. A video image of the urethra is got. The catheter is removed outwards, if a cicatricial-sclerotic altered mucosa of the urethra is detected, the mark of the beginning of the stricture is made on the catheter, and if a visually unchanged mucosa of the urethra is detected, the mark of the end of the stricture is made on the catheter.

EFFECT: method allows to increase the efficiency of the method of endoscopic determination of the length of the urethral stricture by providing promptness and favorable conditions for endoscopic determination of the extent of the urethral stricture and determining the volume of subsequent, if required, surgical treatment.

1 cl, 2 ex, 2 dwg

Description

SUBSTANCE: invention relates to medicine, namely to urology and instrumental methods of diagnostics, and can be used for diagnostic urethroscopy and, if there is a narrowing of the urethra, for measuring the length of urethral stricture.

State of the art

There is a known method for diagnosing urethral stricture: "Retrograde urethrocystography" (Visualization of urethral obstruction in men. M.I. Kogan et al. 2017, textbook). Retrograde urethrography is a method of X-ray imaging of the lumen of the urethra after filling it with a liquid or gaseous contrast medium. For the first time, urethrography was applied in 1910 by J.H. Cunningham. In our country, urethrography has been introduced into practice by A.P. Frumkin in 1924 and is still considered the leading research method in the diagnosis of urethral obstruction. The main advantages of urethrography are ease of execution, availability, low cost, sufficiently high information content and simultaneous obtaining of information about nearby anatomical structures.

However, the known method does not allow to accurately determine the length of the urethral stricture, and the disadvantages of radiological techniques should be considered: static and projection of the image, radiation exposure to the patient and the doctor, limitations in the ability to diagnose local complications and changes in the paraurethral space, the need to use radiopaque preparations.

Known "Method for diagnosing the extent of spongiofibrosis of the urethra in patients with urethral stricture disease (patent RU No. 2699729 of 09.09.2019). The essence of this method consists in carrying out optical coherence tomography of the lower urinary tract and surrounding tissues in the patient's prone position, the substance is first injected into the urethra, then the tomograph sensor is scanned, the urethra is scanned, characterized in that the penis is placed in an extended position, while previously into the urethra injected as a substance gel-type "cathegel"; after which the tomograph sensor used to visualize the coronary arteries is gradually inserted through the external opening of the urethra inwards; scanning the urethra with fixing the study on an electronic medium; receive a video image of the scanned part of the urethra in the frontal plane, as well as in the longitudinal plane; removing the sensor outward, when an altered structure of the urethra that differs from normal tissue appears, the mark of the beginning of spongiofibrosis is marked on the sensor, and when normal tissue of the urethra appears, the mark of the end of spongiofibrosis is marked on the sensor; the distance between the marks on the sensor is equal to the length of the urethral stricture.

However, the disadvantage of the known method is the need to have an optical cognitive tomograph in the urologist's office or in the hospital of the urological department, which greatly complicates the process of conducting the study, both in terms of the time of the study, and in terms of the use of complex expensive equipment, which, moreover, is not included in the equipment standard of either the outpatient service or the hospital, according to the profile "urology".

The technical problem to be solved by the claimed method of endoscopic determination of the length of the urethral stricture is the creation of a simple and effective method for diagnosing the urethra and the length of the urethral stricture without the need for radiation exposure to the patient and the urologist.

Disclosure of invention

The objective of the invention is to create a more efficient, operational and informative method for endoscopic determination of the length of the urethral stricture.

The technical result is to increase the efficiency of the method for endoscopic determination of the length of the urethral stricture by providing promptness and favorable conditions for endoscopic determination of the extent of the urethral stricture and determining the volume of subsequent, if necessary, surgical treatment. The method is carried out without the use of X-ray equipment and, thus, eliminates additional radiation exposure for the patient and the doctor.

The technical result is achieved due to the fact that the method of endoscopic determination of the length of the urethral stricture is characterized by carrying out an optiune semi-rigid urethrocystoscopy, with the patient placed in an examination chair, in the Trendelenburg position, while a cathegel-type gel is first introduced into the urethra as a substance, then an optical retrograde urethroscopy of all parts of the urethra: the urethra of the glans penis, the spongy part of the urethra, the bulbous, membranous and prostatic parts of the urethra, as well as the area of the bladder neck, using a polymeric two-channel urethral catheter with semi-rigid optics, on the outer surface of the body of which ring risks are made with a uniform pitch, with subsequent fixation of the study on electronic media; get a video image of the urethra; the catheter is removed outward, if a cicatricial-sclerotic altered mucosa of the urethra is detected, the mark of the beginning of the stricture is marked on the catheter, and if a visually unchanged mucosa of the urethra is detected, the mark of the end of the stricture is marked on the catheter.

Thus, the technical result is achieved through a minimally invasive method for assessing the condition of the urethra, increasing accuracy and efficiency.

Brief description of the drawings

The method for endoscopic determination of the length of the urethral stricture is illustrated by the drawings, where in Fig. 1 - shows a general view of the urethra in men with stricture of the penile urethra, with a catheter passed through the urethra to the end of the narrowing of the urethra; in fig. 2 - shows a general view of the urethra in men with stricture of the penile urethra, with a visus catheter in the urethra, at the site of the beginning of the narrowing of the urethra, during the removal of the visus catheter.

Implementation of the invention

The method of endoscopic determination of the length of the stricture of the urethra is as follows. For diagnostic manipulation, the patient sits in an examination chair in the Trendelenburg position. Previously, the area of the external part of the urethra is treated with an antiseptic, a cathegel-type gel is injected into the urethra. This tool has not only an analgesic effect, but also gives a slip to the urethrocystoscope, which facilitates the urethrocystoscopy. A semi-rigid urethrocystoscopy is performed, where a urethral catheter is used instead of a rigid cystoscope. The optics of the company PolyDiagnosy model D-2381 is used as an optical element. The urethral catheter consists of a tubular body with an open-type tip made of elastic material, with a total length of 30 cm and a working length of 26.7 cm, inside which there are two channels, one of which is designed to accommodate high-resolution diagnostic optics, and the other channel - for irrigation, while on the outer surface of the tubular body, circular risks are applied with a uniform step, for example, one centimeter. Performing marks with a uniform step allows you to increase the visibility and accuracy of the measurements. During urethrocystoscopy, all sections of the anterior and posterior urethra, as well as the prostatic urethra, are evaluated. The entire study is recorded on electronic media, so in case of detection of neoplasms of the urethra, urethral stricture, this information serves as diagnostic material, which is subsequently stored on a USB drive and sent along with the patient to the hospital of the medical unit.

In the case of detection of extended spongiofibrosis (Fig. 1) 1, removing the urethral catheter 2 outwards, with the appearance of scar-sclerotic tissue (urethral structure) 3, in the intended section of the urethra, the mark of the beginning of spongiofibrosis is marked on the catheter 4. When a visually unchanged urethral mucosa appears (Fig. 2) 1, mark the end of spongiofibrosis on the catheter 4. The length of the altered tissues is equal to the length of the urethral catheter inserted into the urethra from the beginning of the appearance of urethral spongiofibrosis on the screen until its normal optical structure appears. The distance between the marks on the catheter is equal to the length of the urethral stricture. In the study in the unchanged sections of the male urethra, the glans penis, the spongy part of the urethra, the bulbous section, the membranous and prostatic sections and the area of the bladder neck are normal by directly passing a catheter with an optical element retrogradely through the urethra into the bladder and when it is removed. The method allows to visually assess the structure of the urethra in depth in any part of interest in real time. The urethra, modified due to fibrosis, spongiofibrosis, has characteristic differences from the normal healthy urethra - narrowed, has characteristic annular narrowing, whitish mucosa, the vascular pattern on the mucosa is not traced. This method allows you to visually assess the urethra, identify neoplasms of the urethral stricture, determine the length of its length, thereby at the preoperative stage is determined with the volume of the intended surgical aid (anastomotic urethroplasty or buccal urethroplasty).

Examples of the implementation of the invention

Clinical example No. 1.

Patient V., 38 years old, turned to a urologist at the place of residence with complaints of difficult, sluggish urination.

From the anamnesis it is known that she has been suffering from urolithiasis for more than 10 years, contact ureterolithotripsy was performed twice for ureteral stones. Three years ago, the structure of the urethra was diagnosed for the first time, after which an optical urethrotomy was performed. The above complaints are dismissed over the past year, with a gradually progressive deterioration in the quality of urination.

According to the survey, in the general analysis of urine and blood without significant deviations from the norm. Ultrasound: the kidneys and bladder without pathological changes, the prostate gland with a volume of 24 cm3, homogeneous. With uroflowmetry, the maximum rate of urination is 8.8 ml/sec. In the conditions of an outpatient department, the patient underwent a diagnostic semi-rigid urethrocystoscopy, using a catheter instead of a cystoscope. During the diagnostic manipulation in the bulbous-membranous part of the urethra, an annular narrowing (stricture recurrence) was detected, which was easily passed by the instrument under optical control, no additional narrowings in the urethra were detected. During the manipulation on the urethral catheter, circular risks of the beginning and end of the urethral stricture were visually recorded, after the end of the manipulation, comparing the risks with a ruler, the length of the stricture was determined - 12 mm. Considering a single stricture of the urethra, 12 mm long, it was decided to prepare the patient for anasmatous urethroplasty. Then the patient in the conditions of the urological department underwent an operational benefit in the amount of: anasmamatic plasty. The postoperative period was uneventful, spontaneous urination was restored in full.

Clinical example No. 2.

Patient V., aged 55, turned to a urologist at the place of residence with complaints of difficult, sluggish urination.

From the anamnesis it is known that he has been suffering from urolithiasis for more than 25 years. Stones were repeatedly removed from both sides. In January 2005, in the GVKG im. N.N. Burdenko performed ureterolithotomy in the lower third on the left. Subsequent ESWL of a right ureteral stone with passage of fragments. In 2006, the patient underwent right pyelolithotomy. In the postoperative period there was a ventral hernia. In May 2009, the examination revealed kidney stones and kidney cysts. November 10, 2009 in the clinic of urology MMA them. THEM. Sechenov performed contact ureterolithoextraction on the left. Since the summer of 2016, the patient began to notice complaints of difficult, sluggish urination. In the clinic of urology UKB No. 2 of the First Moscow State Medical University. THEM. Sechenov was diagnosed with urethral stricture, on November 1, 2017, urethrocystoscopy and optical urethrotomy were performed. The urethral catheter was removed on the 3rd day, spontaneous urination was restored in full. On November 1, 2018, urethrocystoscopy and optical urethrotomy were performed due to recurrence of urethral stricture. In the postoperative period, antibacterial and anti-inflammatory therapy was carried out with an effect. The urethral catheter was removed on the 4th day. Urination was restored in full. On March 26, 21, optic urethrotomy and transurethral electroresection of prostatic hyperplasia were simultaneously performed due to recurrence of urethral stricture and prostatic hyperplasia. The postoperative period was uneventful, antibacterial, anti-inflammatory therapy, alpha 1-adrenergic blockers were carried out. On the 3rd day, the urethral catheter was removed, spontaneous urination was restored in full. Histological conclusion: prostate hyperplasia. In a satisfactory condition, he was discharged under the supervision of a urologist at the place of residence. A progressive deterioration in the quality of urination has been noted over the past few months. Consulted at the LDO Clinic of Urology UKB No. 2 of the First Moscow State Medical University. THEM. Sechenov, hospitalized in a planned manner for additional examination and determination of further treatment tactics.

According to the survey, in the general analysis of urine and blood without significant deviations from the norm. Ultrasound: kidneys and bladder without pathological changes, prostate gland with a volume of 18 cm3, homogeneous, a TUR defect is determined, a neck up to 1.5 cm wide. With uroflowmetry, the maximum urination rate is 7.6 ml/sec. In the cystoscopy room, the patient underwent a diagnostic semi-rigid urethrocystoscopy using a urethral catheter. During diagnostic manipulation in the penile part of the urethra, an annular narrowing (recurrence of the structure) was detected, under optical control, no additional narrowing in the urethra was detected. During the manipulation on the urethral catheter, circular risks of the beginning and end of the urethral stricture were visually fixed, after the end of the manipulation, comparing the risks with a ruler, the length of the stricture was determined - 34 mm. Given the pronounced length of the urethral stricture, it was decided to prepare the patient for buccal urethroplasty. Then the patient in the conditions of the urological department performed an operational benefit in the amount of: buccal urethroplasty. The postoperative period was uneventful, spontaneous urination was restored in full.

Thus, in both cases, to determine the extent of the narrowing of the urethra, the patients did not have to perform retrograde urethrography, which is technically difficult in an outpatient department, and also creates additional radiation exposure for both the patient and the urologist. In both cases, to measure the length of the urethral stricture, it was sufficient to perform urethrocystoscopy using a urethral catheter.

The advantages of the proposed method are: efficiency, since it does not require the introduction of a contrast agent into the urethral cavity, the absence of radiation exposure for the patient and medical personnel, visualization and differentiation of tissues in real time. At the same time, the assessment of the length of the urethral stricture is more accurate than with retrograde urethrography.

Claims (1)

A method for endoscopic determination of the length of the urethral stricture, characterized by optical semi-rigid urethrocystoscopy with the patient placed in an examination chair in the Trendelenburg position, while the urethra is first injected with a gel of the “cathegel” type as a substance, then an optical retrograde ureteroscopy of all parts of the urethra is performed: the urethra of the glans penis , the spongy part of the urethra, the bulbous, membranous and prostatic parts of the urethra, as well as the region of the bladder neck, using a polymeric two-channel urethral catheter with semi-rigid optics, on the outer surface of the body of which circular risks are made with a uniform pitch, followed by fixing the study on an electronic medium; get a video image of the urethra; the catheter is removed outward, if a cicatricial-sclerotic altered mucosa of the urethra is detected, the mark of the beginning of the stricture is noted on the catheter, and if a visually unchanged mucosa of the urethra is detected, the mark of the end of the stricture is marked on the catheter.