RU2143848C1 - Method for making hemostasis and urethrocervical anastomosis in cases of prostate adenoma - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves carrying out suprapubic transvesical access and adenomectomy. To separate urinary bladder walls and prostate adenoma bed, wound dilators with bubble mirrors and jaws are introduced. A wound dilator having a shorter mirror, is introduced along the anterior wall of the urinary bladder, whereas one having longer mirror is brought along the posterior wall. Lateral dilators have the same sizes. Prostate adenoma bed is dilated with their jaws, hemorrhage zones are detected and measures are undertaken for completely stopping it. Small bleeding blood vessels are treated with diathermocoagulation. Larger size blood vessels are sutured with resolvable threads for hemostatic reasons. Then the urethrointestinal anastomosis is built and Foley catheter is set in the urethra or two catheters are used for irrigating the urinary bladder. EFFECT: enhanced reliability of homeostasis; prevented complications. 2 dwg

Description

 The invention relates to medicine, namely to surgery, urology.

 The prototype of the invention is a method of adenomectomy with removable sutures, proposed by P.I. Helfer (V.I. Gorova, V.I. Gandzyuk, Method of hemostasis in case of transvesical adenomectomy. J. Clinical surgery. - 1990. - 12 - P. 61-62) . According to this method, a conventional adenomectomy is performed from the median suprapubic through bubble access. For the purpose of hemostasis, 2 to 3 catgut removable sutures are placed on the neck of the bladder, which are carried out next to the urethral catheter. The tension of removable joints (load about 1 kg) acts hemostatically. The tension of the removable joints is carried out during the day. This method of hemostasis is temporary. When removing removable sutures, bleeding often intensifies or late postoperative bleeding develops on days 6 - 9 and later, which lead to tamponade of the bladder with blood, thromboembolic and other complications.

 The aim of the invention is to increase the reliability of hemostasis, the prevention of complications.

 In FIG. 1 and 2 depict devices for expanding the neck and bed of adenoma of the prostate gland and the location of the device in the bladder and bed of the adenoma.

 The device comes with four expanders. They have a handle 1, a curved mirror 2 for diluting the walls of the bladder, at the end of which there are sponges 3 for expanding the walls of the bed of the adenoma of the prostate gland. The retractors in the kit are equally arranged, differ in length and curvature of the bubble curved mirror 2.

 The method of hemostasis and urethrocervicoanastomosis in patients with prostate adenoma is as follows. Conventional adenomectomy is performed from the median suprapubic through the bubble access, most often under epidural anesthesia. A device for diluting the walls of the bladder and the bed of prostate adenoma is introduced into the bladder and bed of prostate adenoma. A retractor with a shorter bubble mirror is carried out along the front, with a longer one along the back wall of the bladder. Side retractors are the same size. Sponge devices expand the bed of prostate adenoma. The bed is revised, sources of bleeding are identified. Sources of bleeding can be: bleeding vessels of the bladder wall, branches of the lower bubble arteries, branches of the ureter arteries, vessels of the surgical capsule of the prostate adenoma, bleeding from the damaged cervical urethra. A final stop of bleeding is carried out by methods accepted in surgery. Small bleeding vessels are exposed to diathermocoagulation. Bleeding vessels of a larger caliber are stitched for hemostatic purpose with threads from absorbable materials. Impose urethroshoe anastomosis 3 - 4 with knotted sutures from absorbable sutures, which contributes to an even more reliable hemostasis. The operation ends with the installation of a Foley catheter NN 20-24 about the Charrier or 2 different caliber plastic catheters in the urethra to establish bladder irrigation. Reliable hemostasis allows the bladder to be sutured tightly by two-row catgut (or other absorbable) sutures. Install drainage in the prebubble space. Bladder irrigation is carried out for 1, rarely 2 days. Anesthesia is determined by specialist anesthetists, usually epidural.

 Example 1. St-in VA 73 years old. Complaints about difficulty urinating with a delay. He urinates 5-6 times at night. Urinary retention is noted for 5 years and progresses. On rectal examination, the prostate gland is enlarged, with a dense-elastic consistency with a smooth surface. Rhythmic pulse-78 V, Al-135/90 mmHg Pathology from the parenchymal organs of the abdominal cavity was not detected. Kidney function is satisfactory. Indicators of nitrogen excretion function are normal.

 Under epidural anesthesia, an adenomectomy was performed from the median suprapubic through the bubble access. Special retractors have been introduced into the bladder and bed of the adenoma. Produced final hemostasis diathermocoagulation. Large-caliber vessels are sewn with catgut seams. A Foley catheter is inserted into the urethra. The bladder is sutured tightly by a two-row catgut suture. The first seam is continuous. A rubber turunda is installed in the prebubble space. Layered seams on the wound. Silk seams on the skin. Irrigation with furatsilin solution is established. The Foley catheter was removed on day 7. Self-urination recovered. Sutures were removed on the 8th-9th day. Discharged for outpatient observation by a urologist on the 11th day. No complications of the operation were noted.

 Example 2. Trkiy VV 58 years old. Received in an emergency with acute urinary retention. For 2 years, progressive obstructed urination was noted. Urination at night 2 to 3 times. An acute delay in urination was provoked by the intake of alcohol. Objectively: the correct physique. Pulse-80 v, AD-145/95 mmHg The stomach is soft. The kidneys are not palpable. The symptom of striking is negative. An enlarged bladder palpates, 4-5 cm above the bosom. A rectal examination determines a sharply enlarged prostate gland of a dense-elastic consistency with a smooth surface. Bladder catheterization was performed twice, about 1200 ml was withdrawn. transparent light yellow urine. Clinical laboratory and radiation examinations, ECG were performed on an emergency basis. Cardiologist consultation. Under epidural anesthesia, an adenomectomy was performed by layer-by-layer median through bubble access. A device for expanding the bladder and bed is installed in the bladder.

 According to this method, we operated on 19 patients. The postoperative period was satisfactory. There were two complications. One patient developed acute right-sided epididymitis. In another patient, an impurity of blood was observed visually for 5 days. The cause of hematuria was bleeding from the cervical urethra. When an adenomectomy with removable sutures, according to the prototype, more or less pronounced postoperative bleeding from the bed of the prostate adenoma is constantly observed. Increased bleeding from the bed is often noted when removing removable sutures. There is a threat of late bleeding from the bed of the prostate adenoma on the 6th-9th day, when there is an ejection of retracted blood bundles from the lumen of the blood vessels.

Claims (1)

 The method of hemostasis and urethrocervicoanastomosis in patients with prostate adenoma, including suprapubic through bubble access and an adenomectomy, characterized in that retractors with bubble mirrors and sponges are introduced into the bladder to dilate the walls of the bladder and the bed of the adenoma of the prostate, with a shorter retractor with carried along the front wall of the bladder, and with a longer bubble mirror along the back wall of the bladder, with lateral conservatives they have the same size, then they expand the bed of prostate gland adenomas with sponges, identify the sources of bleeding and finally stop the bleeding, expose small bleeding vessels to diathermocoagulation and flush larger vessels with absorbable materials for hemostatic purpose, then apply urethrocic anastomosis with 3-4 knotted sutures from absorbable filaments, a Foley catheter according to the Charrier or two plastic catheters of different calibers for irrigation of the bladder are placed in the urethra i.

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