RU2194537C2 - Conservative method for treating urethral strictures - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves applying bougieurage and medication therapy. Urethra bougieurage is carried out in single session. Bougies of number 13-14 are used to begin with and numbers 21-23 to finish the process. Medication is administered locally and lymphotropically daily once a day during 7-10 days Enzyme for making lymph stimulating, antibiotics and immune modulation in single doses beginning from a day before bougieurage. The preparations are introduced 1 cm far from the middle inguinal suture or scrotum at the level of urethral stricture. Antibiotic and immune modulation are alternated in succession in each administration. EFFECT: long storage period of high preparation concentrations at the urethra stricture place; accelerated urethral mucosa regeneration; enhanced effectiveness of treatment. 3 cl

Description

 The invention relates to medicine, namely to urology, and can be used for the treatment of strictures of various etiologies with urethral bougienage and local lymphotropic therapy.

 There is a method of treating strictures using classical bougie with parallel injection of the vitreous body (2 ml under the perineal skin) in combination with chronolaser therapy, the administration of SC lidase, hormone therapy, and the administration of methyluracil inside (V. I. Rusakov. Surgery of the urethra. Rostov- on-Don: Phoenix, 1998, pp. 226-227).

 The disadvantages of this method are: strict indications for bougienage, since with it the scars do not resolve, but only tear or stretch. On the contrary, due to the constant traumatization of scars, their tears and the intensification of the inflammatory reaction of tissues around the circumference after bougieurage, additional conditions are created for the growth of cicatricial masses and can contribute to malignancy (ibid., Pp. 178-179).

 The invention is aimed at solving problems: to expand the indications for a conservative method of treating urethral strictures with maximum method efficiency and good long-term results.

 These tasks are achieved by bougieurage, which differs from the classical one. With classical bougieurage, the urethral stricture only stretches, the session should be painless and bloodless (ibid., P. 225). With the proposed bougieurage, it is necessary to break the keloid scars of the stricture by a simultaneous session, starting from bougie 13-14 and ending with 21-23. In parallel to bougieurage and during bougieurage, medications are administered topically lymphotropically. Due to this, high long-lasting concentrations of drugs are created directly in the focus of pathological changes and the nodulolymphatic region with the mandatory introduction of an immunomodulator, which helps to replace stricture rupture with physiological tissues and normal mucous membrane regeneration from the urethra. An antibiotic is also administered to prevent the spread and final suppression of microflora and inflammation. The enzyme is used to lymphostimulate and soften the keloid scar. Local lymphotropic therapy is carried out at the level of stricture localization with a course of 7-10 days, before and in parallel to the bougieurage sessions.

 The method is as follows. The day before bougieurage, an enzyme, for example, lidase, an antibiotic, for example ampicillin, and an immunomodulator, for example cycloferon, are administered locally lymphotropically at a stricture level in single doses with a dispenser at a rate of 1 ml per 1 minute. The injection points are 1 cm lateral from the midline suture of the perineum or scrotum on both sides. The needle is inserted to a depth of 3-4 mm under the dermal layer of the skin itself. First of all, an enzyme is introduced on the left and on the right, for example, 20-30 IU of lidase per 5 ml of 0.25% novocaine solution, then an immunomodulator on the left, for example 3 mg polyoxidonium, and an antibiotic on the right, for example 40 mg gentamicin with the same dilution of 0.25 % solution of novocaine. The immunomodulator and antibiotic alternate in each session. After a day, as a rule, under intravenous anesthesia, bougienage is performed for a good rupture of the stricture, which can be accompanied by hemorrhagic discharge, starting from 14-16 and ending with 21-23.

 Bougienage is carried out 1 time in the 3rd day 5-7. At the same time, the aforementioned drug therapy is carried out locally lymphotropic daily. The number of bougienage sessions 5-7 is determined individually: the disappearance of pain, hemorrhagic discharge from the urethra, the relief of dysuria, which corresponds to the healing of stricture ruptures, the replacement of collagen scars with delicate connective tissue formations, and the restoration of the normal mucous membrane from the urethra.

Case Studies
Example 1
Patient K., 27 years old, was admitted to the hospital with a diagnosis of acute urethritis, chlamydia.

 Due to the small effect of traditional therapy, including antibiotics, anti-inflammatory drugs, uroseptics, modern local physiotherapy, urethrography was performed, where a stricture of the prostatic urethra was found over 1.5 cm, obliterating the lumen of the urethra up to 60%.

 On the first day and during bougieurage, local lymphotropic at the level of transition of the median suture of the scrotum to the perineum 1 cm to the left and right, 20 units of lidase per 5 ml of 0.25% novocaine solution were introduced using a dispenser at a rate of 1 ml per 1 minute. Then 2 ml of cycloferon on the left and gentamicin 40 mg on the right, at the same speed and the same dilution. Once a day in a single dose of 8 days. The next day, bougienage from 16 to 21 until the appearance of blood. Bougie once every 3 days, 6. With repeated bougie-up, there is no fresh blood, scarce sacred blood, and from the 4th session, bougie 23 was completely free.

 Clinical phenomena of urethral stricture were stopped, normalization of tests and the patient was discharged with recovery. The patient was observed up to 2 years. There was no data for relapse.

Example 2
Patient S., 32 years old, was admitted to the hospital with a diagnosis of post-traumatic stricture of the back of the urethra.

 The patient categorically refused surgery. On urethrography, the stricture of the membranous part is 1 cm without fistula. Against the background of local lymphotropic therapy: lidase 20 PIECES per 10 ml of 0.25% novocaine solution, antibiotic claforan 0.5 g to 5.0 novocaine 0.25%, polyoxidonium 3 mg to 5.0 novocaine 0.25% - and bougieurage from 16 to 23 (1 time in 3 days) for 7 sessions, the clinical manifestations of stricture were stopped. The patient was discharged with recovery. Within 3 years, there is no relapse of stricture.

Example 3
Patient P., 45 years old, was admitted to the hospital with a diagnosis of recurrence of stricture of the posterior urethra.

 The operation six months ago, after 4 months the appearance of difficulty urinating. On urethrography in the membranous section, two strictures. The patient refuses from a second operation. Agreed to conservative treatment.

 Against the background of local lymphotropic therapy with lidase, 20 IU per 10 ml of a 0.25% solution of novocaine, ampicillin 0.5 g and polyoxidonium 6 mg in the same dilutions 1 time per day for 10 days and urethral bougie number 5 (once every three days) the patient’s complaints were stopped. Discharged with a clear improvement, observed 2 years. There is no data for relapse.

The positive effect of using the proposed method is:
expanding indications for conservative treatment of urethral strictures; convenience of drug administration - 1 time per day and drug savings;
good near and long-term results.

Claims (3)

 1. A method of conservative treatment of urethral strictures with the help of bougienage and drug therapy, characterized in that the urethra is bougiended by a simultaneous session, starting with bougie 13-14 and ending 21-23 once every three days with a course of 5-7 times; simultaneously topically lymphotropically daily for 7-10 days, once a day, an enzyme for lymphostimulation, an antibiotic and an immunomodulator are administered in single doses, starting a day before the course of bougieurage.  2. The method according to p. 1, characterized in that the enzyme, antibiotic and immunomodulator are administered on both sides 1 cm from the middle suture of the perineum or scrotum at the level of urethral stricture.  3. The method according to p. 1, characterized in that the immunomodulator and antibiotic alternate with each introduction.