RU2767137C1 - Method for restoring spontaneous urination in patients with extended defects of the anterior urethra - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to urology. A midline perineal incision is performed and an intact section of the bulbose urethra is isolated at the site of the defect, the onset of stricture or obliteration and intersected, forming an external urethral opening in the wound, through which bougie N25 freely passes into the bladder. In the upper part of the midline incision, using scissors and fingers, the skin of the perineum and scrotum is peeled off, creating a tunnel into which from the outside, using a gauze swab on a clamp, the skin of the scrotum is brought out into the wound in the form of an inverted tube, at the end of which a hole is cut out, comparable in size to the previously formed external opening of the urethra. A Foley N22 catheter is inserted into the bladder. Anastomosis is performed by applying circularly 4-6 catgut sutures to the edges of the holes. The catheter is left until the anastomosis heals for 2 weeks, after which the patient begins to urinate on his own through the hole in the scrotum; remove the epicystostomy.

EFFECT: method allows to simplify and shorten the operation, to reduce the risk of complications when working with scar tissue, to work in the same operating field, prevents the formation of a rough cicatricial process, the method is more physiological and convenient for the patient while waiting for the second stage of urethral plasty.

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Description

The invention relates to medicine, surgery, in particular to urology, and relates to methods for restoring spontaneous urination in case of extended defects, strictures and obliterations of the anterior urethra.

A known method of removing the remaining part of the bulbous section of the anterior urethra on the skin of the perineum - direct and trapezoidal perineostomy (1) The disadvantage of this method is the frequently occurring infiltrative-inflammatory process of the anastomosis area of the thin mucous membrane of the urethra with the skin and subcutaneous fat layer of the perineum, often leading to a narrowing of the formed opening of the perineostomy.

A known method of replacing the defect, narrowed or obliterated part of the urethra buccal flap or flaps with extended defects, strictures and obliterations of the urethra. An autologous buccal mucosal flap is taken from the oral cavity, a urethral platform is prepared, and urethral plastic surgery is performed in one or two stages (2). This method is taken by us as a prototype.

The disadvantage of this method is that the replacement of a narrowed or obliterated urethra with a buccal flap may be technically impossible due to the length of the defect. Extraction of a significant flap or several from the oral cavity can lead to a pronounced cicatricial process in the latter, speech defects, and indigestion. The collection of the buccal flap requires two teams of surgeons (often different specialties) working on two surgical fields.

Preparation of the urethral site for a significant length lengthens the time of the operation. Working with scar tissue is associated with the risk of bleeding. In the field of plastic surgery, early complications of the operation can be the formation of hematomas and the failure of the sutures. In addition, the second reconstructive stage of creating the missing section of the urethra of considerable length can be complicated by the occurrence of its secondary strictures.

The aim of the invention is to create a new method for restoring spontaneous urination in patients with extended defects of the anterior urethra.

This goal is achieved by performing a median incision of the perineum and isolating an intact area of the bulbous urethra at the site of the defect, the onset of stricture or obliteration and crossing it, forming an external opening of the urethra in the wound, through which bougie No. 25 freely passes into the bladder; in the upper part of the median incision, using scissors and fingers, the skin of the perineum and scrotum is exfoliated, creating a tunnel, into which the skin of the scrotum is brought into the wound in the form of an everted tube, at the end of which a hole comparable in size to the previously formed one is cut out using a gauze swab on a clamp. external opening of the urethra; introduce a Foley catheter No. 22 into the bladder; anastomosis is performed by applying circularly 4-6 catgut sutures to the edges of the holes; the catheter is left until the anastomosis heals for 2 weeks, after which the patient begins to urinate on his own through the hole in the scrotum; remove epicystostomy.

A significant length of the defect, obliteration or stricture of the anterior urethra does not prevent the creation of an anastomosis according to the claimed method. No need to prepare the urethral site simplifies the operation, shortens the duration of the latter, reduces the risk of complications when working with scar tissue.

The use of the scrotum for anastomosis of the skin allows not to involve other specialists for the sampling of the autograft and to work on the same surgical field. Thin, mobile and elastic skin of the scrotum provides a sufficient amount of material to create an anastomosis with the urethra, and prevents the formation of a rough cicatricial process, leading to its narrowing. The location of the new opening for self-urination on the scrotum is more physiological and convenient for the patient in anticipation of the second stage of urethral plastic surgery - the formation of a urethral tube from the skin of the scrotum and penis.

The method is implemented as follows. A median incision of the perineum is performed and an intact area of the bulbous urethra is isolated at the site of the defect, the onset of stricture or obliteration and crossed, forming an external opening of the urethra in the wound, through which bougie No. 25 freely passes into the bladder. In the upper part of the median incision, using scissors and fingers, the skin of the perineum and scrotum is peeled off, creating a tunnel into which the skin of the scrotum is brought into the wound in the form of an inverted tube at the end of which, comparable in size to the previously formed external opening of the urethra. Enter into the bladder catheter Foul and No. 22; anastomosis is performed by applying circularly 4-6 catgut sutures to the edges of the holes. The catheter is left until the anastomosis heals for 2 weeks, after which the patient begins to urinate on his own through the hole in the scrotum. The epicystostomy is removed.

The application of the method is illustrated by a clinical example.

Patient K., aged 78, who came to us, was missing almost the entire bulbous part of the urethra and the entire hanging section up to the scaphoid fossa. In history - during surgery for oblique inguinal hernia occurred iatrogenic removal of 15-17 cm of the urethra. The patient underwent an epicystostomy. Later, the patient was operated on by the proposed method. The operation was performed quickly, without technical problems and intraoperative complications. No complications were observed in the postoperative period either. After the Foley catheter was removed, the patient began to urinate on his own through the opening in the scrotum. The epicystostomy was removed. From the proposed plastic surgery - the formation of the missing section of the urethra, referring to his age, the patient refused - he was satisfied with the female type of urination from the hole in the scrotum.

The method can be used in surgical urological hospitals for the treatment of patients with extended defects, strictures, obliterations of the anterior urethra.

SOURCES OF INFORMATION

1. S.V. Kotov, S.P. Darenkov, O.B. Laurent, A.V. Zhivov, K.I. Glinin The results of perineostomy for the treatment of complex strictures of the anterior urethra in men / Medical Bulletin of Bashkortostan No. 2, 2013.

2. С.X. Al-Shukri, E.S. Nevirovich, P.V. Perekalin, D.M. Ilyin, I.A. Korneev / Replacement urethroplasty with free flaps of the buccal mucosa for extended strictures of the anterior urethra // Urological Gazette, Volume II No. 2, P. 48-51, 2012.

Claims (1)

A method for restoring spontaneous urination in patients with extended defects of the anterior urethra, including the use of autologous material to create an anastomosis with the intact part of the urethra, characterized in that a median incision is made in the perineum and an intact area of the bulbous urethra is isolated at the site of the onset of the defect, stricture or obliteration and cross it , forming in the wound an external opening of the urethra, through which bougie No. 25 freely passes into the bladder; in the upper part of the median incision, using scissors and fingers, the skin of the perineum and scrotum is exfoliated, creating a tunnel, into which the skin of the scrotum is brought into the wound in the form of an everted tube, at the end of which a hole comparable in size to the previously formed one is cut out using a gauze swab on a clamp. external opening of the urethra; introduce a Foley catheter No. 22 into the bladder; anastomosis is performed by applying circularly 4-6 catgut sutures to the edges of the holes; the catheter is left until the anastomosis heals for 2 weeks, after which the patient begins to urinate on his own through the hole in the scrotum; remove epicystostomy.