RU2775879C1 - Method for treatment of postcoital cystitis - Google Patents

Abstract

FIELD: medicine; urology; gynecology.

SUBSTANCE: distal compartment of the urethra with a length of 1.5-2 cm is isolated. Vulva tissues under the base of the clitoris are dissected to form a hole. A tunnel is formed from the previously formed hole to the urethra with a length corresponding to the length of the isolated urethra compartment. The distal compartment of the urethra is placed in the formed tunnel. A support is created for the distal compartment of the urethra from sections of womb-necked fascia – Galban fascia by applying a U-shaped suture of long-term absorbable material under the distal compartment of the urethra.

EFFECT: method allows for the creation of an additional support from cross-linked sections of womb-necked fascia, which prevents the displacement of the urethra to an initial place, which can cause discomfortable urination; as a result of these manipulations, a strong support is formed for the support of a mobilized compartment of the urethra.

1 cl, 4 ex

Description

The present invention relates to the field of medicine, in particular to urology and gynecology, and can be used in the surgical treatment of patients suffering from postcoital cystitis caused by hypospadias and urethral hypermobility.

Cystitis and urinary tract infections are among the most common infectious and inflammatory diseases in women. According to statistics, one in three women has at least one episode of acute cystitis by the age of 24, and in half of them the process becomes recurrent.

Postcoital cystitis is an inflammation of the bladder that develops after sexual intercourse. This disease is quite common and brings physical and moral suffering due to constant dysuria, which can lead to sexual disharmony, and sometimes to the rejection of sexual activity. Postcoital cystitis may develop due to congenital hypospadias or urethral hypermobility. Hypermobility and hypospadias of the urethra can form secondarily due to multiple transurethral interventions accompanied by bougienage of the urethra, as well as after surgical interventions: perineoplasty, levatoroplasty and anterior colporrhaphy.

There are various surgical methods for the treatment of postcoital cystitis: dissection of urethrohymenal adhesions, transposition of the urethra and its various techniques.

A known method of surgical treatment of postcoital cystitis, which consists in the combined treatment of postcoital cystitis - excision of urethrohymenal adhesions and paraurethral implantation of the filler. When implementing the method, urethrohymenal adhesions are excised, after which 1-2 ml of filler (gel) is implanted paraurethral fan-shaped (RF patent for the invention RU 2660993 C2, publ. 11.07.2018).

The main disadvantage of the method of surgical treatment of postcoital cystitis according to patent RU2660993 is the low efficiency of treatment associated with the natural biodegradation of the volume-forming gel, the need for its reimplantation, which may be complicated by the recurrence of cystitis.

A known method of surgical treatment of chronic cystitis with hypermobility of the urethra in women, according to which a vertical incision is made, starting above the head of the clitoris and enveloping it and the external opening of the urethra. After mobilization of the urethra, the external opening is fixed to the skin. At the same time, the clitoris is maximally mobilized in soft tissues with the intersection of its supporting ligament. The mobilized section of the urethra is placed between the legs of the clitoris, the latter is brought down to the entrance to the vagina. Fix the external opening of the urethra above its original position to the skin and the clitoris to the vaginal mucosa (RF patent for the invention RU 2362500 C2, publ. 27.07.2009).

There is also known a method of transposition of the external opening of the urethra in women, which consists in dissecting the tissue from the clitoris to the external opening of the urethra, isolating the distal urethra, moving it under the legs of the clitoris and fixing it behind the edges of the opening. The posterior wall of the urethra in the proximal part is fixed to the paravaginal tissues. The integrity of the vagina is restored (RF patent for the invention RU 2132652 C1, publ. 10.07.1999).

As the closest analogue, a method of surgical treatment of hypermobility and vaginal ectopia of the urethra by its transposition was chosen, which consists in isolating 1.5–2 cm of the distal urethra, moving it under the legs of the clitoris and fixing it beyond the edges of the urethral opening, forming a submucosal tunnel from the clitoris to external opening of the urethra with a length of 1.5 - 2 cm and passing through the formed tunnel of the mobilized distal urethra (RF patent for the invention RU 2408296 C1, publ. 10.01.2011).

The disadvantage of the closest analogue, as well as other known methods for the treatment of postcoital cystitis, is the insufficiently high efficiency of the operation, which does not lead to a cure after transposition of the urethra, and due to the fact that during treatment in accordance with known methods an anatomical support is not created to support the mobilized urethra after myatus fixation. This leads to recurrence of postcoital cystitis.

The technical problem to be solved by the developed method is to increase the effectiveness of treatment, reduce the risk of relapse in the postoperative period and complete recovery of patients.

The technical result obtained by using the claimed invention is to increase the reliability of fixing the urethra in the postoperative position.

The technical result is achieved by the fact that a method for treating postcoital cystitis, including the isolation of the distal urethra 1.5-2 cm long, the dissection of the tissues of the vulva under the base of the clitoris with the formation of a hole, the formation of a tunnel from the previously formed hole to the urethra with a length corresponding to the length of the selected urethra, placement of the distal urethra in the formed tunnel, according to the invention, after placing the distal urethra in the tunnel, it is supported from sections of the pubocervical fascia (Galban fascia) by applying a U-shaped suture from a long-term absorbable material under the distal urethra.

The technical result is achieved due to the fact that for the mobilized distal urethra an additional support is created from stitched sections of the pubocervical fascia (Galban fascia), which prevents the urethra from shifting to its original place, which can cause uncomfortable urination. As a result of these manipulations, a strong support is formed to support the mobilized urethra.

The method is carried out as follows.

The method of treatment of postcoital cystitis is performed under epidural anesthesia. First, the labia minora is fixed with hooks of the Scott retractor, then the bladder is catheterized with a Foley catheter for intraoperative traction of the urethra, after which the periurethral tissues are infiltrated with saline solution with adrenaline. Next, a circular tissue incision is made around the myatus and the distal urethra 1.5-2 cm long is isolated alternately by blunt and sharp methods using bipolar coagulation. The planned length of the mobilized part of the urethra depends on the severity of hypospadias. Next, the tissues of the vulva are dissected under the base of the clitoris with the formation of a hole, a tunnel is formed alternately by blunt and sharp methods from the previously formed hole to the urethra with a length corresponding to the length of the selected section of the urethra. After that, the distal urethra is placed in the formed tunnel. The walls of the urethra are fixed to the skin of the vulva of the formed hole. After placing the distal urethra in the tunnel, a support is created for it from sections of the pubic-cervical fascia (Galban fascia) by applying a U-shaped suture under the distal urethra. The U-shaped suture provides a large area of comparison of the sutured tissues of the Galban fascia, which has a positive effect on the strength of the created support. When applying a suture, a long-term absorbable material is used. The integrity of the anterior wall of the vagina and the skin of the vulva is restored with a continuous long-term absorbable material, a Foley catheter is left in the bladder for one day.

Below are examples of the implementation of the claimed method for the treatment of postcoital cystitis.

Example #1

Patient A., 23 years old. With the onset of sexual activity (from the age of 18), after each sexual intercourse, cystitis occurs. There were no episodes of cystitis prior to the onset of sexual activity. The urologist at the place of residence repeatedly prescribed courses of antibacterial and anti-inflammatory therapy with a periodic effect. When examined in a gynecological hospital, a wide external opening of the urethra with a diameter of 5 mm and hypermobility of the myatus were visualized. The operation was carried out according to the claimed method. 3 months after the examination, the external opening of the urethra was under the clitoris. Miatus is closed. There were no episodes of cystitis after the onset of sexual activity.

Example #2

Patient Z., 30 years old. Complaints about regular episodes of exacerbation of cystitis after intercourse for 7 years. The urologist at the place of residence repeatedly prescribed courses of antibacterial and anti-inflammatory therapy with a periodic effect; for the last 3 years, conservative therapy has not brought a positive effect. When examined in a gynecological hospital, an enlarged urethral opening with a diameter of 5 mm and urethral hypermobility are visualized. The operation was carried out according to the claimed method. 2 months after the examination, the external opening of the urethra was under the clitoris. Miatus is closed. There were no episodes of cystitis after the onset of sexual activity.

Example #3

Patient I., 52 years old. Complaints about episodes of postcoital cystitis for 3 years. Menopause - 3 years. When examined in a gynecological hospital, an enlarged urethral opening with a diameter of 5 mm and urethral hypermobility are visualized. The operation was carried out according to the claimed method. 4 months after the examination, the external opening of the urethra was under the clitoris. Miatus is closed. There was not a single episode of postcoital cystitis in the postoperative period. After the resumption of sexual activity, no episodes of cystitis were noted.

Example #4

Patient Z., 19 years old. Complaints about the development of postcoital cystitis since the onset of sexual activity. Examination revealed hypospadias of the urethra. Myatus is located on the anterior wall of the vagina 0.5 cm from the introitus. The distance from the base of the clitoris to the introitus is 3.5 cm. The operation was carried out according to the stated method. Four months after the surgical treatment, the patient was re-examined: the external opening was located under the clitoris. With the resumption of sexual activity, the patient did not experience episodes of postcoital cystitis.

Claims (1)

A method for treating postcoital cystitis, which includes isolating the distal urethra 1.5-2 cm long, dissecting the tissues of the vulva under the base of the clitoris with the formation of a hole, forming a tunnel from the previously formed hole to the urethra with a length corresponding to the length of the selected urethra, placing the distal urethra in the formed tunnel, characterized in that after placement in the tunnel of the distal urethra, a support is created for it from sections of the pubocervical fascia - Galban fascia by applying a U-shaped suture from a long-term absorbable material under the distal urethra.