SU1202562A1 - Method of treatment of extended structure of posterior urethra - Google Patents

Description

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The invention relates to the field of medicine, more specifically to urology, and can be used in the treatment of patients with strictures or urethra.

The purpose of the invention is to prevent the deformation of the penis and the development of organic impotence.

In the position of the patient for cumulative operations, cystotomy is performed. The bugs inserted through the internal and external opening of the urethra determine the level and extent of the stricture arrangement (Figure 1). A longitudinal incision in the perineum is used to expose the urethra from all sides to the stricture and in the area of the scars cross it in the transverse direction. Scar-modified surrounding tissues and cicatricial urethra are excised, and a significant urethral defect is formed (Fig. 2). The distal urethra is mobilized for 8–10 cm in order to provide a comparison of the central and peripheral ends of the organ without undue tension. Separate sutures on the silicone tube connect both ends of the urethra. When comparing and adapting the ends of the organ, the anterior urethra is practically moved to the posterior urethra. At the same time, the cavernous bodies of the penis are bent, and the penis is drawn into the scrotum. To reduce the tension of the urethral anastomosis, the cavernous bodies in their inflection zone are fixed to each other, forming a fold of the penis (Fig. 3). The urethral tube is removed for 3–4 days, and the epistostomy drainage is maintained until the next stage of the operation.

After weeks, upon confirmation of normal urethral patency, the second stage of surgical treatment is performed. The position of the patient for perineal operations. The penis behind the head is pulled from the scrotum. A distal section of the urethra is separated from all sides up to its external opening by a longitudinal incision in the pentocrotal angle 5–6 cm long. The molded cavernous bodies of the penis are mobilized from the surrounding tissues, and the nylon ligatures, applied during the first operation, are removed from them, straightened 025622

There are penis, which acquires the original anatomical size and shape. But at the same time, the urethral region moves to the region of the musculature and the external opening of the urethra is sewn into the skin of the scrotum or in the area of the foam-scrotal angle (Fig. 4). The skin lines of the penis and scrotum are sutured. After the operative wound has healed, the patient begins to wet through the newly formed external opening of the urethra. The suprapubic drainage is removed, the fistula heals.

15 After 6-8 weeks, the missing anterior segment of the urethra is restored. The position of the patient on the back. Two parallel incisions on the ventral surface of the penis, starting from the head and lower by 0.4-0.5 cm of the newly formed external opening of the urethra, cut out the median skin graft not wide.

25 less than 2 cm (figure 5 and 6). Then, a skin flap on a silicone catheter is stitched into a tube, which serves as a continuation of its own natural urethra (Fig. 7). Then sutured

30 lateral patches of skin on average nii. After 10 days, the cyst is removed, after which the patient begins to urinate in a natural way.

Fig. 8 shows the final result of the recovery of extensive defects of the posterior urethra. The posterior part of the urethra, represented by the cranially displaced anterior urethra in FIG. 3, is marked with the letter A. The anterior urethra is restored by the skin tube and is marked with the letter B.

Example. Patient P., 24 g. Diagnosis: Post-traumatic recurrent obliteration of the membranous-prostatic urethra, epicisagostosis. Three years ago, in a road accident, he suffered a fracture of the pelvic bones with a ruptured urethra. An urgent epicystostomy was performed. At the place of residence, urethral resection was performed twice, but urination was not restored due to the stricture reshaping. In the clinic of urology RODNMI, operation 55 was performed resection of the urethra with anastomosis end to end. During surgery, extensive obliteration of the membranous-prostatic urethra was found.

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Cicatricial tissues and cicatricial-substituted section of the posterior urethra were excised. The urethral defect was 8–9 cm. To bring the central and peripheral ends together without tension, a wide mobilization of the anterior urethra was performed. After connecting the ends of the urethra, the cavernous bodies of the penis are shaped as a horseshoe, and the penis is noth in the scrotum. The postoperative period is smooth. Perineal; on healed by primary tension. Stitches are you on the 5th day. Two weeks later, the patient recovered self-urination while maintaining suprapubic drainage. The patient completed the second stage of the operation. Produced complete dissection of the anterior urethra up to the external opening of it,

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the cavernous bodies of the penis are highlighted, their inflection is eliminated, and the penis has acquired its usual anatomical dimensions. The external opening of the urethra is sewn into the skin of the scrotum at the foam-scrotal angle. The postoperative period is smooth. Stitches are removed on day 6, the wound healed by primary tension. Urinary flow through the newly formed external opening of the urethra in a natural way, suprapubic fistula healed.

Two months later, the third stage of the operation was carried out. Anterior urethra

(5 formed due to the skin of the penis. The wound healed initially, removed epitsistostomy, urination free on the urethra. After 11 days, the patient was discharged for outpatient treatment almost healthy.

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FIG. five

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Compiled by Yu.Esilevsky Editor V.Ivanov Tehred Z.Kastelevich Proofreader O Lugova

Order 8344/4 Circulation 721 Subscription VNII1SH USSR State Committee

for inventions and discoveries 113035, Moscow, Zh-35, Raushsk nab., 4/5

Branch P1TP Patent, Uzhgorod, Proektna St., 4

Fig.8

Claims (1)

METHOD FOR TREATING AN EXTENDED STRUCTURE OF THE BACK URETRA, including resection of the urethra and matching the ends of the organ, o + characterized in that, in order to prevent penile deformation and the development of organic impotence, after healing of the urethra, the anterior segment of the urethra is separated from the cavernous body, it into the scrotum and form a new external opening of the urethra in the skin of the scrotum, separate the corpora cavernosa from the surrounding tissues and straighten the penis, and subsequently produce restoration of the anterior urethra by skin grafting.