SU1361753A1 - Method of treating ureterostricture - Google Patents

Abstract

This invention relates to surgery, more specifically to urology. The goal of the prevention is to reduce the morbidity of the operation and to simplify it. To do this, after resection of the stricture, a magic cylinder fixed to the thread is placed in the distal end of the urethra, and a stump is formed around the thread with a twisting stitch. To remove the thread through the cystos | 0 Ш5 пктв - B i .- ;: 0 stoma and the reduction of the proximal magnet, an elastic string with a curved end directed along a rigid catheter is used. Lastly, the proximal magnet is brought down to the flush with the distal one, forming the “side-to-end joint”. If necessary, the formation of magnetic anastomoses “side by side and end to end, wire the string with the thread through the side wall of the urethra and closing the end opening with a seam is possible. For anastomoses, a pair of cylindrical magnets with a diameter of 5-10 mm, corresponding to the internal diameter of the anastomized ends of the urethra, are taken. When connecting the magnets, the cavity formed by the recesses is sufficient for 5-6 units of the 4 / 0-6 / 0 threads used for applying 6b seams and does not disrupt the anastomosis formation process, since between the rounding and recess of the base an area is preserved co; touch, with S 00 and with with

Description

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This invention relates to surgery, specifically to urology.

The aim of the invention is to reduce the morbidity of the operation and to simplify it, which is achieved by creating a seamless anastomosis between the cult of the urethra using a compression device - standing (x magnets on the thread, which are distal and proximal to the urethra.

The method is carried out as follows.

After the mobilization of the ends of the urethra and the resection of the stricture into the distal end of the urethra, a magnetic cylinder fixed to the thread is stained, and a stump is formed around the thread with a blanket stitch. To remove the thread

by breaking, it is sufficient for 5-6 knots of 4 / 0--6 / 0 threads used for stitching seams, and does not disrupt the process of anastomosis formation, since the area of contact between the rounding and recess of the base is maintained.

Example I. Bolnby K., 5 years. Diagnosis: posttraumatic urethral stricture. 7 months after injury. Complaints on a, lack of normal urination. On examination and examination, he does not urinate on his own, urine passes through a cystostate, a complete obliteration of the posterior urethra with diastasis is determined on the cytourethrogram.

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through cystostomy and lowering of the proximal ends about 3 cm. With a mixed perineal-crotonic approach, the ends of the urethra are exposed and mobilized before comparison without tension. According to the lumen of the non-dilated distal end, magnets with the following characteristics are selected: diameter 7 mm, force 23 G / mm, rounding radius of the working base 0.6 mm, axial hole 1 mm, deepening the working diameter 4 mm and depth I mm. The distal magnetic cylinder, fixed to the thread through the side wall of the distal end, is placed in its lumen, after which the lumen is closed with a net HIBOM. After mobilization, the proximal end of the urethra was obliterated in its terminal part, due to which it was possible not to impose a second suture covering the lumen. The thread coming out of the distal end is fixed by a string ,. conducted through the lateral wall of the psi-normal end, a proximal magnet is lowered along it, the ends are matched with their side walls. The operation is completed by restoring the cystostomy. Operation time 2 h ,, 30 min. The nearest postoperative period is smooth. Pa 10 days removed cystostomy. Restored normal urination. On the 14th day and –1.5 months after the operation on the cystourethrogram, the lumen of the urethra does not have a tendency to narrow. With the control bougienage, free pass. Diet buzh number 18 on Sharyer.

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A flexible magnet uses an elastic string with a curved end directed along a rigid catheter. The string is lowered, the wound coming from the distal end is fixed with the end of the string, and the catheter with the string and thread is removed from the cystostomy. Twist- tiJGOM form a proximal stump. The drink coming out of the cystostomy is passed through the axial orifice of another magnet, and the latter is lowered by the catheter into the proximal urethral stump. Preventing magnets from closing. In the postoperative period, urine is retracted through a cystostomy, which is used to remove the magnets after their rejection for 7-9 days.

Taking into account the individual characteristics of strictures of the urethra, if necessary, the formation of a magnetic urethral brain “side to side and“ end to end of a wire string with a thread through the side wall of the urethra and closing the end opening with a suture is possible.

Without changes, the technique can be used for fresh urethral ruptures.

To form the anastomosis, a pair of cylindrical magnets with a diameter of 5 to 10 mm, corresponding to the internal diameter of the anastomosed ends of the urethra, are used. The specific force from 10 to 40 G / mm ensures fixation of the ends of the urethra and necrosis of tissues that are applied between the magnets. The radius of rounding of the circumference of the working bases from 0.4 to 0.8 mm allows to obtain an ideal comparison of the layers of the urethra and especially the mucosa in the anastomosis zone. A smaller rounding radius causes early necrosis of the mucous membranes with the formation of extensive ulcer defects, up to inconsistency and subsequent stenosis of the anastomosis, and a larger radius leads to a more common CQ inflammatory process and scarring and can cause the anastomosis spur to prevent the removal of magnets. The working base of the magnet has a recess 2-4 mm smaller than 35

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Example 2. Patient M., 13 years old. Diagnosis: post-traumatic stricture of the membrane part of the urethra, 6 months after injury. The examination revealed a stricture of the membranous part of the urethra with a length of about 2.5 cm, complicated by perineal fistula. Intermediate access is exposed and bulbar bulbar urethra mobilized to stricture. Callus scars that form the stricture are excised together with a fistula, a cylinder diameter of 0.5–1 mm for 55, the back wall of the obliterated on nodes formed after tying at the ki-end of the proximal urethra. AT

according to internal diameter more

 narrow distal end pick up the stitching of the stitches. When connecting magnets. Cavity, formed by

by breaking, it is sufficient for 5-6 knots of 4 / 0--6 / 0 threads used for stitching seams, and does not disrupt the process of anastomosis formation, since the area of contact between the rounding and recess of the base is maintained.

Example I. Bolnby K., 5 years. Diagnosis: posttraumatic urethral stricture. 7 months after injury. Complaints on a, lack of normal urination. On examination and examination, he does not urinate on his own, urine passes through a cystostate, a complete obliteration of the posterior urethra with diastasis is determined on the cytourethrogram.

the ends are about 3 cm. Mixed between Example 2. Patient M., 13 years old. Diagnosis: post-traumatic stricture of the membrane part of the urethra, 6 months after injury. The examination revealed a stricture of the membranous part of the urethra with a length of about 2.5 cm, complicated by perineal fistula. Intermediate access is exposed and bulbar bulbar urethra mobilized to stricture. Kalezny scars, forming a stricture, excised along with a fistula, the back wall of the proximal proximal urethra obliterated at the end is exposed. AT

pits with the following 1 | 1 (diameter, diameter 9 mm, force 32 g / mm, rounded circumference of the working base 0, 8 mm. recess I mm with a diameter of 6 mm, axial hole 1.0 mm. After placing a distal magnet in the lumen and forming stump wrapping a suture (silk b / o) into the wound of the rigid catheter through the side wall of the urethra of the proximal end, the string with the curved end is lowered, the thread is fixed to the end of the string and removed from the cystostomy with a hard catheter. distal to form a compound e "side to end. The postoperative period is smooth. The magnets are removed for 10 days, the cystostomy was closed after 2 days. Discharged with good urination — good flow. According to urofluometry, the flow velocity is 17 ml / s.

Example 3. Patient A., 5 years. Di agnosis: condition after autotrauma, shock 2-3 degree, fracture of the pelvic bones, rupture of the urethra. After the anti-shock measures, the child is operated on. Perineal access mobilized the ends of the urethra, imposed cystostomy. A magnetic cylinder with a diameter of 5 mm and a force of 15 g / mm is placed in the distal segment of the urethra. with a radius of 0.6 mm, an axial bore of 0.5 mm, an angle of 0.5 mm and a diameter of 3 mm, fixed to a nylon line of 0.4 mm. The line was drawn through the cystostoma with the help of a rigid catheter and a string, formed at the ends of the urethra. Then, the proximal magnetic cylinder is pulled out, connected to the distal one, forming an anastomosis “one end to the end. Operation Brem 1 h 40 min. The postoperative period is smooth. Magnets removed ig 8 days per thread. On the 2nd day after the operation, he was discharged home with a normal urine. M. KN Jiipii (.- B; i App. J-fl

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emitting. On miCT ypC i | i) i rammlh ir- | ic.i 3 months per gyusle operation rkchk-yunio Ch and to narrowing in the area of unstromo .; not.

Thus, the preferred method is limited by the simplicity of coKjvimdci operation during the operation, the use of magnets with effective characteristics and protection. i.e. (- anastomosis meticity, healing of the anastomosis line by primary tension, rapid subsiding of inflammatory diseases, preventing the development of subsequent scientific research institutes, does not require bougie in the posoperative period, improves; results, surgical treatment.

Formations of the Bileless Artery Anastomosis of the Urethra with magnets are used in the CPC in the treatment of 7 6o. U) with urethral strictures and one patient with a fresh urethral fracture ;. The testing of the operation technique and the radiation of the morphology of the magnetic anastomosis were carried out in an experiment on 56 dogs.

With proper observance of the technical details of the operation, the restoration of normal urination was noted in all observations.

Claims (1)

Invention Formula The method of treating urethral strictures by resection and anastomosis is distinguished by the fact that, in order to reduce the gravity of the operation and to simplify it, a compression anastomosis is created, for which a permanent magnet of the filament is inserted into the distal end of the urethra and withdrawn through the walls or the lumen of the urethra and then through the urinary bladder to the outside, then the urethral stump is formed, the second magnet is lowered into the proximal end of the urethra until it approaches the first, and after the junction is formed, the magnets remove the traction over the thread. Sotstaul Y. Esnl1  I. Veres Corrector L. Pojo Circulation. Subscription