SU1273077A1 - Method of treatment of urethra strictures - Google Patents

Abstract

The invention relates to medicine, in particular to urology. The purpose of the invention is the development of ischemia of the anastomosis zone by matching the ends 1 of the resected urethra using metal hooks 3 to grip the outer surface of the central end 1 of the urethra or bladder neck, metal wire loops 5, which are sewn to the outer surface of the peripheral end of the urethra, and threads 4, get curved, their hooks with loops. One of the ends of each thread 4, threaded into the eye of each hook 3, is carried out under the corresponding, 5 loop with a surgical needle. Through the external opening along the urethra into the bladder is carried out a tube 2 (slaconate), which is fixed in a known manner. Gperipherical end of the urethra tweezers combined with the central. The threads are tied up and, by hooks approaching the loops, the edges of the urethra are connected. To relieve tissue tension in the event of an erection, the outer surface i (L of the distal urethra is fixed in an accessible place to paraurethral tissues with sutures from a monolithic nylon. The epicystostomy is applied. The tube is removed after 14 days. After urination is restored, the epicostoma is closed. 3 Il 1ch oe oh fig 2

Description

. The invention relates to medicine, in particular to urology, and can be used in the treatment of patients with strictures of both the anterior and posterior urethra. The aim of the invention is to prevent ischemia of the anastomosis zone by comparing the ends of the resected urethra with metal hooks to grip the outer surface of the central end of the urethra or bladder neck, metal wire loops that are attached to the outer surface of the peripheral end of the urethra, and the threads tightening the hooks with loops. Fig. 1 shows the elements of a device for connecting the ends of the resected urethra by the proposed method, (hooks, hooks and loops); in fig. 2 and 3 are diagrams of the method for connecting the ends of the resected urethra. In the drawings, the ends 1 of the resected urethra, tube 2, hooks 3, threads 4, loops 5, sponge body protein shell 6, spongy body 7 urethra, mucous membrane 8 are indicated. The device for connecting the ends of the resected urethra consists of metal hooks, metal loops , filaments from a monolithic nylon with a diameter of 0.25 mm and a tube, for example silicone. Hooks and loops are made of wire with a diameter of 0.4 mm from metal of grade 40 КХНМ. Each hook is provided with an eyelet for nitn, and a loop with two eyelets at the ends for sewing to the urethra. The length of the hook is 5 mm, the length of the sting hook 2.5 mm. angle between fore and tip 45 °, diameter of eyelet hole 0.4 mm, loop length 4 mm, loop curvature radius 4 mm, diameter of eyelet loop holes 0.4 mm. The method is carried out as follows. The urethra in the stricture zone is separated by an industrial access, crossed at the level of scars, the scar-modified area of the urethra and the scar tissue surrounding it are excised, orienting to the bougure inserted inside (Upper urethral opening after the cystotomy is performed. The outer surface of the central end of the urethra or necks of the bladder, 7–9 mm indentation from the edge, are successively seized with four or five metal hooks, holding each of them along the gullet with a hemostat and clamping them circumferentially at the same distance They are separated from each other. Threads are threaded into the hooks at the ends of the hooks. Loops of metal wire are sewn to the outer surface of the peripheral end of the urethra, also 7–9 mm indent from the edge, according to the number and location of the hooks. A wire is threaded into the eyelet of each hook under a suitable loop using a surgical needle. A tube, such as a silicone one, is inserted into the bladder through the external opening and fixed in a known manner. The peripheral end of the urethra is aligned with the central tweezers, the threads are tied up and, approaching the hooks to the loops, thereby connecting the edges of the urethra. To relieve tissue tension in the event of an erection, the outer surface of the distal portion of the urethra is fixed in an accessible place to the paraurethral tissue with the nylon monolithic tissue. Perineal wound is drained by rubber graduates and sutured to drainage. Impose epitsistostyu. The tube is removed after 14 days. After urination is restored, the epicystostomy is closed. Example. Patient D., 36 years old,; calab on the impossibility of self-urination, the presence of epicystostomy. 8 months back the patient was injured - a fracture of the pelvic bones with a ruptured urethra. In this connection, an eiicistostomy was imposed on the patient. After 3 months, the urethra according to Rusakov was made about the formed stricture of the posterior urethra. After 2 months recurrence of the stricture occurred, which required the imposition of a temporary epicocytostomy. In urethrography, a patient has a stricture of the membranous-prostatic urethra, 3 cm in length. The proposed method has been performed. Perineal access resected a narrowed area of the urethra and cicatricial paraurethral tissues. The connection ends of the resected urethra performed by the proposed method. There were no complications after surgery. The perineal wound healed by primary tension. On the 14th day, the urethral tube was removed, and on the 17th day, the epicystostomy was closed. Self urination was restored. On the control urethrogram, made before discharge on the 18th day after the operation, the patency of the urethra is good. There is no constriction in the anastomosis area, metal hooks and loops are located outside the inner surface of the urethra. There is no contrast substance. The proposed method of treating urethral strictures does not impair the blood supply to the urethral tissues in the zone of connection of its ends, which creates the best conditions for the healing of the urethral anastomosis by a gentle movable scar; simplifies the operation, since the need to flush the central end of the posterior urethra or bladder neck is eliminated, and grabbing hooks to the tissues in these difficult-to-manipulate areas is virtually simple, stitching loops to your

Claims (1)

Claim A method of treating urethral strictures, including resection of the urethra with subsequent matching of the ends on the tube, characterized in that, in order to prevent ischemia of the anastomosis zone, after the resection, the central end of the urethra is grabbed on the outer surface by hooks, sewed to the peripheral end of the urethra on the outer surface of the loop, and after matching the ends of the urethra tied the threads tightening the hooks with