SU1560118A1 - Method of treating extension structure of anterior urethra - Google Patents

Abstract

This invention relates to urology. The aim of the invention is to prevent the deformation of the penis. Make a circular incision in the skin of the penis, indent 1 cm from the coronary sulcus. The skin-fascial flap is pulled back as far as possible to the root of the penis. The anterior section of the urethra is fully mobilized to the pento - scrotal angle. Resection of the narrowed area of the urethra is performed. The neurovascular bundle in the deep fascia of the penis is separated from the protein membrane. After the albugine is completely exposed, provisional sutures are placed on it to determine the optimal width of the duplicator. With a good preliminary comparison of the edges of the urethra, duplication of the tunica is performed by invaginating it without opening the cavernous bodies. Put 8-10 knotted silk stitches. The width of the duplicate created is directly proportional to the length of the resected part of the urethra. After shortening the cavernous bodies, an urethro-anastomosis is performed according to the conventional "end-to-end" technique with nodular vicryl sutures being applied. Next, the urethra is fixed throughout the rarefaction of the albugineum (through 1-1.5 cm / nodal catgut sutures). Form the foreskin. Suture skin defect. A pressure belt is applied for 24-48 hours.

Description

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This invention relates to medicine, specifically to urology.

The aim of the invention is to prevent the deformation of the penis.

This goal is achieved by creating a circular duplicatory of the tunica albugine by invaginating it without opening the cavernous bodies after excision of the narrowed part of the urethra before suturing its ends.

The method is carried out as follows.

Make a circular incision in the skin of the penis, indent 1 cm from the coronary sulcus. The resulting skin-fascial flap is pulled as far as possible towards the root of the penis. The anterior part of the urethra is fully mobilized to the penoscrotal angle, as far as this access allows. Resection of the narrowed area of the urethra is performed. The next step is to separate the vascular-nerve bundle from the protein tunica, which passes into the deep fascia of the penis. After the albugine is completely exposed, provisional sutures are placed on it to determine the optimal duplicative width, which would allow the urethro-anastomosis to be imposed without tension. With a good preliminary comparison of the edges of the urethra, duplicatory of the tunica is carried out by its invagination without opening the cavernous bodies. To this end, impose 8-10 knotted silk seams. The width of the created duplicator is directly proportional to the length pe00.

part of the urethra. At the maximum length of the urethral stricture (10 cm), two duplications of the tunica alba are performed, however, their total width does not exceed the specified dimensions. The duplicate is placed at a uniform distance from the ends of the resected urethra, and thus the anastomosis of the urethra is projected onto the immersion site of the albumen. After shortening the cavernous bodies, resulting from the circular duplicatory of the tunica, the urethro-anastomosis is performed according to the conventional method “end-to-end with the imposition of nodular sutures. Next, the urethra is fixed on the sowing with rare (through 1 -1.5 cm) nodular catgut sutures to the albugineum. The final stage of the operation is the cutting off of the foreskin, which is necessary in connection with excess skin, due to some shortening of the penis, after which the skin defect is sutured. A pressure belt is applied for 24-48 hours.

Example 1. Patient N., 22 years. Diagnosis: stricture and urinary fistula of the anterior urethra, erectile deformity of the penis. Complaints about the presence of urethral svkshcha, deformation of the penis. In October 1985, as a result of shrapnel wounds, the abdominal wall of the penis was damaged. An operation was performed in one of the hospitals, fragments were removed, the abdominal wall was sutured, and cystostomy was performed. After self-urination was restored, the urinary fistula opened at the urethra. When viewed in the clinic, there are multiple scars on the anterior abdominal wall and above the lap, the penis is curved, on its ventral surface, proximal to the coronary furrow, about 3 cm there is a urethral fistula. When urinating, a stream of urine (3-4 cm in diameter) is released from the latter. In examinations, the total nitrogen-excreting kidney function is satisfactory. According to the results of isotope renography and excretory urography, the morphofunctional state of the upper urinary tract is satisfactory, concrements have not been found. No pathological changes were detected on the downstream cystogram. According to retrograde urethrography, the urethra is uniformly performed with a contrast agent until the fistulous course. Fistulography indicated the available patency of the urethra proximal to the urethral fistula. According to the data of cavernosography, the contour of the cavernous bodies is even, their homogeneous September 26, 1987, contrasting as the first stage of the operation, trocar cystostomy was performed. On September 28, 1987, the following operation was performed: excision of the fistulous passage, circular duplicatory of the albugine membrane, urethro-anorestomosis, elimination of penile deformity. Under endotracheal anesthesia, a circular skin incision was made, a distance of 1 cm from the coronary sulcus, the skin was retracted to the root of the penis. Predominantly acute selection produced and excision

fistulous passage, urethra mobilized from the coronary sulcus to penoscrotal angle. The scar is changed, the narrowed area of the urethra is resected. The length of the resected area was 3.5 cm. After

the distal and proximal ends of the urethra were reduced, the diastasis was 5 cm. A significant defect of the urethra did not allow a direct urethro-anorestomosis. In order to match the ends of the resected urethra and reduce the length of the urethral defect, the cavernous bodies are shortened by creating a circular duplicatory of the 3 cm wide anterior sheath of silk sutures. After a satisfactory comparison of the ends of the urethra, the end-to-end urethroplasty of the urethral urethral urethral catheter along Scharier was made. Then, the urethra is fixed to the albugine along the entire length by separate catgut sutures. b

Taking into account the presence of erectile deformity to the left by 30 ° (which was visualized before the operation with the help of artificial erection), a protein resection was performed.

0 shell together with cicatricial tissue. Formed ellipsoid defects of the tunica are sutured with vicryl sutures. The re-created artificial erection (by intracavernous administration of 60.0 isotonic solution) testified

5 to eliminate the deformation of the penis. The wound is sutured. The skin defect formed after excision of the fistula is sutured with catgut sutures. Imposed pressure. The postoperative period was uneventful. Intubating urethra drainage is removed for 5 days. Cystostomy removed on day 18. Independent urination was restored for 30 days. With spontaneous erection, no curvature was observed.

Example 2. Patient K., 67 years old. Diagnosis:

5 urethral stricture, anterior urethral defect, anterior urethral fistula, epicystostomy, bladder stone. In March 1986, it was produced by adenomectomy. On the 22nd day after the operation, the urethra was dilated, after which

0 Opened urinary fistula in the anterior part of the urethra, the opening of which was localized in the penoscale corner. According to the survey data, the total concentration and nitrogen secretion of the kidneys is satisfactory. At the survey level, a bladder stone is determined. On a series of excretory urograms, the contrast agent is excreted in a timely manner into the cup-pelvis system, the last

not deformed and not expanded, there is no violation of the passage of urine through the upper urinary tract. The filling defect due to the bladder stone is determined on the descending x-ray diagram. On the urethrogram, the urethra is visualized from the external opening for 7 cm, where the flow of the contrast agent is determined, and the fistulous passage is contrasted. Further, the fistulous course of the urethra is not visualized. In the picture with the buzzer, the urethra is passable throughout, in its anterior part there is a defect in the posterior wall. The anterior urethral stricture was diagnosed with a fistulous course. When the digital rectal examination of the prostate in size is not enlarged, somewhat atrophic, clear boundaries, painless. In order to restore an independent urination act and get rid of cystostomy drainage, the patient was treated on 04.09.86: a scar resection of the anterior urethra, a circular duplicatory of the tunica albugineum, end-to-end urethro-anorestomosis. Under intubation anesthesia, a circular incision of the penis skin was made, 1 cm indent from the coronary sulcus, the skin was retracted to the root of the penis, the fistulous urethral cavity was excised, the urethra was maximally separated to the penostoral angle. The scar-modified part of the urethra was resected, the length of the resected area of the urethra was 8 cm and after the distal and proximal ends of the urethra had shortened, the diastasis was 10 cm. The presence of such a significant defect in the urethra did not allow imposing a direct urethro-anastomosis. since the ends of the resected urethra were not matched. In order to better adapt the edges of the urethra in order to compensate for the extended urethral defect, the cavernous bodies were shortened by creating a circular duplicatory of the tunica 6 cm wide, 10 noose silk sutures. After a satisfactory comparison of the ends of the urethra, the urethra is superimposed

0 5 „

Urethroanastomosis “end to end nodal vicryl sutures. The urethra is fixed all the way to the tunica albugs with ketogut sutures, the wound is stitched, a pressure is applied for 47 hours. The urethro-urinary anastomosis is superimposed on Sharyer's urethral catheter 18. The calculus of the bladder was simultaneously removed through cystostomy fistula.

The postoperative period was uneventful. A urethrography was performed on day 25, demonstrating good urethral patency throughout. However, during the month the patient failed to heal the urinary fistula. A control cystouroucroscopy was performed, which revealed a satisfactory permeability of the urethral anastomosis and the presence of an average proportion of prostate adenoma was diagnosed. 10.15.86, a transurethral resection of prostate adenoma was performed. The next stage of treatment was the suturing of a labial fistula in the suprapubic area. The patient was discharged in a satisfactory condition. Independent urination was restored, cystostomy drainage was removed. The data of uroflowmetry before discharge indicate the absence of infravesical obstruction.

The positive effect of the invention lies in the one-stage nature of the plastic of the urethra with its strictures with a reduction in treatment time from 9-10 to 2-3 weeks, maintaining a copulatory function with extended anterior urethral strictures due to the absence of curvature of the penis.

Claims (1)

Invention Formula The method of treatment of the extended anterior urethral stricture by excision of the constricted part and stitching of the ends of the urethra, characterized in that, in order to prevent deformation of the penis, before stitching the urethra, a circular duplication of the tunica is created by invaginating it without opening the cavernous bodies.