urethral dilation

Male urethral stricture is a common disease in urology, which can be divided into three categories according to its etiology, congenital, inflammatory and traumatic. Congenital urethral stricture is less common, such as congenital urethral stricture, urethral valve, fine hypertrophy, urethral lumen narrowing. Inflammatory urethral stricture is caused by a specific or non-specific urinary tract infection. In specific infections, gonorrhea urethral stricture is more common; in non-specific infections, the urethral orifice and penile urethral stricture are common due to repeated foreskin and penile head inflammation, and the inflammatory urethra is caused by improper placement of the catheter. Stenosis has attracted widespread attention. This type of stenosis is more common in the corpus cavernosum. The traumatic urethral stricture is the most common acquired urethral stricture. The stenosis depends on the injury site. Most of the causes are in the urethra of the ball. In patients with pelvic fractures, located in the urethra of the membrane or at the tip of the prostate, the stenosis is generally not long, but the scar is hard. Severe urethral stricture can cause upper urinary tract water and renal dysfunction. There is often inflammation in the proximal and surrounding tissues of the urethral stricture. In some cases, inflammation around the urethra, abscess around the urethra, and even scrotal perineum can be worn. The formation of long-term unhealed urethra fistula, often complicated by urinary tract and reproductive tract infections, and some cases also have a suprapubic bladder stoma, should be prepared according to the specific circumstances. The stenosis is lighter and the scar is not heavy. It is expected to be cured by urethral stricture. If the urethral stricture expansion fails or the curative effect is poor, other surgical treatment methods should be selected. Endoscopic surgery for the treatment of urethral stricture has a positive effect, has been widely used in clinical, with small trauma, less bleeding, less postoperative complications, etc., should be the preferred method for the treatment of urethral stricture. However, it requires special equipment. For complicated urethral strictures, especially those with long stenosis, open surgical treatment is still the main means. Therefore, endovascular treatment can not completely replace other surgical treatments. Treatment of diseases: urethral stricture Indication The main indication for stenosis of the urethra is prevention and treatment of inflammatory, traumatic and urethral stricture after urethral surgery. The urethral stricture expansion treatment of urethral stricture, on the one hand, plays a role in mechanical expansion of the stenosis, on the other hand acts as a massage to enhance local blood circulation and promote scar softening and infiltration. In addition, urethral stricture can also be used as one of the measures to treat chronic prostatitis, chronic urethritis, mild bladder neck obstruction and other diseases, and to detect the presence of stones or metallic foreign bodies in the urethra or bladder. Contraindications 1. Acute urethritis, acute prostatitis, avoid urethral stricture, in order to avoid the spread of inflammation. 2. Chronic urethritis has more purulent secretions, avoid urethral stricture expansion. 3. Urethral injury avoids urethral stricture expansion, so as not to aggravate injury, hemorrhage, shock, or cause falsehood. 4. Suspected of having a urethra tumor. 5. Each urethral stricture after urethral stricture has urinary tract heat. Preoperative preparation 1. Check that all urethral probes are complete. In general, there should be a complete set of urethral probes, in order to expand the urethra according to the needs of the disease. Prepare the catheter and, if necessary, postoperative catheterization. 2. Patients with chronic urethritis, give antibiotics 1 to 2 days before surgery, and drink plenty of water. Surgical procedure 1. The probe is inserted into the urethra If the patient is in a supine position, the surgeon is placed on the left side of the patient (the right side is also available, depending on the examiner's habit); if the patient is a lithotomy position, the surgeon can stand between the two thighs of the patient. The surgeon holds the probe handle with the right thumb, the middle finger and the middle three fingers, and the probe is coated with a sterile lubricant. Support the patient's penis with the left hand, make it straight up, use the thumb and middle finger to separate and fix the external urethra, and slowly insert the probe into the urethral opening. 2. The spy is sent to the ball urethra After the probe is inserted into the external urethra, it remains parallel to the abdominal wall of the patient, and the probe is inserted inward. After passing through the urethral tract, the tip of the probe slides into the urethra of the ball. 3. The tip of the probe spans the urethra of the membrane After the tip of the probe enters the urethra of the ball, the surgeon releases the left hand to pull the penis without tension, and the surgeon gently pushes the probe gradually toward the posterior urethra, pushing the probe to the vertical position parallel to the abdominal wall. The tip is placed across the urethra of the membrane into the urethra of the prostate. 4. The tip of the probe enters the bladder After the tip of the probe passes through the urethra of the membrane, the probe is pushed forward, and pushed forward by pressing it perpendicular to the abdominal wall to make it parallel. When fully parallel, the front of the probe has entered the bladder, completing the operation of the entire urethral stricture. When the probe enters the bladder, it can be twisted left and right in the urethra and bladder. After the urethral stricture is completed, follow the above procedure to pull out the probe in the opposite procedure. complication Urethral bleeding The urethral probe passes through the stenosis and can cause local mucosal tears to bleed. If the bleeding is not heavy and there is no difficulty in urinating, you can drink more water, and give appropriate antibacterial drugs. Generally, local bleeding can stop spontaneously within a few hours. However, sometimes due to improper urethral dilation, the use of a thick probe to force the narrowing of the urethra, causing a local large tear, or breaking the urethra at the distal end of the urethral stricture, causing tearing of the urethra submucosa or urethral sponge If there is a crack, a large amount of bleeding can occur, and in severe cases, hemorrhagic shock can occur. Due to localized bleeding and tissue edema, dysuria may occur, or a large amount of bleeding may occur in the posterior urethra, and blood may flow into the bladder to form a blood clot that blocks urinary retention in the urethra. If the bleeding is heavier and there is difficulty in urinating, the catheter should be indwelled. If the balloon catheter can be inserted, it is better. Inject 15 to 20 ml of sterile liquid into the balloon and pull it slightly to prevent the bleeding in the urethra from flowing into the bladder and blocking the catheter. At the same time, the perineum and penis are padded with cotton pads or ice packs to stop bleeding, strengthen anti-infective treatment, and remove the catheter after the bleeding stops for 2 to 3 days. If the urethral hemorrhage is severe and the dysuria is difficult to insert into the catheter, a temporary suprapubic bladder ostomy should be performed. 2. Urethral rupture The worn parts are more common in the urethra and posterior urethra. The tip of the probe penetrates from the distal side of the urethral stricture, and can be worn submucosally, the entire urethra or even into the rectum, or form a false passage into the bladder. The main reason for urethral perforation is the lack of experience and rigorous operation. The finer the urethral probe is, the more likely it is to occur. Symptoms that appear immediately after urethral perforation are pain and bleeding. If broken into the rectum, it is easy to cause infection of the prostate and the tissues around the posterior urethra, pain in the perineum, rectum and suprapubic area, difficulty in urinating and fever. After wearing the posterior urethra, there may also be extravasation of the prostate and bladder around the bladder. Patients with urethral perforation should take immediate hemostasis measures and anti-infective measures. Patients with bleeding and dysuria should have a temporary suprapubic bladder stoma and a urethral indwelling balloon catheter. In the case of infection around the urethra or abscess formation, drainage should be performed. 3. Infection In addition to upper urinary tract infections and germline infections, urethral stricture can also cause urinary tract heat or sepsis. The latter two are the most serious complications of urethral stricture expansion, and death can not be caused by timely rescue. There are many bacteria hidden in the mucosal folds of the urethral stricture. When the urethra is dilated, bacteria and their toxins enter the blood due to dilated squeeze or local damage, causing transient toxemia, bacteremia or sepsis. Within a few hours after the expansion of the urethral stricture, the patient suddenly had high fever, chills, nausea, vomiting, and even hypotension, and toxic shock occurred. In severe cases, acute adrenal insufficiency or acute renal failure may occur. Leukocytes are significantly elevated, and sometimes blood cultures can produce the same bacteria as urine or urethral secretions, most of which are Gram-negative bacilli. Urinary tract heat and sepsis must be treated immediately and intravenously infused with effective antibiotics until the infection is fully controlled. Those with hypotension should use booster drugs, intravenous adrenal cortical hormones and pay attention to maintain blood volume and correct metabolic acidosis.