urethral intubation

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. Those with narrower stenosis and less scars are expected to be cured by urethral dilatation. If the urethral dilatation fails or the effect is not good, other surgical treatment methods should be chosen. 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. Urethral intubation refers to the resection of the urethral scar stenosis, the two ends do not make a contralateral anastomosis, but the distal urethral stump is pulled to the proximal urethral stump by the traction of the catheter to reconstruct the urethra. Continuity. This method was first used by Solovov (1932) to treat traumatic posterior urethral stricture. Badenoch (1950) further advocated and is still used in many hospitals. The advantage of this operation is that it only needs to remove the scar of the urethra scar, free the distal urethral stump, and not do the urethral anastomosis, so there is no need to dissociate the proximal urethra, and the operation is simple. The disadvantage is that the urethral alignment of this operation is maintained by the traction force. If the traction force is too small, the two ends of the urethra often cannot meet, and there is a distance in the middle; if the traction is too large, the two ends of the urethra are nested or the urethra is broken. Avascular necrosis, stenosis will still occur in the future. The surgical indications should be strictly controlled in the clinic, and only those patients who have difficulty in performing urethral anastomosis should be considered for this operation. Treatment of diseases: urethral stricture Indication Urethral intubation is suitable for posterior urethral stricture, with a deeper position and a wider range of stenosis, or has undergone urethral surgery, urethral defect is longer, and urethral anastomosis is difficult. Surgical procedure 1. Free the distal urethra and fix the broken end on the traction catheter. According to the operation procedure of the perineal perineal urethral anastomosis, the genital urethra is exposed and the urethra of the cavernous body is cut at the distal end of the scar stenosis. The distal end of the free urethra is inserted into the catheter from the external urethra, and its tip to the end is exposed to a length of about 5 cm. 3 to 3 cm from the tip of the catheter is tightly wrapped with 2-0 absorbable lines for 2 to 3 turns and knotted, and the distal urethral stump is sutured with a 4-0 absorbable line. On the slit coil. 2. The proximal urethra is exposed to open the bladder. The metal urethral probe is inserted into the posterior urethra of the bladder to the proximal end of the scar stenosis. The scar is completely removed under the guidance of the probe to reveal the proximal urethra. 3. Traction of the distal urethra is inserted through the bladder through a catheter and through the proximal end of the urethra. The catheter has a thick thread at the tip of the catheter, and the suture is sewn to the tip of the catheter in the distal urethra. The catheter in the bladder is pulled out, so that the distal end of the urethra is closely attached to the proximal urethral stump with the traction of the catheter. 4. Fix the traction line, close the incision, pull the suture at the tip of the catheter through the bladder, pull it slightly and fix it on the abdominal wall, so that the two ends of the urethra meet. After the pubis, the rubber tube is drained, the bladder is made, and the abdomen and perineal incision are closed layer by layer.