Bypass heterotopic urethroplasty as a method of possible choice in the surgical treatment of extended strictures of the posterior urethra. One concept - three clinical cases

Мұқаба

Дәйексөз келтіру

Толық мәтін

Ашық рұқсат Ашық рұқсат
Рұқсат жабық Рұқсат берілді
Рұқсат жабық Рұқсат ақылы немесе тек жазылушылар үшін

Аннотация

Objective. To study the effectiveness of surgical treatment of extended strictures of the posterior urethra by the method of bypass heterotopic urethroplasty.

The authors present 3 patients after urethral reconstruction by the method of bypass heterotopic urethroplasty. Patients before surgery were united by the lack of patency of the posterior urethra for a significant length as a result of trauma or iatrogenic injury, as well as the need to have a cystostomy and the inability to restore the patency of the urethra by traditional methods of conservative and surgical treatment.

The patency of the urethra was restored in all patients, the cystostomy was removed, and a certain level of control of urination was achieved.

The method of bypass heterotopic urethroplasty may become the operation of choice in the treatment of hard-to-reach strictures and obliterations of the posterior urethra due to the high effectiveness of treatment. Despite the fact that the issue of incontinence remains unresolved, this method allows us to hypothesize that neosphincter mechanisms can spontaneously form in the area of anastomosis of the heterotopic urethra and the bladder wall over time.

Толық мәтін

Рұқсат жабық

Авторлар туралы

А. Kamalov

Medical Research and Education Center of the Lomonosov Moscow State University

Email: armais.kamalov@rambler.ru
ORCID iD: 0000-0003-4251-7545

Academician of the Russian Academy of Sciences; Dr.Sc.(Med), Full Prof., Director, Head Dept of Urology and Andrology Faculty of Fundamental Medicine 

Ресей, Moscow

R. Adamyan

Medical Research and Education Center of the Lomonosov Moscow State University; Petrovsky National Research Centre of Surgery

Email: rtadamyan@mail.ru

Dr.Sc.(Med), Full Prof., chief researcher 

Ресей, Moscow; Moscow

А. Istranov

Sechenov First Moscow State Medical University

Email: plasticsurgeon@yandex.ru

Dr.Sc.(Med), Prof., Departments of Oncology, Radiotherapy and Plastic Surgery 

Ресей, Moscow

О. Startseva

Sechenov First Moscow State Medical University

Email: ostarceva@mail.ru

Dr.Sc.(Med), Prof., Departments of Oncology, Radiotherapy and Plastic Surgery 

Ресей, Moscow

S. Zorkin

Sechenov First Moscow State Medical University

Email: zorkin@nczd.ru

Dr.Sc.(Med), Full Prof., head of the Center for Pediatric Urology and Andrology, Head of the Urology department with reproduction and transplantation groups, National Medical Research Center for Children’s Health Federal state autonomous institution

Ресей, Moscow

А. Verzin

N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology – branch of the NMRRC of the Ministry of Health of Russia

Email: sekr.urology@gmail.com

PhD (Med), Head of the Microsurgery and Urological Trauma Group

Ресей, Moscow

M. Ekhoyan

City Clinical Hospital 31

Email: miso83@list.ru

urologist

Ресей, Moscow

K. Imanova

Sechenov First Moscow State Medical University

Email: hannaimanova@yandex.ru
ORCID iD: 0000-0001-8335-8283

student

Ресей, Moscow

O. Nesterova

Medical Research and Education Center of the Lomonosov Moscow State University

Хат алмасуға жауапты Автор.
Email: oy.nesterova@gmail.com
ORCID iD: 0000-0003-3355-4547

PhD (Med), Urologist, Researcher, Urology and Andrology Unit, senior lecturer of the Dept. of Urology and Andrology, Faculty of Fundamental Medicine

Ресей, Moscow

Әдебиет тізімі

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Әрекет
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Жүктеу
2. Fig. 1. Patient K. Retrograde urethrography before surgery a-extended stricture of the prostatic urethra (marked with an arrow), deformation of the bladder neck, b-view of the installed stent (marked with an arrow) in the position of the prostatic urethra.

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3. Fig. 2. Patient K. The second stage of the operation: Isolation of the urethra throughout (a) and its cutting off at the level of the stricture in the area of the beginning of the membranous urethra (b); isolation of a radial cutaneous-fascial autograft, from which a neourethra will subsequently be formed on a Foley catheter. The dimensions of the flap were 14 cm x 3.5 cm. The length of the vascular pedicle (radial artery with concomitant veins) was 8 cm. The distal end of the flap is oriented towards the hand, proximal to the elbow (c); anastomosis of the native urethra with the proximal end of a tubularized fasciocutaneous radial autograft (d), vesico-neourethral anastomosis (e).

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4. Fig. 3. Patient K. Retrograde cystourethrography after surgery. The beginning and end of the neourethra are marked with arrows. Oblique projection.

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5. a – appearance of the patient’s body; b – dissected pubic bones on a plain radiograph (marked with an arrow); c, d – absence of the bladder neck, prostatic and membranous parts of the urethra during cystourethrography (marked by arrows). Fig. 4. Patient S. upon admission

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6. Fig. 5. Patient S. First stage of the operation Tubularized inguinal fasciocutaneous flap (a and b); c – view of the isolated bladder wall; d – creation of a neourethral-vesical anastomosis.

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7. Fig. 6. Patient C. Appearance of the patient’s body after the first stage of the operation. “Urine” through the neourethra when the abdominal muscles are tense

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8. Fig. 7. Patient S. Second stage of the operation a – preoperative marking; b – isolation of the neourethral conduit from its external opening to the point of entry into the wall of the bladder; c – isolation of the urethra to the site of the beginning of the stricture and its rotation around the pedicle of the corpus cavernosum; d – passage of the isolated fragment of the urethra into the subcutaneous tunnel above the pubis; d and f – urethro-neourethral anastomosis under the skin of the anterior abdominal wall

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9. Fig. 8. Patient S. Mixture multispiral cystourethrography 3D reconstruction of the urinary tract: a - direct projection, b - sagittal projection, c - direct projection without pelvic bones, d - direct projection taking into account soft tissues

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10. Fig. 9. Patient L. upon admission A – appearance of the patient’s body, b-d – 3-D reconstruction of a computed tomographic image based on MSCT data of the urinary system.

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11. Fig. 10. Patient L. Stages of the operation a – the urethra is isolated to the point where obliteration begins, b – the isolated fragment of the urethra is carried out in the subcutaneous tunnel above the pubis, c – the bladder wall is exposed through the epicystostomy opening, d – the stage of formation of the urethro-vesical anastomosis.

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