Postcoital cystitis: a view at the problem, technique and results of extravaginal transposition of the urethra

Мұқаба

Дәйексөз келтіру

Толық мәтін

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

Аннотация

Aim. To present a view on the problem of postcoital cystitis, the technique and results of extravaginal urethral transposition using the method we developed.

Materials and methods. From 2005 to 2025, extravaginal urethral transposition was performed in 602 patients aged 18 to 61 years (average 26.7±1.3 years) at the Urology Clinic of the I.I. Mechnikov North-Western State Medical University. In all cases, the method developed at the clinic (patent No. 2408296 dated 10.01.2011) was used. It involves complete mobilization of the urethra and its placement in the submucosal tunnel into the clitoris area, where it is brought out through a separate incision and fixed with interrupted sutures. The posterior wall of the urethra is captured in the suture when closing the vaginal incision, which makes the urethra more securely fixed in a new place. Urethro-hymenal adhesions are necessarily excised.

Results. Early postoperative complications occurred in 17 (2.8%) patients. In the late period from 6 to 192 months (mean 38 ± 2 months), 435 (72.3%) women were examined. Complete recovery occurred in 339 (77.9%), while significant improvement was noted in 66 (15.2%) cases. In 30 (6.9%) patients, urethral transposition was ineffective, and reintervention was successful in 10 patients. A positive result was achieved in 415 (95.4%) women.

Discussion. In all patients, the meatus was in the same place above the introitus and was never located inside it. There was no ectopia/dystopia in relation to the vagina. The abnormality was that in patients with postcoital cystitis, both tubes, urethral and vaginal, were located low, but at the same level. The external opening of the urethra and the introitus, without changing their position in relation to each other, were located under the pubis or even behind it. Obviously, the transformation of the urogenital sinus into the vestibule of the vagina occurred, and the urethra and vagina did not completely emerge from under the pubis behind it. This can be called sub-symphyseal or retro-symphyseal urethro-vaginal dystopia.

Conclusions. Retro-symphyseal urethro-vaginal dystopia should be considered as a mild urogenital malformation, but sufficient to become the anatomical basis for the development of postcoital cystitis. This anomaly and frequent episodes of cystitis after sexual intercourse are indications for surgical intervention. The best results are achieved with proper selection of patients and compliance with all technical features of the extravaginal transposition of the urethra developed in our clinic.

Толық мәтін

Рұқсат жабық

Авторлар туралы

Boris Komyakov

FGBOU VO North-Western State Medical University named after I.I. Mechnikov

Хат алмасуға жауапты Автор.
Email: komyakovbk@mail.ru
ORCID iD: 0000-0002-8606-9791

Honoured Physician of the Russian Federation, Ph.D., MD, professor, Head of the Department of Urology

Ресей, 195067, Saint Petersburg, Piskarevsky pr., 47

Әдебиет тізімі

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Әрекет
1. JATS XML
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2. Fig. 1. Intraoperative picture. Stage of the operation – mobilization of the urethra

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3. Fig. 2. Intraoperative picture. Stage of the operation - the urethra is mobilized, a submucosal tunnel is created before the incision in the clitoris area.

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4. Fig. 3. Intraoperative picture. Stage of the operation - the urethra is inserted into the submucous tunnel, its external opening is brought out through an incision in the clitoris area.

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5. Fig. 4. Intraoperative picture. Stage of the operation - the urethra is sutured to the vaginal wall with interrupted sutures. Excision of urethrohymenal adhesions

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6. Fig. 5. Intraoperative picture. Stage of the operation - transverse interrupted suture on the vagina with the capture of the posterior wall of the urethra

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7. Fig. 6. Intraoperative picture. Final stage. Sutures on the vaginal defect

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8. Fig. 7. External genitalia of a woman with PC. Large distance from the clitoris to the external opening of the urethra and the entrance to the vagina

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9. Fig. 8. Magnetic resonance imaging (MRI) of the pelvic region before surgery. Retrosymphyseal position of the urethra (1) and vagina (2)

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10. Fig. 9. MRI of the pelvic region after urethral transposition. Its distal part (arrow) is brought out from under the pubis.

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