RU2266066C1 - Device for separating adenomatous nodes from urethra - Google Patents

Abstract

FIELD: medical engineering.

SUBSTANCE: device has curved tube, rod and knife. The knife is semi-cylindrical and fitted with gap over the tube by means of the rod. Its diameter is equal to 15-20 mm. The knife is usable for separating posterior urethra from adenomatous nodes from three sides. Space between the knife and tube corresponds to urethra wall thickness and its diameter.

EFFECT: enhanced effectiveness in removing postoperative posterior urethra strictures.

2 cl, 7 dwg

Description

The invention relates to medicine, namely to medical equipment.

Benign prostatic hyperplasia (BPH) is the most common disease in elderly and senile men. Due to the increase in life expectancy, the frequency of BPH has increased and amounts to 50-60%. Epidemiological studies show that this disease is observed in 40% after 50 years, 50% after 60 years and in 90-100% of men aged 80 years.

Despite the improvement of diagnostic methods and methods of surgical treatment, the improvement of anesthetic management and postoperative management of patients, unsatisfactory treatment results are often found and reach, according to the series of authors, 10-30% (N.A. Lopatkin, 1987, V.A. Pirogov, 1997 , A.S. Portnoy, 1989, A.S. Pereverzev, and I.F. Sergienko, 1998, K.K. Nielsen, 1990). The causes of the latter, according to the literature, are: cicatricial-sclerotic changes in the neck of the bladder and urethra, inflammatory processes in the lower urinary tract, urinary incontinence, hypotension of the bladder. These complications are associated with damage or tearing of the urethra far beyond the prostate during the enucleation of the prostate nodes.

Currently, the main treatment for BPH remains operational. Transurethral methods are increasingly replacing traditional prostatectomy. However, transvesical prostectomy and transurethral resection of the prostate in a radical volume lead to a large number of complications and increase postoperative mortality and complications associated with damage to the posterior urethra (A.S. Pereverzev and N.F. Sergienko, 1998).

To avoid this complication, a necessary condition is to perform a prostatectomy so that the prostatic part of the urethra is preserved (A.S. Pereverzev and N.F. Sergienko, 1998).

For this N.F. Sergienko (1979) proposed his own technique for the operation of transvesical adenomectomy, called by the author extraurethral. M.G. Arbuliev, 1987 proposed his own version of extraurethral prostatectomy using a cylindrical knife. The disadvantage of this device is that a cylindrical knife separates the posterior urethra from the prostate as a whole along the entire perimeter, including the front of the urethra, which is not in contact with adenomatous tissue (A.A. Rusakov 1953, V.V. Kovanov 1997. A.S. Pereverzev, N.F. Sergienko 1998).

As a prototype, we took "A device for separating adenomatous nodes from the urethra" - SU 1572565 A1, 06/23/1990 - prototype.

Therefore, it was necessary to construct a new scalpel in the form of a half-cylinder or semi-oval shape, so that it could separate the lateral and posterior walls of the prostatic part of the urethra from the adenomatous nodes, so that the front wall of the urethra remained not separated, since it is not connected with adenomatous nodes (Figs. 1, 2 )

With this approach, the blood supply to the urethra will not deteriorate and there will be no need to tax additional sutures between the front of the urethra and the mucous membrane of the bladder neck

Extremely rarely, an adenoma is localized mainly in the anterior myocardium and has intravesical growth. In these cases, a semi-oval-shaped incision is made in front of the internal opening of the urethra. By separating the urethra from the prostatic nodes, the adenoma tissue is removed (fragmented, as described by K. A. Lopatkin, 1998. However, many questions of this problem remain unresolved: first of all, this concerns the determination of indications for the use of extraurethral prostatectomy and, secondly, the identification of complications, associated with the use of extraurethral prostatectomy.

All of the above factors determine the relevance of developing a new technique for extraurethral prostatectomy.

The aim of the device proposed as an invention is to eliminate postoperative strictures of the posterior urethra and facilitate the work of a urologist.

This goal is achieved by the fact that the proposed device is a semi-cylindrical knife worn on a hollow curved tube, while the knife is put on the tube in place of the curved part using a rod.

SUMMARY OF THE INVENTION

The 1st part of the tool is a hollow metal tube soldered at the point of transition of the curved part into a straight line (Fig. 3). A rod is soldered to the curved part. The rod is smooth, and the straight part of the tube is worn on it. When assembled, such a curved metal tube is inserted during an adenectomy into the bladder. In the bladder from the straight part of the hollow tube, the curved part is unscrewed (figure 4). The second part of the device is a semi-cylindrical knife (figure 5). On the straight part of the hollow tube, a semi-cylindrical knife is worn (Fig.6), inside which there is a rod. In the process of translational movement, the knife cuts off the adenoma around the urethra from the back and from the sides, preserving the latter, in addition, the urethra does not separate in front. There are no adenomototic tissues. Hollow metal tubes are made in various diameters, corresponding to the Charrier scale.

To preserve the integrity of the urethra during the translational movement of the half-cylindrical knife, the latter was designed of various diameters (from 15 to 22 mm) so that the gap between the half-cylindrical knife and the hollow metal tube corresponds to the thickness of the urethral wall and its diameter. By removing the semi-cylindrical knife and the hollow metal tube of the latter, an adenomectomy is performed in the usual way, as described by P.A. Lopatkina (1986). (Fig. 7) Further, the urethra is sutured with interrupted catgug sutures to the neck of the bladder from 3 sides on the sides and behind.

In the postoperative period, antibiotic therapy, infusion therapy, and perfusion of the bladder are carried out in combination with other generally accepted methods of postoperative management of patients after adenomectomy.

An example of a specific implementation.

Extract from the medical history No. 12766.

A 57-year-old patient M. was admitted to the urology clinic on November 12, 2001, with complaints of frequent urination, which interferes with normal work and disrupts sleep. Sick for the past 4-5 years. The disease is progressing. Rises up to 10 times at night. A clinical and radiological examination established the diagnosis of stage II prostate adenoma. The operation — transvesical adenomectomy — was performed on 11/17/87 using a device to preserve the posterior urethra.

Description of the progress of the operation. A hollow metal tube is inserted into the bladder cavity through the urethra. The curved part is unscrewed from the latter. At the end of the straight part of the metal tube, installed at the level of the neck of the bladder, a cylindrical knife is put on, which cuts the urethra from the adenomatous tissue in the process of translational movement. Semi-cylindrical knife and hollow tube are removed. An adenomectomy is performed. Catgut sutures were placed between the initial part of the urethra and the neck of the bladder. The duration of the operation is 1.5 hours. On day 10, the patient was discharged in satisfactory condition for outpatient treatment.

Signs of the invention, distinctive from the prototype.

The prototype uses a cylindrical knife that separates the posterior urethra into a circular, i.e. on all sides, the blood supply to the urethra is disturbed.

The invention uses a semi-cylindrical knife, which separates the posterior urethra from 3 sides, the front wall of the urethra remains connected to the surrounding tissue and the blood supply to the urethra is not disturbed.

POSITIVE EFFECT

For the period from 1997 to 2003, transvesical adenomectomy with preservation of the prostatic part of the urethra was performed in 40 patients. For comparison, we took 40 patients who underwent an adenomectomy in the usual way, i.e. without using the device of our design.

40 patients treated by the proposed method have never met with signs of narrowing of the posterior urethra and urinary incontinence.

The proposed method of adenomectomy has the following advantages over the known method:

1. The prostatic part of the urethra is not removed or damaged.

2. The stricture of the posterior urethra does not develop.

3. There is no urinary incontinence.

4. The use of the proposed method can reduce postoperative complications by 2 times and significantly reduce the rehabilitation of patients.

5. The work of the surgeon-urologist is facilitated.

Claims (2)

1. A device for separating adenomatous nodes from the urethra, containing a curved tube, a rod and a knife made for putting on with a gap on the tube using a rod, characterized in that the knife has a diameter of 15 to 22 mm and is made semi-cylindrical to separate the posterior urethra from adenomatous nodes on three sides, while the gap between the knife and the tube corresponds to the thickness of the urethral wall and its diameter. 2. The device according to claim 1, characterized in that the tube is made of metal, and the rod is made smooth and soldered to the curved part of the tube.

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