RU2350278C1 - Method of scraping from male urethra - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, namely to urology, andrology. After preliminary emiction, enter the instrument into a man's urethra. A material collecting is carried out. The tool system consisting of Nelaton disposable urological catheter, connected with a disposable syringe as the instrument is used. The catheter is entered into average or back department of the man's urethra. Aspiration using the syringe is carried out. Thus frame negative pressure pressing walls of the urethra to walls of the catheter and involving mucous urethra in apertures of lateral walls of the catheter. Then catheter traction on the urethra outside is carried out with sensation of resistance from suction of mucous in catheter apertures. An aspiration using the syringe and the catheter traction is carried out simultaneously.

EFFECT: method allows to take a material for research from average and-or back department of a male urethra, to reduce morbidity of scraping procedure.

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Description

The invention relates to medicine, namely to urology, andrology, and can be used to take material from the urethra for any study: bacteriological, cytological, polymerase chain reaction, immunofluorescence reaction.

Known methods of taking material from the male urethra for examination using a Volkman spoon, a disposable plastic probe, wire loop, grooved probe (Molochkov V.A., Ilyin I.I. Chronic urethrogenic prostatitis. - M .: Medicine, 2004. -126 p .).

The disadvantages of the known methods: taking material for research is impossible at a distance of more than 2-3 cm from the external opening of the urethra, pain when receiving a scraping.

Effect: the possibility of taking material for research from the middle and / or from the posterior part of the male urethra, reducing soreness when receiving a scraping.

The indicated result is achieved by using an instrumental system for scraping from the urethral mucosa, consisting of a disposable urological catheter Nelaton and a disposable syringe.

The method is as follows:

Before examination, the patient should urinate. The patient is placed in a supine position on an examination couch or in a urological chair, and the patient’s penis is washed with cotton wool with a sterile physiological solution of sodium chloride. A Nielaton sterile disposable catheter with a diameter of No. 12 or No. 14 according to Charrier made of polyvinyl chloride, is cut off at the base of the adapter and tightly put on the tip of a disposable syringe with a capacity of 2 or 5 ml. A Nelaton catheter is inserted into the middle or posterior part of the urethra and moderate aspiration is carried out with a syringe to 0.2 - 0.5 ml divisions, focusing on the patient's sensations - there should be no pain. The negative pressure created in the syringe and catheter presses the walls of the urethra against the walls of the catheter and slightly draws the urethral mucosa into the openings of the side walls of the Nelaton catheter. Then perform a slow traction of the catheter out. During traction, they feel a slight resistance that arises from the mucous membrane being drawn into the holes of the catheter; this resistance is controlled by the degree of aspiration with a syringe. It is due to this retraction of the mucosa and traction of the catheter that the mucosa scrapes off with the edge of the hole in the catheter. During the procedure, the doctor controls the comfort for the patient and the effectiveness of the scraping by the degree of aspiration, controlling the syringe plunger. Traction of the catheter along the urethra with metered aspiration is performed from the middle or from the posterior urethra to the external opening of the urethra. In this way, an aspirate scraping is obtained from the corresponding urethra. After removal of the catheter from the urethra, the resulting material is removed from the holes of the catheter with a needle from a syringe onto a glass for cytological examination or by washing with physiological saline for bacteriological examination, polymerase chain reaction, immunofluorescence reaction.

Case Studies

Example 1

Patient N., 38 years old, married, has children. Occupation - manager. Complaints: weakened adequate erection, episodes of discomfort at the time of ejaculation, episodes of rapid urination. Suffers for 1 year. Has casual sexual intercourse. Regularly gives smears at a venereologist, while no infections are detected. On examination: the external genitalia are formed correctly, the testicles in the scrotum, the elastic appendages are painless, palpation of the urethra is painless. Rectal: the prostate gland is moderately swollen and painless, the interlobar groove is smoothed. The secretion of the prostate leukocytes is 50 - 70 in the field of view, the flat epithelium is 20-30 in the field of view, mucus and leukocyte-mucous casts, amyloid bodies. Ultrasound: the prostate gland is 4.3-2.7-3.3 cm in size, the structure is heterogeneous, there is a small number of small hyperechoic formations without acoustic paths behind them, residual urine of 7-8 ml. When trying to insert a disposable Nelaton catheter into the posterior urethra, pain appeared, so further advancement of the catheter was stopped and scraping aspirate was performed from the middle section of the urethra to the external opening of the urethra. Cytological examination of the material obtained found: catarrhal-purulent inflammation, trichomoniasis; polymerase chain reaction confirmed trichomoniasis. Diagnosis: Chronic prostatitis exacerbation, chronic urethritis exacerbation, urogenital trichomoniasis. A complex etiotropic, pathogenetic and symptomatic treatment was prescribed.

Example 2

Patient L., 70 years old, married, has children, senior citizen. Complaints: there are no personal complaints, it is examined in connection with the detection of trichomonas infection in the wife, about which the wife is being treated by a gynecologist. On examination: the external genitalia are formed correctly, the testicles in the scrotum, the elastic appendages are painless, the palpation of the urethra is painless, rashes on the glans penis, no plaque. Rectally: the prostate gland is enlarged, somewhat swollen and painful in all departments, the interlobar groove is smoothed, elastic adenomatous nodes in both lobes are palpated. In the secretion of the prostate of leukocytes 10-12 in the field of view, the epithelium is flat single. According to ultrasound: the prostate gland is 4.7-4.0-4.2 cm in size, the gland volume is 51.0 cm, the structure is heterogeneous in places hyperechoic, symmetrically located isoechoic nodes in both lobes, residual urine of 18 ml are determined. A Nelaton disposable catheter is freely inserted into the posterior urethra. A scraping aspirate was taken from the entire length of the urethra, a cytological examination found: mild dysbiosis, there are no data for specific urogenital infections, trichomoniasis is also rejected by the polymerase chain reaction. Diagnosis: Chronic prostatitis exacerbation, BPH 1 tbsp. Urogenital infections were not detected. Comprehensive etiotropic, pathogenetic and symptomatic treatment is recommended.

Example 3

Patient G., 28 years old, divorced, sex life - casual relationships, occupation - specialist in oil production, is on a business trip. Complaints: frequent urination and the appearance of scanty discharge from the urethra for about 1 year. Previously examined at the place of residence, 2 years ago, chlamydia was detected. Chlamydia treated, control of cure - chlamydia was not detected. On examination: the external genitalia are formed correctly, the testicles in the scrotum, the elastic appendages are painless, the palpation of the urethra is painless, rashes on the glans penis, no plaque. Rectally: the prostate gland is somewhat swollen, slightly painful in all departments, the interlobar groove is somewhat smoothed. The secretion of the prostate white blood cells is 20-30 in the field of view, mucus and leukocyte-mucous casts. Ultrasound: the prostate gland is 3.8-2.8-3.0 cm in size, the structure is heterogeneous, there is a small number of small hyperechoic formations without acoustic paths behind them, there is no residual urine. A Nelaton disposable catheter is freely inserted into the posterior urethra, an aspirate is scraped from the posterior urethra to the external opening of the urethra. Cytological examination of the material obtained found: catarrhal inflammation, against the background of papillomavirus infection, metaplasia of the urethral epithelium with dyskeratosis; polymerase chain reaction revealed the human papillomavirus low carcinogenic risk. When cystourethroscopy revealed: in the bladder (at 6 o’clock, in the patient’s position on the back in a urological chair) at a distance of 1.5 cm from the internal sphincter of the bladder there is a papilloma on a wide base with a diameter of about 1.0 cm, a height of about 0.7 cm Diagnosis: Chronic prostatitis exacerbation, chronic urethritis exacerbation, urogenital papillomavirus infection, bladder papilloma. A complex etiotropic, pathogenetic and symptomatic treatment was prescribed. Bladder papilloma was removed endoscopically and histologically confirmed.

Example 4

Patient V., 21 years old, single, no children, sex life - irregular, occupation - high school student. Complaints about episodes of scarce, mucous discharge from the urethra for about 3 months. It was examined by a venereologist - no pathology was detected in a smear from the distal urethra, according to an enzyme-linked immunosorbent assay in the blood, antibodies to common urogenital infections were not detected. On examination: the external genitalia are formed correctly, the testicles in the scrotum, the elastic appendages are painless, the palpation of the urethra is painless, rashes on the glans penis, no plaque. Rectally: the prostate gland is significantly swollen and painful in all departments, the interlobar groove is smoothed. The secret of the prostate due to soreness is not taken. Ultrasound: the prostate gland is 4.1-3.0-3.2 cm in size, the structure is heterogeneous, somewhat hypoechoic, and 12 ml of residual urine. When trying to insert a disposable Nelaton catheter into the posterior urethra, pain appeared, so further advancement of the catheter was stopped and scraping aspirate was performed from the middle section of the urethra to the external opening of the urethra. When cytological examination of the obtained material was established: purulent inflammation, against the background of DNA-viral infection; polymerase chain reaction revealed the herpes simplex virus. Diagnosis: Chronic prostatitis exacerbation, chronic urethritis exacerbation, urogenital herpes virus infection. A complex etiotropic, pathogenetic and symptomatic treatment was prescribed.

This method of taking material for examination using a scraping aspirate from the male urethra allows you to obtain additional, valuable diagnostic information that helps to make the correct diagnosis and the success of treatment.

The method is used to obtain scraping aspirate in 35 patients with diseases of the urogenital system. (see table).

The results of the application of the method The patients Age years Diagnosis established prior to aspirate scraping with conventional urethral swabs Additional diagnosis based on material obtained by scraping an aspirate from the deep parts of the urethra Patient No. 1 28 Chron. prostatitis exacerbation Chron. urethritis exacerbation, urogenital papillomavirus infection, metaplasia of the urethral epithelium, dyskeratosis Patient No. 2 31 Chron. prostatitis remission Chron. urethritis exacerbation, urogenital chlamydia Patient No. 3 21 Examination at the UGI Chron. urethritis exacerbation, urogenital herpes virus infection Patient No. 4 25 Examination at the UGI Chron. urethritis exacerbation, urogenital ureaplasmosis Patient No. 5 31 Examination at the UGI Urethral dysbiosis, gardnerellosis Patient 6 33 Chron. prostatitis exacerbation Chron. urethritis exacerbation, epidermal staphylococcus is sown 100 000 CFU Patient No. 7 34 Chron. urethritis exacerbation Chron. urethritis exacerbation, urogenital papillomavirus infection, metaplasia of the urethral epithelium Patient No. 8 37 Chron. prostatitis exacerbation Chron. urethritis exacerbation, 1000 stf CFU and clostridial flora 1000 CFU planted Patient No. 9 38 Chron. prostatitis exacerbation Chron. urethritis exacerbation, trichomoniasis Patient No. 10 41 Chron. prostatitis exacerbation Chron. urethritis exacerbation, urogenital papillomavirus infection, metaplasia of the urethral epithelium Patient No. 11 22 Chron. prostatitis exacerbation Chron. urethritis exacerbation, urogenital ureamycoplasmosis Patient No. 12 56 Chron. prostatitis remission Chron. urethritis exacerbation Patient 13 70 Examination at the UGI Is healthy Patient No. 14 37 Chron. prostatitis remission Chron. urethritis exacerbation, urogenital papillomavirus infection, metaplasia of the urethral epithelium, dyskeratosis Patient No. 15 38 Chron. prostatitis exacerbation Chron. urethritis exacerbation, urogenital chlamydia Patient No. 16 44 Chron. urethritis exacerbation Chron. urethritis exacerbation, urogenital papillomavirus infection, ureaplasmosis Patient No. 17 23 Chron. prostatitis exacerbation Chron. urethritis exacerbation, urogenital papillomavirus infection Patient # 18 35 Chron. prostatitis exacerbation Chron. urethritis exacerbation, epidermal staphylococcus is sown 100 000 CFU Patient No. 19 33 Chron. urethritis exacerbation Allergic urethritis Patient No. 20 47 Chron. prostatitis exacerbation Chron. urethritis exacerbation, urogenital herpes virus infection Patient No. 21 fifty Chron. prostatitis remission Chron. urethritis exacerbation, ureaplasmosis Patient No. 22 34 Chron. prostatitis remission Chron. urethritis exacerbation, urogenital papillomavirus infection, metaplasia of the urethral epithelium, candidiasis Patient No. 23 33 Chron. prostatitis remission Chron. urethritis, urethral dysbiosis, gardnerellosis Patient 24 22 Examination at the UGI Chron. urethritis exacerbation, urogenital herpes simplex infection, metaplasia of the urethral epithelium Patient No. 25 25 Chron. prostatitis remission Chron. urethritis exacerbation, epidermal staphylococcus 10,000 CFU Patient No. 26 51 Examination at the UGI Chron. urethritis exacerbation, chlamydia Patient No. 27 48 Chron. prostatitis remission Chron. urethritis exacerbation, candidiasis, gardnerellosis Patient # 28 39 Chron. prostatitis remission Chron. urethritis exacerbation, urogenital papillomavirus infection Patient No. 29 41 Chron. prostatitis exacerbation Chron. urethritis exacerbation, E. coli sown 100,000 CFU Patient No. 30 40 Chron. prostatitis exacerbation Urethral dysbiosis, urogenital papillomavirus infection, urethral epithelial metaplasia, gardnerellosis Patient No. 31 35 Chron. urethritis exacerbation Chron. urethritis exacerbation, sown golden staphylococcus 100,000 CFU Patient 32 27 Examination at the UGI Is healthy Patient No. 33 26 Chron. urethritis exacerbation Chron. urethritis exacerbation, chlamydia Patient No. 34 28 Examination at the UGI Chron. urethritis exacerbation, chlamydia Patient No. 35 61 Chron. prostatitis exacerbation Chron. urethritis exacerbation, trichomoniasis

Claims (1)

A method of taking a scraping from the male urethra, including preliminary urination of the patient, insertion of the instrument into the male urethra and sampling of material, characterized in that the instrument system consists of a disposable urological catheter Nelaton connected to a disposable syringe, the catheter is inserted into the middle or back department of the male urethra, perform aspiration with a syringe, creating a negative pressure that presses the walls of the urethra to the walls of the catheter and draws the urethral mucosa into the holes b the walls of the catheter, then traction of the catheter along the urethra to the outside with a sense of resistance from pulling the mucosa into the holes of the catheter, performing aspiration with a syringe and traction of the catheter at the same time.