RU2408296C1 - Method of surgical treatment of hypermobility and vaginal ectopia of urethra - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to urology and gynecology. Distal part of urethra on length of 1.5-2 cm is isolated and then moved under crus of clitoris and fixed by opening edges. Urethra is exposed. Submucous tunnel from clitoris to external urethra opening 1.5-2 cm long is formed with further passing through it of distal part of urethra.

EFFECT: method allows to reduce operation trauma, which reduces risk of development of urethra narrowing and reduces terms of patients' rehabilitation.

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Description

The invention relates to medicine, namely to urology and gynecology, and can be used to transpose the external opening of the urethra in women in the surgical treatment of hypermobility and vaginal ectopia of the urethra.

Hypermobility should be understood as the increased mobility of the external opening of the urethra, more often this is due to the presence of urethro-hymenal adhesions, which are the remains of the hymen.

With vaginal ectopia, the external opening of the urethra is located proximal to its usual place - at the border, and in some cases on the front wall of the vagina. In both cases, during intercourse, the external opening of the urethra in the vagina is displaced with its simultaneous opening, creating the conditions for retrograde infection of the urethra with the vaginal flora. In the clinic, such conditions manifest themselves in the form of dysuria, pain during intercourse, which leads to a significant decrease in sexual activity, and in some cases, abandonment of sexual activity.

The main surgical method of treatment proposed to remove the external opening of the urethra from the vagina is hymenoplasty. However, this operation is effective only in the presence of urethro-genital adhesions leading the external opening away from its anatomical site (1, 2, 3).

In cases where there is a vaginal ectopia of the external opening of the urethra or hypermobility with unexpressed urethro-genital adhesions, hymenoplasty is ineffective.

According to the closest technical essence, as a prototype, we have chosen the method of transposition of the external opening of the urethra in women (4).

The essence of the method: Dissect tissue from the clitoris to the external opening of the urethra. Allocate its distal section for 1.5-2 cm. The selected part of the urethra is moved under the legs of the clitoris and fixed at the edges of the hole. The posterior wall of the urethra in the proximal part is fixed to paravaginal tissues. Restore the integrity of the vagina. The method allows to create conditions for preventing the penetration of infection into the urinary tract during intercourse.

The disadvantage of the prototype is the trauma of the paravaginal tissues surrounding the distal urethra caused by an incision along the entire length from the clitoris to the external opening of the urethra, which:

- increases the risk of scarring of the surrounding tissue of the urethra and can lead to its narrowing;

- reduces the reliability of the fixation of the distal urethra.

High trauma to the mucous membrane and vaginal tissues is also a disadvantage of the prototype and can lead to an increase in rehabilitation time.

The objective of the invention is to reduce the risk of recurrence of urethral hypermobility, as well as reducing the rehabilitation time of patients.

The technical result of the invention is to increase the reliability of fixation of the urethra, reducing the risk of narrowing of the urethra, reducing the invasiveness of the method.

The technical result is achieved by isolating the distal urethra for 1.5-2 cm. After this, a submucous tunnel is formed from the clitoris to the external opening of the urethra 1.5-2 cm long and the distal urethra is passed through it. Then it is moved under the clitoris legs and fixed at the edges of the hole.

The method is as follows.

In the position for vaginal surgery, a bordering incision is made around the external opening of the urethra. The distal urethra is isolated in a blunt and sharp way for 1.5-2 cm. 0.5 cm from the clitoris, they cut the mucosa and bluntly form a submucous tunnel to the external opening of the urethra. Then the selected distal urethra is moved in the submucosal tunnel under the clitoris legs and without tension is fixed at the upper opening of this tunnel. After that, the external opening of the urethra is finally formed with sutures from synthetic absorbable materials. Then restore the integrity of the vagina and establish a transurethral Foley catheter for drainage of the bladder for 2-4 days. The vagina is treated with antiseptic solutions.

Salient features of the proposed method are:

- after allocation of the urethra, the formation of a submucous tunnel from the clitoris to the external opening of the urethra with a length of 1.5-2 cm;

- conducting through the formed tunnel of the distal urethra.

A causal relationship between the salient features and the result:

- the formation of a submucous tunnel from the clitoris to the external opening of the urethra is necessary for the distal urethra to pass through it;

- conducting the distal urethra through the formed tunnel reduces the invasiveness of the method, and also reduces the risk of narrowing of the urethra due to the prevention of trauma to surrounding tissues, in contrast to the prototype, including cutting the mucous membrane and soft tissues throughout from the clitoris to the external opening of the urethra.

The exclusion of dissection of paravaginal tissues, in contrast to the prototype method improves the fixation of the distal urethra in these tissues.

The set of distinctive essential features is new and improves the reliability of urethral fixation, which reduces the risk of recurrence of urethral hypermobility; reduce the invasiveness of the operation, which reduces the risk of narrowing of the urethra and shortens the rehabilitation of patients.

Case Studies

Example 1. And / b No. 30726-s. Patient X., 25 years old, went to the clinic with complaints of rapid and painful urination. According to the patient, these complaints arose 12-24 hours after sexual intercourse. The first such complaints appeared 6 years ago, immediately after the onset of sexual activity. Marital sex is not regular due to frequent exacerbations of cystitis. The patient has been treated repeatedly for exacerbations of chronic cystitis with a short-term effect. Twice the patient was hospitalized with exacerbations of chronic pyelonephritis. At the last hospitalization on October 13, 2007, the patient revealed a vaginal ectopia of the urethra and an operation was performed to transpose the distal urethra of the claimed method. The postoperative period was uneventful. At the control examination after 6 months, the external opening of the urethra is located under the clitoris. With further observation for 1.5 years, exacerbations of chronic cystitis were not observed. Sex life returned to normal.

Example 2. And / b No. 6590. Patient K., 30 years old, complained of rapid and painful urination after intercourse. These complaints bothered the patient for 11 years after the onset of sexual activity. The patient repeatedly received anti-inflammatory therapy for exacerbation of chronic cystitis and urethritis with a short-term positive effect. Examination revealed vaginal ectopy and hypermobility of the distal urethra. The patient performed a transposition of the distal urethra of the claimed method. During dynamic observation for 3 years, exacerbations of chronic cystitis were not observed. Sexual life is regular, no complaints after sexual intercourse.

Using the proposed method, we operated on 21 women suffering from frequent exacerbations of chronic cystitis or urethritis. These exacerbations, as a rule, were associated with sexual intercourse. In 19 patients operated using this method, a pronounced clinical recovery was noted. Dysuric phenomena after intercourse did not bother. In 2 patients, frequent exacerbations of chronic cystitis persisted.

The inventive method improves the reliability of fixation of the urethra, which is confirmed by the fact that in all 21 operated patients there was no relapse of hypermobility of the urethra.

The rehabilitation period in patients operated on by the claimed method is 6-8 days.

The control group - 8 women operated on by the prototype method. 2 patients had a relapse of urethral hypermobility. The rehabilitation period in patients operated on by the prototype method is 8-10 days.

Thus, the claimed method, compared with the prototype, increases the reliability of fixation of the urethra, which, in turn, reduces the risk of recurrence of hypermobility of the urethra. The advantage of the proposed method is also to reduce the morbidity of the operation, which reduces the risk of narrowing of the urethra and shortens the rehabilitation of patients.

Claims (1)

A method of surgical treatment of hypermobility and vaginal ectopia of the urethra, including the allocation of the distal urethra for 1.5-2 cm with its subsequent movement under the legs of the clitoris and fixing it beyond the edges of the opening, characterized in that after the allocation of the urethra, a submucous tunnel is formed from the clitoris to the external urethral orifices 1.5-2 cm long followed by the distal urethra through it.