bulbourethral anastomosis

Male urethral stricture is a common disease in urology, which can be divided into three categories according to its etiology, congenital, inflammatory and traumatic. Congenital urethral stricture is less common, such as congenital urethral stricture, urethral valve, fine hypertrophy, urethral lumen narrowing. Inflammatory urethral stricture is caused by a specific or non-specific urinary tract infection. In specific infections, gonorrhea urethral stricture is more common; in non-specific infections, the urethral orifice and penile urethral stricture are common due to repeated foreskin and penile head inflammation, and the inflammatory urethra is caused by improper placement of the catheter. Stenosis has attracted widespread attention. This type of stenosis is more common in the corpus cavernosum. The traumatic urethral stricture is the most common acquired urethral stricture. The stenosis depends on the injury site. Most of the causes are in the urethra of the ball. In patients with pelvic fractures, located in the urethra of the membrane or at the tip of the prostate, the stenosis is generally not long, but the scar is hard. Severe urethral stricture can cause upper urinary tract water and renal dysfunction. There is often inflammation in the proximal and surrounding tissues of the urethral stricture. In some cases, inflammation around the urethra, abscess around the urethra, and even scrotal perineum can be worn. The formation of long-term unhealed urethra fistula, often complicated by urinary tract and reproductive tract infections, and some cases also have a suprapubic bladder stoma, should be prepared according to the specific circumstances. Those with narrower stenosis and less scars are expected to be cured by urethral dilatation. If the urethral dilatation fails or the effect is not good, other surgical treatment methods should be chosen. Endoscopic surgery for the treatment of urethral stricture has a positive effect, has been widely used in clinical, with small trauma, less bleeding, less postoperative complications, etc., should be the preferred method for the treatment of urethral stricture. However, it requires special equipment. For complicated urethral strictures, especially those with long stenosis, open surgical treatment is still the main means. Therefore, endovascular treatment can not completely replace other surgical treatments. Treatment of diseases: urethral stricture Indication The urethral stricture and stenosis length of the ball within 3cm, urethral dilatation treatment failure or no significant effect, feasible urethral scar stenosis and urethral end-to-end anastomosis. Inflammatory urethral stricture, local inflammation should be no obvious; traumatic urethral stricture should be performed 3 months after the injury. Contraindications Urethral stenosis complicated by acute or subacute urethritis, or those with sacral tract, contraindications for urethral anastomosis, should be performed first pubic urethroplasty, and urethral surgery should be performed 3 months after inflammation or sacral cure. Otherwise, not only will the chances of successful surgery be minimal, but there is a risk of spreading the infection and even causing sepsis. Surgical procedure 1. Incision and exposure of the urethral bulbar body If the urethral stricture near the scrotum root, the perineal straight incision can be used; if close to the membrane urethra, a "U" shaped incision should be used. Cut the skin and subcutaneous tissue to the surface of the bulbous muscle by layer. The surrounding tissue is bluntly freed from the surface, so that the corpus cavernosum muscle is completely exposed within the incision. 2. The free urethral stricture segment longitudinally incision of the corpus cavernosum muscle, revealing the bulbar urethra surrounding it. The urethra is released from the corpus cavernosum muscle along both sides of the urethral sponge body and up and down. Then, a tissue forceps is used to clamp the urethral scar, and between the corpus cavernosum and the corpus cavernosum, separated by scissors, so that the urethral scar stenosis segment and the proximal and distal portions of the normal urethra are completely separated from the corpus cavernosum. 3. Resection of the stenosis of the scar The urethra is inserted into the urethral orifice through the external urethra, and the distal obstruction site is the distal end of the urethral stricture. The transverse urethra is cut off in the normal urethra where the tip of the probe is blocked. The distal urethral stump is clamped with a tissue pliers to temporarily stop the bleeding, and then the urethral segment of the scar is resected, revealing the normal proximal urethral stump, and the broken end is also used. Tissue clamp full layer clamp lifted. 4. Anastomotic urethral urethral stump with 2-0 or 3-0 absorbable line discontinuous end anastomosis, indwelling catheter in the urethra. 5. Place the drainage and close the incision.

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