METHOD FOR SURGICAL TREATMENT OF PATIENTS WITH LOCALIZED FORMS OF PROSTATE CANCER AND URETHRAL STRICTURES Russian patent published in 2022 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to operative urology. In the position of the patient lying in the lithotomy position on the operating table, after processing the surgical field, two operating teams simultaneously perform the stages of surgical intervention under endotracheal anesthesia. A urethral catheter is passed along the urethra to the stricture zone in the penile region, then the soft tissues are dissected in layers along the ventral surface of the penis with a longitudinal incision 8 cm above the stricture, the ventral and lateral walls of the urethra are isolated. The modified fragment of the urethra is mobilized from the cavernous body with the exposure of the dorsal surface and with the capture of healthy areas of 1 cm proximally and distally. Then the urethra is dissected longitudinally through the narrowing zone, including 7 mm of healthy tissue proximally and distally, the total defect of the urethra and the length of the required graft are assessed. After pre-treatment of the oral cavity and hydropreparation, a buccal graft is taken from the inner surface of the cheek. The resulting defect is sutured with a continuous suture, and the graft, cleared of adipose tissue, is placed on the albuginea of the cavernous body opposite the defect of the urethra, the mucosa towards the lumen of the urethra. The edges of the graft are compared with the urethral mucosa with interrupted monocryl sutures 4/0; a silicone profiled Foley catheter No. 14 is passed through the urethra into the bladder and the wound is sutured in layers. Simultaneously with plastic surgery of the urethra, with the help of the second operating team, an incision is made in the paraumbilical region 3 cm below the navel, 4-4.5 cm long, access to the prevesical space is made in layers. The index finger forms the primary cavity into which the balloon dilator is inserted. Pressure is injected into the dilator with a hand pump, and a working space is formed. A laparoscope is inserted into the dilator to assess the correct standing of the dilator, and with the correct setting of the balloon dissector, the latter is removed and the laparoscope is inserted into the working cavity through the access described above. On the right, 3 cm lateral to the main access, the skin is punctured with a scalpel, after which a 5 mm trocar is installed; similarly set the trocar on the left. 3 cm medial to the iliac spine on the right, after a skin incision 1 cm long, a 12 mm port is placed. Similarly, a 5 mm port is installed on the left; perform skeletonization of the anterior surface of the prostate and bladder. Then, two tunnels are alternately formed to the right and left of the projection of the bladder neck in the layer of adipose tissue located medially to the tendinous arch of the pelvis and lateral to the pubovesical complex, until the vas deferens and seminal vesicles appear, the external lateral bundles of the detrusor and vesicle are verified along the inner surface of the formed tunnels and crossed. - the prostatic muscle, releasing the proximal urethra along the posterolateral semicircle, is united by tunnels. Then they move along the contour of the base of the prostate from the depth outward from 6 to 12 hours of the conventional dial. The anterior detrusor apron is dissected cranially, then the proximal part of the intraprostatic urethra is traversed, the seminal complex is isolated, the seminal ducts are traversed, the posterior dissection of the prostate is performed, starting medially to the tendinous arch of the pelvis. The layer is divided between the lateral periprostatic, intrapelvic fascia and the fascia of the muscles that lift the anus until the pubic-perineal muscle is exposed on both sides, after which, focusing on the layer of adipose tissue between the pubovesical complex and the anterior periprostatic fascia, they are separated to the urethral sphincter. In this case, the dorsal venous complex is not stitched. Next, the distal intraprostatic urethra is isolated and transected, the prostate gland is moved into a container for subsequent extraction, anastomosis is made between the proximal urethra and the bladder neck with continuous self-tightening sutures; control the position of the profiled urethral Foley catheter. In this case, the balloon is inflated to 10 ml; the tightness of the anastomosis is controlled by introducing 150 ml of sterile saline. The prostate and seminal vesicles are removed en bloc in a container through central port access; instruments, trocars are removed, sutures and an aseptic bandage are applied to the skin.

EFFECT: method allows to maintain the effectiveness of both methods with a significant reduction in the intervention time, and, accordingly, the duration of anesthesia due to the possibility of synchronous interventions, hospitalization periods and the duration of the patient's rehabilitation, patients note the absence of significant differences in the quality of life in the early postoperative period.

1 cl, 1 ex