METHOD FOR SURGICAL TREATMENT OF PROLONGED RECURRENT STRICTURES OF THE ANTERIOR URETHRA OF TUBERCULOUS GENESIS Russian patent published in 2023 - IPC A61B17/00 

FIELD: medicine.

SUBSTANCE: invention relates to the field of medicine, in particular to urology. Dissection of the stenosed part of the urethra and combined plastic surgery from the autograft of the cheek mucosa and the cutaneous fascial flap of the penis are performed. In this case, the patient is pre-administered with a course of specific or non-specific therapy until the elimination of the inflammatory process in the urethra. After that, an ultrasound method is used to assess the condition of the spongioid body and, if a moderate degree of spongiofibrosis is established, surgical intervention is performed, including an incision of the skin, subcutaneous tissues and the urethral wall along the ventral surface of the penis throughout its penile section. Then a second incision is made in the perineum with a dissection of the bulbous urethra, on one side of the incision of the penile urethra, a longitudinal ventral skin flap of the penis with a width of 1.0 cm is isolated, the length of which is determined by the length of the stricture of the penile urethra. Then, an incision is made on the inner surface of the penile urethra throughout the affected area, the length of the defect is measured, a buccal graft is taken with a width of 1.0-1.5 cm and a length equal to the sum of the length of the stricture of the penile section and the stricture of the bulbous section, it is divided into 2 corresponding fragments and the mucous surface is placed inside the urethra. Moreover, the first buccal graft is placed in the dorsal defect of the penile urethra, fixed with nodular sutures of polyglyconate 5/0 to the urethra in its distal and proximal sections and with a continuous suture of polyglyconate 5/0 to the urethra along the side walls. Then the buccal graft is fixed over its entire area to the underlying cavernous bodies with polyglyconate 5/0 nodular sutures, the urethra is reconstructed along its ventral surface of the penile section using a skin-fascial flap of the penis, which is rotated, placed longitudinally to the axis of the penis with the epidermis into the urethral lumen and fixed to the lateral walls of the urethra. Distally, the cutaneous fascial flap is connected to the tissue of a healthy urethra, and proximally to the ventral buccal graft of the bulbous urethra, removing the flap into the perineal incision for this purpose. The spongioid body is sutured over the bulbous urethra with the capture of the buccal graft with a step frequency of 5 mm and on both sides, parallel to the suture line, the tissues of the spongioid body are sutured with the pickup of the buccal graft with a step frequency of 5 mm, longitudinally with respect to the incision line of the spongioid body.

EFFECT: method makes it possible to eliminate obstruction of the urethra in this severe disease, reduce the number of postoperative complications, eliminate relapses of the disease, restore independent adequate urination, get rid of cystostomy drainage and thereby improve the quality of life of patients and their social adaptation.

1 cl, 2 ex