MODERN METHODS OF TREATING DISEASES OF THE BULBO-MEMBRANOUS PART OF URETHRA

V A Vorobev,V A Beloborodov

doi:10.29413/abs.2018-3.5.17

Abstract

Strictures of the bulbous-membranous urethra are a common cause of obstructive urination disorder. Modern trends in the development of medicine lead to a wider application of endoscopic method, a more frequent cause of iatrogenic injury of the urethra. At present, conservative, endourologic and reconstructive methods of care are used to treat urethral strictures. There are several conservative, endourological and reconstructive methods for treating patients with urethral stricture. Conservative methods include interventions that do not involve the destruction of urethral stricture or its reconstruction, such as stenting, blind dilatation, and recanalization of the urethra. Performing blind dilatation strictures of the bulbo-membranous urethra is not recommended because of the high risk of false path formation and low efficiency. Endourological operations refer to surgical methods of care and suggest the natural restoration of urethral tissues after the destruction of stricture. Because of the low effectiveness of correction of strictures of the posterior urethra (more than 90 % of relapses in five years), this method is a variant of temporary or palliative care. Currently, two approaches to the reconstruction of the bulbo-membranous urethra are used: anastomotic and replacement operations. Anastomotic surgery involves excision of the affected area and juxtaposition of healthy urethral tissues without tension. Replacement plastic allows to restore patency of the urethra by increasing the diameter of the lumen due to the implantation of various grafts. The article shows that, based on international clinical studies, the most effective method of reconstructing the bulbomembranous urethra is reconstructive surgical methods.

Highlights

Repeat transurethral manipulation of bulbar strictures is associated with increased stricture complexity and a marked delay to curative urethroplasty.”,”author”:[{“dropping-particle”:””,”family”:”Hudak”,”given”:”Steven J”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Atkinson”,”given”:”Timothy H”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Morey”,”given”:”Allen F”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””}],”container-title”:”The Journal of urology”,”id”:”ITEM-1”,”issue”:”5”,”issued”:{“date-p arts”:[[“2012”,”5”]]},”page”:”1691-5”,”title”:”Repeat
Transurethral manipulation of bulbar urethral strictures is associated with increased stricture complexity and prolonged disease duration.”,”type”:”article-journal”,”volume”:”187”},”uris”:[“http://www. mendeley.com/documents/?uuid=b4763632-561f3f1e-a85f-083522465819”]},{“id”:”ITEM-2”,”itemDa t a” : { “ D O I ” : ” 1 0 . 1 0 1 6 / j . j u ro . 2 0 1 3 . 0 1 . 0 1 4 ”,” I S SN”:”1527-3792”,”PMID”:”23313208”,”abstract”:”PURPOSE The long-term success rate of dilation and/or internal urethrotomy is low in cases of recurrent urethral stricture
We investigated the ability of the MemokathTM 044TW stent to maintain urethral patency after dilation or internal urethrotomy for recurrent urethral stricture

Summary

CONCLUSIONS

Intraurethral replacement plastic [56]21 ANTA, described in 2012, is one of the most complex of substitute urethroplasty methods. This technique is performed with strictures of the proximal part of the bulbar urethra. In the BMP of the urethra this method is not applicable Rarer techniques such as endoscopic urethroplasty with a skin or mucosal flap with different fixation mechanisms have the advantage of being less invasive, but not sufficiently studied to talk about their success. In a pilot study [49] published in 2011, the results of the replacement of the BMP of the urethra in 10–14 year old boys with the use of tissue-engineered tubular flaps were analyzed. Similar results claim a new “gold standard” of assistance after a multicenter study [55]

RESULTS

ENDOUROLOGICAL METHODS

CONCLUSION