Urethral stricture or atresia endoluminal incision

As the improvement of urethral endoscopic surgical instruments is becoming more and more perfect, many diseases that have been treated with open surgery have been cured by urethroscopic endoscopic surgery. These include urethral tumors and valves, and fine sputum hyperplasia, while the most are administered to the urethral traumatic or inflammatory stenosis or occlusion. The method of endoscopic sinus surgery for urethral stricture and occlusion depends on the location of the lesion, the length of the stenosis or occlusion, the cause of the stenosis, the previous surgery, the thickness of the local scar, the presence or absence of infection, and complications. . Intracavitary surgery has small trauma, is easy to operate, and can be repeated. According to various types of lesions, a variety of urethroscopic endoscopic procedures can be selected. Treatment of diseases: urethral stricture Indication Endoscopic incision should be preferred for patients with lesion length <2.5 cm without stenosis and occlusion length <1 cm. Open surgery should be considered first if the stenosis length is >3.0cm and the occlusion is >2.0cm or the urethral axis is severely variable, or if the diverticulum, false tract, or urinary fistula are combined. Preoperative preparation 1. Pay attention to adjusting the general condition of the patient. Patients with cardiovascular and respiratory dysfunction and renal dysfunction and imbalance of water and electrolyte balance should be corrected. Middle-aged and elderly patients should check blood sugar and urine sugar. Those with diabetes should be controlled before surgery. 2. Chronic urethral surgery diseases, often due to obstruction and infection leading to renal insufficiency, in addition to concomitant water and electrolyte imbalance, malnutrition, anemia, etc., should be corrected before surgery. For young children and elderly patients, when correcting the imbalance of water and electrolyte balance, care should be taken not to overload the liquid and supplement it as much as possible by oral route. For severe anemia, a small amount of blood transfusion can be interrupted. 3. Long-term urethral obstruction, complicated by renal insufficiency, should first drain urine to control infection. After the general condition improved, the renal function improved, and then urethral surgery. The method of draining urine can be based on the condition, or indwelling catheterization, or performing a suprapubic bladder stoma, or performing a renal stoma. 4. Infection is an important cause of urethral surgery failure, and must pay great attention to the application of antibiotics before surgery. Urine bacterial culture and drug sensitivity test should be done before surgery, and the most effective antibacterial drugs should be selected. For patients with indwelling catheters or suprapubic stoma, daily cleansing should be performed and catheters should be replaced regularly to maintain patency and avoid urine deposits. 5. Adult patients start taking female hormones 2 days before surgery to inhibit the erection of the penis after surgery to break the suture or the anastomosis. Common diethylstilbestrol 2mg, 3 times a day. 6. Do a good job in the patient's ideological work, eliminate concerns, and increase confidence. The necessary sedative and hypnotic medication was given on the night before the operation to ensure adequate sleep. 7. Prepare surgical instruments, sutures, drains and catheters. The model, thickness and size should meet the surgical requirements so that the operation can be carried out smoothly. Need a blood transfusion, cross-matching blood before surgery. 8. After urethral trauma, often due to extravasation of urine, hemorrhage, exudation of tissue fluid, etc., resulting in severe local reactions, or the proliferation of connective tissue, scar formation. If the vaginal bladder stoma has been performed, it is not advisable to perform urinary tract surgery. First, local physiotherapy, hot compress or local corticosteroid treatment is used. After waiting for local reaction to resolve or scar softening, the corresponding surgical treatment can be performed. Surgical procedure 1. Indirect stenosis of urethral stricture The urethroscopicoscope was inserted into the stenosis, the sheath was removed, the obturator was withdrawn, the 30° endoscope and cold knife operator were placed, the 5F ureteral catheter was inserted through the cannula, and it was passed through the stenosis to the bladder under direct vision. Lead out the urine. A serrated cold knife was inserted along the ureteral catheter, and the round knife was used to cut the 12, 5, and 7 points of the lithotomy position. The endoscope is advanced along the ureteral catheter while trimming. If you can't push it, use a metal probe to expand from 16F to 24F, and expand the cut that has been cut. Cold-cut scars can be re-recovered, and irregular scar tissue must be removed by laser, electrocautery, electric cutting or liquid-electric treatment according to their respective conditions, but do not do a circle at the same level to avoid burnt scars. narrow. If the scar is long or thick and hard, it is necessary to perform a 10 to 2 point scar resection. After the operation, the 20F silicone catheter was placed. If the urethra is unobstructed due to oozing after the endoscopic operation, the ureteral catheter can be inserted only through the end of the endoscope, and then drained until the visual field is clear and then cut. Care should be taken when cold, laser, electrocautery, and electrothermal treatment of scar areas to avoid penetration into the rectum. 2. Endotomy of urethral occlusion The vast majority of these cases are traumatic and postoperative, located in the posterior urethra with a suprapubic bladder stoma. The surgical procedure for the incision is: 1 the assistant passes the metal probe through the pubis ostomy, and gently inserts the posterior urethra through the cystoscope (note that the false tract is not inserted); 2 the surgeon inserts the cold-cut mirror into the distal side of the urethral occlusion. Exit the obturator, insert the endoscope and cold cutter, insert the ureteral catheter from the oblique side socket to the distal side of the endoscope to drain the irrigation fluid. Isotonic saline continued to perfusion, keeping the visual field clear; 3 the operator's left hand finger is placed in the patient's rectum, the first assistant to swing the probe in the posterior urethra to determine the proximal end and direction of the occlusion segment, the cold cutting mirror longitudinal axis and the probe The vertical axis is placed on the same horizontal line. Those with conditions should determine the position under X-ray screen monitoring. Under the guidance and monitoring of the fingers, the serrated knife is used to puncture the incision and locking at the 10, 12, and 2 o'clock positions, and then the large knife is used to open and expand the narrow ring, and then the cold cutting mirror is gradually advanced to occlude. The segment enters the bladder. The cold-cut mirror was withdrawn, and the metal urethral probes of 22F, 24F, and 26F were further expanded. If the urethral occlusion section is <0.5cm, the irregular scars on the edge of the narrow ring are cold-cut and treated with laser, liquid electric or electrocautery to prevent re-adhesion and restenosis. If the occlusion segment is >0.5cm, and it is hard, it is best to cut the scar portion of the calculus position 9 to 3 points by electric cutting, taking care not to injure the external urethral sphincter. Finally, a 22F balloon silicone catheter was placed. If the neck is completely occluded after prostate surgery, it can not be blindly puncture and incision, so as to avoid the formation of false tract. The urethra can be placed through the urethra. At the same time, the cold scalpel is placed through the suprapubic bladder stoma, and the upper and lower joints are cut open, accurate and effective. it is good.