actabiomedicaActa Biomedica ScientificaActa Biomedica Scientifica2541-94202587-9596Scientific Centre for Family Health and Human Reproduction Problems10.29413/ABS.2018-3.2.16actabiomedica-566Research ArticleХИРУРГИЯ И НЕЙРОХИРУРГИЯSURGERY AND NEUROSURGERYСпособ реконструкции бульбо-мембранозного отдела уретрыMini-invasive reconstruction technique of the bulbomembranous urethraВоробьёвВ. А.VorobyevV. A.terdenecer@gmail.comБелобородовВ. А.BeloborodovV. A.bva555@yandex.ruФГБОУ ВО «Иркутский государственный медицинский университет» Минздрава России; ОГАУЗ «Иркутская городская клиническая больница № 1»Irkutsk State Medical University; Irkutsk City Clinical Hospital N 1201828042018329196Copyright © Воробьёв В.А., Белобородов В.А., 20182018Воробьёв В.А., Белобородов В.А.Vorobyev V.A., Beloborodov V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.actabiomedica.ru/jour/article/view/566

Представлен способ реконструкции бульбо-мембранозного отдела уретры при стриктурах и сфинктер-стенозах. Метод предполагает использование аутологичного лоскута, имеет потенциальные преимущества в сравнении с бульбо-простатическим анастомозом. Цель исследования: разработать метод помощи пациентам с несостоятельными уретральными анастомозами, поврежденной шейкой мочевого пузыря и угрозой последующей инконтиненции, а также желающим сохранить эректильную функцию. Методы. С августа 2013 года по июль 2017 года у 35 пациентов выполнены 36 реконструкций уретры (11 - после предшествующих пластик уретры; 14 - операций на простате, в том числе 4 - после радикальной простатэктомии; 7- дистракционного дефекта уретры). Возраст пациентов составил от 58,17± 12,2 года. Медиана периода наблюдения составила 525 (341; 813) дней. Средняя протяженность поражений уретры составила 15 (10; 15) мм. Средний диаметр сохранившегося просвета уретры 1,4 ± 0,56 мм. Реконструкция с использованием трансплантата выполняется трансбульбарно внутриуретрально с использованием увеличительной оптики. Результаты. Общая эффективность при первичном выполнении у 35 пациентов - 91,4 %; повторная реконструкция, проведённая двум пациентам, была успешной. Все пациенты прошли комплексный контроль результатов. Средний безрецидивный период - 447 дней. Все пациенты сохранили способность к удержанию мочи. Ухудшений эректильной функции не отмечено. Заключение. Предложенная методика показала высокую эффективность в восстановлении проходимости проксимальной части бульбарной уретры, бульбо-мембранозного отдела и зон сопоставления после ранее перенесенного бульбо-простатического анастомоза или радикальной простатэктомии. Сохранение кровоснабжения позволило при необходимости успешно выполнить одномоментную реконструкцию стриктур переднейуретры. Отсутствие натяжения уретры профилактировалоукорочение полового члена, а сохранность дистального мочевого сфинктера - возникновение инконтиненции.

The paper presents the technique of the reconstruction of the bulbar and membranous urethra in the occurrence of strictures and sphincter-stenosis. The method uses an autologous graft and has potential advantages over the bulboprostatic anastomosis. Objective. To develop a method of helping patients with existing urethral anastomoses, with a damaged neck of the bladder and a risk of subsequent incontinence, wishing to maintain the erectile function. Materials and methods. 35 patients underwent 36 reconstructions of the urethra from August 2013 to July 2017, 11 - after previous urethral plastics, 14 - after prostate surgery (4 - after radical prostatectomy), 7 - suffered from a urethral distraction defect. The age of the patients was 58.17 ± 12.2 years. The median follow-up period was 525 (341; 813) days. The average length of urethral strictures was 15 (10; 15) mm. The average diameter of the urethra in the stricture zone was 1.4 ± 0.56 mm. Reconstruction with the use of a buccal mucosa graft is performed intraurethrally through corpus spongiosum using magnifying optics. Results. The overall efficacy of the primary reconstruction in 35 patients was 94.2 %; the repeated reconstruction in two patients was successful. All patients underwent the comprehensive monitoring of the results, the average follow-up period was 654 days, the average relapse-free period was 447 days. All patients preserved continence and erectile function Conclusion. The proposed technique showed a high efficiency in reconstruction of the bulbar and membranous urethra.

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The authors declare that there are no conflicts of interest present.