References

actabiomedica

Acta Biomedica Scientifica

2541-94202587-9596

Scientific Centre for Family Health and Human Reproduction Problems

10.29413/ABS.2018-3.5.17

actabiomedica-716

Research Article

ХИРУРГИЯ И НЕЙРОХИРУРГИЯ

SURGERY AND NEUROSURGERY

СОВРЕМЕННЫЕ МЕТОДЫ ЛЕЧЕНИЯ ПОРАЖЕНИЙ БУЛЬБО-МЕМБРАНОЗНОГО ОТДЕЛА УРЕТРЫ

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

Воробьев

В. А.

Vorobev

V. A.

664003, г. Иркутск, ул. Красного Восстания, 1.

664046, г. Иркутск, ул. Байкальская, 118.

ul. Krasnogo Vosstaniya 1, Irkutsk 664003.

ul. Baykalskaya 118, Irkutsk 664046.

Urologist.

terdenecer@gmail.com

https://orcid.org/0000-0002-3299-1924

Белобородов

В. А.

Beloborodov

V. A.

664003, г. Иркутск, ул. Красного Восстания, 1.

664046, г. Иркутск, ул. Байкальская, 118.

ul. Krasnogo Vosstaniya 1, Irkutsk 664003.

ul. Baykalskaya 118, Irkutsk 664046.

Doctor of Medical Sciences, Professor, Head of the Department of General Surgery.

bva555@yandex.ru

ФГБОУ ВО «Иркутский государственный медицинский университет» Минздрава России; ОГАУЗ «Иркутская городская клиническая больница № 1».Irkutsk State Medical University; Irkutsk City Clinical Hospital N 1.

2018

28092018

35116125

2018

Воробьев В.А., Белобородов В.А.

Vorobev 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/716

Стриктуры бульбо-мембранозного отдела уретры являются частой причиной обструктивного нарушения мочеиспускания. Современные тенденции развития медицины ведут к более широкому применению эндоскопических методов, более частой причине ятрогенной травмы мочеиспускательного канала. В настоящее время для лечения стриктур уретры применяются консервативные эндоурологические и реконструктивные методы помощи. Существует несколько консервативных, эндоурологических и реконструктивных методов лечения пациентов со стриктурной болезнью уретры. К консервативным методам относятся вмешательства, не предполагающие разрушение стриктуры уретры или её реконструкцию, такие как стентирование, бужирование и реканализация уретры. Эндоурологические операции относятся к хирургическим методам помощи и предполагают естественное восстановление тканей уретры после разрушения стриктуры. Из-за низкой эффективности коррекции стриктур задней уретры (более 90 % рецидивов через пять лет) данный метод является вариантом временной или паллиативной помощи. В настоящее время применяется два подхода к реконструкции бульбо-мембранозного отдела уретры: анастомотические и заместительные операции. Анастомотическая операция предполагает иссечение поражённого участка и сопоставление здоровых тканей уретры без натяжения. Заместительная пластика позволяет восстановить проходимость уретры путём увеличения диаметра просвета за счёт имплантации различных трансплантатов. Перспективным новым методом лечения является регенеративный подход, когда трансплантируют ткане-инженерную конструкцию, выращенную из клеток самого пациента. В статье продемонстрировано, что на основании международных клинических исследований наиболее эффективным методом восстановления бульбо-мембранозного отдела уретры являются реконструктивные хирургические методы.

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.

бульбо-мембранозный отдел уретрыстриктура уретрыстеноз уретрыанастомотическая уретропластикабуккальная пластика уретрывнутренняя оптическая уретротомия (ВОУТ)

bulbo-membranous urethraurethral strictureurethral stenosisanastomotic urethroplastybuccalmucosa urethroplasticdirect visual internal urethrotomy (DVIU)

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