The place of bougienage in the treatment of strictures
Bougienage does not remove the scar, but stretches it, so the effect is temporary: the narrowing returns after weeks or months, and the procedure must be repeated. However, in frail and elderly patients, with contraindications to anesthesia or in anticipation of urethroplasty, it supports urination and avoids cystostomy. Control of the image intensifier (electron-optical converter) makes the procedure safe: the bougie is carried out along a conductor inserted through the stricture, which eliminates perforation. It is performed under local anesthesia or sedation, with one-day observation if necessary.
Indications
- primary short stricture of the urethra (up to 1–1.5 cm) of the bulbous or prostatic region;
- weak, thin or splashing stream, straining, feeling of incomplete emptying;
- residual urine, recurrent infections, bladder stones due to narrowing;
- acute urinary retention due to stricture;
- narrowing of the bladder neck or urethra after TUR, adenomectomy, radical prostatectomy;
- bougienage - for maintenance treatment in patients for whom surgery is contraindicated.
How is the operation performed?
Under spinal anesthesia, an optical urethrotome, a thin endoscope with a video camera and a retractable blade, is inserted into the urethra. Under visual control, a conductor is passed through the narrowed area, then the scar is dissected with a cold knife at 12 o’clock on the conventional dial to the entire depth to healthy tissue; if necessary, additional notches are made. A number of clinics use a holmium laser for cutting. After this, the lumen of the urethra is checked by calibration and a silicone catheter is installed for 3-7 days, which serves as a scaffold during healing.
Bougienage is performed as an independent procedure for short soft strictures or to maintain the lumen after urethrotomy: under local anesthesia and X-ray control, bougies of increasing diameter are inserted into the urethra. The entire operation takes 20–40 minutes; The patient spends 1 day in the hospital.
Preparation
The key study is urethrography (retrograde and voiding): it shows where and how extensive the narrowing is, and determines whether urethrotomy is suitable or whether plastic surgery is needed. Uroflowmetry, ultrasound of the bladder with residual urine, and, if necessary, urethroscopy are also performed. Tests: general analysis and urine culture (the infection is treated in advance), general blood test, coagulogram, ECG, consultation with an anesthesiologist. 6–8 hours on an empty stomach.
Results and recovery
After removing the catheter, the flow is restored immediately. A burning sensation and a small amount of blood may occur for 1–2 weeks. Sexual activity is resumed after 2–3 weeks. Monitoring uroflowmetry - after 1 and 3 months, then every six months. The effectiveness of urethrotomy for short primary stricture is 60–70%; in case of relapse, repeated urethrotomy rarely helps, and urethroplasty (anastomotic or buccal) becomes the method of choice, which gives 85–95% of lasting results. It is described on a separate page.
Treatment of urethral stricture in Tashkent
In the clinics below, optical urethrotomy, X-ray-guided bougienage and the entire range of urethroplasty are performed, so in case of relapse, the patient receives definitive treatment in the same center. Prices according to the clinic’s price list; Anesthesia and bed days are paid separately.
