Complex reconstruction of the bladder neck
Obliteration of the vesicourethral segment is a severe complication in which the patient lives with a cystostomy. Endoscopic dissections rarely help, and open reconstruction is required: scars are excised through the retropubic approach, the neck of the bladder is re-formed and sutured to the urethra using a catheter, and the anastomosis area is wrapped in a flap of the greater omentum - a well-supplied tissue that prevents scarring. The operation is often combined with subsequent correction of urinary incontinence. The catheter and cystostomy are removed in stages after control urethrography.
Indications for urethroplasty
- extended urethral stricture (more than 1–1.5 cm) of any location;
- recurrence of stricture after one or more urethrotomies and bougienages;
- post-traumatic strictures and obliterations (urethral rupture due to pelvic fracture);
- strictures after TUR, adenomectomy, radical prostatectomy (narrowing of the anastomosis);
- obliteration of the posterior urethra - anastomotic plasty with pubectomy;
- strictures with lichen sclerosus (panurethral buccal plastic surgery);
- impossibility of reconstruction - formation of a perineal urethrostomy.
Types of operations
Anastomotic urethroplasty is used for short (up to 2–3 cm) strictures of the bulbous urethra and post-traumatic obliterations: the scar is completely excised, and the healthy ends of the urethra are sutured without tension. In posterior obliteration after a pelvic injury, part of the pubic bone is removed to bring the ends together (pubectomy). Efficiency - 90–95%.
Buccal urethroplasty is the standard for extended strictures: the urethra is dissected along the stricture, and the lumen is expanded with a mucosal flap taken from the inner surface of the cheek. This flap is resistant to humid environments and takes root well; a wound in the mouth heals in 1–2 weeks. Island plasty uses a flap of penile skin on a vascular pedicle, while panurethral plasty restores the entire urethra in case of total damage. Johanson's operation is a staged plastic surgery for complex strictures: first, the urethra is opened and a platform is formed, after 6 months - the second stage. Urethrovesicoanastomosis restores the connection of the urethra to the bladder after radical prostatectomy. Perineal urethrostomy - removal of the urethra to the perineum when reconstruction is impossible.
Preparation
The examination determines the type of plastic surgery: retrograde and voiding urethrography, urethroscopy, ultrasound of the urethra show the extent and depth of the scar. Urine culture is required to treat the infection; in case of cystostomy, sanitation is required. Standard tests, ECG, consultations with an anesthesiologist and, if necessary, a therapist. Before buccal plastic surgery, the oral cavity is sanitized by a dentist. Hospitalization the day before, 8 hours on an empty stomach.
Recovery
The patient spends 3–7 days in the hospital. The urethral catheter is in place for 2–3 weeks; before removal, a control urethrography is performed - if the anastomosis is tight, the catheter is removed and urination is restored with a free stream. The wound on the perineum heals in 2-3 weeks, in the mouth - 1-2 weeks (soft foods, rinses). Physical activity is limited to 4–6 weeks, sexual activity is limited to 6 weeks. Uroflowmetry monitoring at 3, 6 and 12 months, then annually. The effectiveness of anastomotic plasty is 90–95%, buccal plasty is 85–90%; relapses are rare and can be corrected by urethrotomy alone.
Urethroplasty in Tashkent
Reconstructive urethral surgery requires specialization: in the clinics below, all types of urethroplasty are performed - anastomotic, buccal, island, panurethral, operations for posterior obliteration with pubectomy, urethrovesicoanastomosis and urethrostomy. Prices according to the clinic’s price list; Anesthesia and bed days are paid separately. Sign up for a consultation with urethrograms - the surgeon will determine the type of operation.
