ABSTRACT
Anatomic researches on 15 cadavers of male adults were conducted to study the transpubic access to the urethra and substantiate its possible application for the treatment of the urethral strictures. The authors make a comparative evaluation of transpubic and perineal methods of the access. As for basic indices (the depth of operative wound, direction and the angle of the operative axis inclination), the transpubic method of access has a number of advantages over the perineal access, and is an optimal one for surgical interference on the urethra. The transpubic access was applied on 21 patients who were operated for strictures or obliterations of the urethra. In all the patients the transitivity of the urethra was restored. No complications were marked.
Subject(s)
Urethra/surgery , Urethral Stricture/surgery , Adolescent , Adult , Cadaver , Evaluation Studies as Topic , Humans , Intraoperative Complications/epidemiology , Male , Methods , Perineum , Postoperative Complications/epidemiology , Pubic Symphysis , Urethra/anatomy & histology , Urethra/injuries , Urethral Stricture/etiologyABSTRACT
A new method of cystoplasty with free musculocutaneous graft on vascular crus was developed and introduced into clinical practice. This method satisfies the requirements necessary for artificial urinary bladder that are created from the segment of small intestine and considered as a "gold standard" in the treatment of such pathology. Good anatomic-and-functional results (urination way usual for the patient is remained, the volume of reservoir being created is sufficient, low urine pressure, anti-reflux mechanism and preservation of upper urinary tracts) permit to recommend the method for clinical study and use.
Subject(s)
Urinary Bladder Neoplasms/surgery , Urinary Diversion/methods , Cystectomy , Dermatologic Surgical Procedures , Humans , Surgical Flaps , Ureter/surgery , Urinary Reservoirs, ContinentSubject(s)
Exercise Therapy/methods , Ureteral Calculi/therapy , Combined Modality Therapy , Humans , Time FactorsABSTRACT
A total of 17 patients aged 18-60 years were operated on for posttraumatic posterior urethral obliterations, 4 to 13 cm in length. The operation consisted in application of a transpubic access and replacement of the extended posterior urethral defect with perineal ones by removing the subpubic curvature and transposing the perineal portion of the urethra ahead of the cavernous bodies of the penis, which allowed the urethra to be relatively stretched. The musculus sartorius on a pedicle was used to cover the urethral anastomosis with well blood-supplied tissues, to create an external sphincter of the urethra and to replace the pubic articulation defect. The procedure of the operation is in detail given in the present paper. Among the complications there was a partial necrosis of the distal end of the musculus sartorius in 3 patients, orthostatic urinary incontinence in 1 and cutaneous edema of the penis nearly in all the patients following the operation. Orthopedic disorders associated with pubic articulation resection and a marked decrease in and deformity of the penis were not observed.