Infections, hypothermia, autoimmune disorders often affect the health of the genitourinary system of men and women. One of the most common phenomena is the narrowing of the urethral canal. This condition is difficult to carry, accompanied by frequent attacks, complicated by fever and psychological stress. A similar disease occurs even in infants in the form of congenital anomalies. To restore the lumen of the urethra in urology using the method of bougienage. This is a long-known and used technique that many patients are afraid of. In order to properly prepare yourself for the procedure, it is better to learn about the bowing in advance.
The essence of the procedure
The technique of bougienage is that a special rod-shaped tool is introduced into the hollow tubular organ. This allows doctors to eliminate stenosis (narrowing sites in organs). Bouges are urethral, for the Eustachian tube, for the esophagus, etc. The urethral tubes are designed to penetrate the urethra and rehabilitate its patency.
There are women's, men's and children's bougie. They also differ in shape and material, they are rigid and straight, flexible from synthetics, metal curved. For each patient, select the diameter of the rod, depending on the width and length of the urethra. For example, in women, the urethra is short and wide, while in men it is narrow and long. Depending on the anatomy and localization of stenosis, the desired size and shape of the instrument is selected.
Bougie is injected into the urethra using local anesthesia or general anesthesia. Most often, local anesthesia is sufficient, anesthesia is used mainly for children and mentally unbalanced adults. By advancing the tube through the canal, the doctor can accurately determine the location of the narrowing or localization of the stone, and using a set of bougie with different diameters, the normal passage of the canal is restored. Stenosis can occur in any part of the urethra, it leads to difficulty urinating, constant pain and discomfort. To eliminate it in one procedure is impossible, since a sharp expansion of the walls can lead to rupture of the channel.
The patient is prescribed several sessions, during each of them the doctor inserts a rod slightly larger than the previous time. At the end of each bougie there is an oval extension in the form of a cone, a drop, or a synthetic balloon. When the doctor reaches the site of stenosis, the instrument is left in this position for 5-15 minutes. During this time, the balloon or “drop” expands the narrowed lumen. As a result of such actions, patency is restored, attacks of pain and discomfort disappear.
Indications and contraindications for bougienage
The procedure is used for diagnosis and treatment. During the diagnosis, the doctor, advancing the bougie, reaches the point of maximum narrowing. A stone in the urethra can also impede progress. Thus, the exact location of the stenosis or stone is established. The treatment procedure begins immediately after the diagnosis, it goes the same way, but it lasts longer. The only indication for such manipulations is urethral stenosis in adults and children.
This happens for various reasons:
- congenital anomalies;
- after infections and inflammations, sexually transmitted diseases;
- from mechanical injuries of the pelvis and lower abdomen;
- after incorrectly performed medical procedures with penetration into the urethra;
- scarring of tissue after surgery.
Not for all types of contractions can carry out such treatment. Aging of the urethra is not prescribed for:
- suspicion and the presence of tumors;
- acute inflammation;
- narrowing the foreskin;
- too low level of blood clotting;
- chronic and acute renal failure.
In addition, the patient himself may refuse treatment in favor of other methods. The main competition for bougienage today is plastic urethra. Women for various reasons, to carry out such manipulations may prohibit an obstetrician-gynecologist or gynecologist. In order to accurately determine whether the patient needs such a procedure and to exclude the presence of contraindications, a series of examinations are first carried out. Careful preparation of the patient reduces the likelihood of complications.
The main part of the training is tests and diagnostics before bougienage. The patient must undergo ultrasound. During an ultrasound, the diameter of the urethra, the place of stricture formation or the location of the stone is determined. Examination can also completely exclude the possibility of bougienage, for example, if a tumor is detected. According to the ultrasound, the urologist will select the diameter and shape of the bougie for the first session.
In addition, the patient must pass:
- Urine and blood tests.
- Retrograde urethrography. A contrast agent is injected into the cavity of the urinary duct and several pictures are taken.
- Computed tomography.
Consultations with other doctors may also be prescribed: a neurologist, a therapist, a gynecologist. If no contraindications are found, the doctor calls the date of the procedure. A few days before it is necessary to give up alcohol, it is recommended not to eat the day before and on the day of it. Before the process itself, the patient is asked to empty the bladder if he can do it on his own.
Medical and diagnostic bougienage
The procedure is carried out on an outpatient basis or in a hospital if the patient is already in the department. Outwardly, this process looks quite traumatic, but it is quite tolerant, as confirmed by reviews of patients. It is very important that the patient is not tense, because anxiety causes excessive muscle contraction. Such a phenomenon can greatly interfere with the doctor during the manipulations and deliver more discomfort to the patient himself. Therefore, when entering the office, it is better to think about the positive results of the procedure, and the patient is offered sedatives if he is too worried. In extreme cases, bougienage is performed under general anesthesia. The patient is dressed in sterile clothing and transferred to the room where the process will take place. This may be an operating room or simply a urologist's office. Participate will be the doctor himself and his assistants. The course of the procedure is slightly different in men and women.
Since the female urinary duct is much shorter and wider than the male, the bougienage process is easier for women. However, such anatomy leads to the fact that infections reach the bladder faster, so for women stenosis of the urethra is also not uncommon. For the diagnosis and treatment of female organs, predominantly hard and straight bougie are used. This is a thin tube, at the end of which there is an expansion in the form of a drop. This tube is treated with glycerin or vaseline for easy gliding. Anesthetic is injected into the cavity of the urinary canal. Then the doctor inserts the rod into the urethra to the place of stenosis, the tube is left for some time in this position. At the end, the instruments are removed, the external genitals are treated with antiseptics.
After 8-48 hours you need to repeat the session. At the second admission, the doctor first uses a bougie of the diameter that was used last time. Then they take a slightly larger bougie, leaving the widest for a few minutes. To fully restore the lumen, a woman may need from two to five such procedures.
The principle of bougienage for men is the same as for women. However, given the anatomy of the male urethra, it takes more time and requires more caution. For manipulations take hard or flexible bougie. Rigid are straight and curved, the latter is used to eliminate stenosis in the back of the urinary duct, the straight ones are suitable for anterior stenosis. The easiest way is transferred to the bougienage by a flexible tube; this is a rod of synthetic material, at the end of which there may be the same expansion or balloon. The balloon is called a hollow insert on the tube, which, upon reaching the stricture, is filled with water. As a result, such a tool is easier to promote through the channel. But the type of the used boge depends on the situation, only the doctor can decide what he will do with the manipulation.
The course of the procedure:
- The patient lies on the table, which looks like a gynecological chair. I put my legs on special stands so that they are divorced and slightly bent.
- If necessary, the patient is administered sedative drugs intravenously. In the cavity of the urethra injected anesthetic in the form of a gel or liquid. When using flexible instruments and localization of narrowing in the front of the canal, anesthesia may not be required at all. In rare cases, use local anesthesia.
- The genital area and instruments are treated with antiseptics. The core of the bougie is additionally lubricated with a slip gel.
- The doctor slowly introduces the bugu into the urinary duct. Forced promotion can damage organs, so the doctor monitors the patient's condition. If at some point the patient panicked, the process is stopped until he calms down. If the patient feels pain or strong pressure, he must tell the doctor about it. In this way, the location of the stenosis can be calculated.
- The extended part of the instrument should be in the place of constriction. Bougie is left for a few minutes in this position, then slowly removed. Once again, the organs are treated with an antiseptic substance.
During one session, the doctor may change several bougie, this is necessary so that the diameter of the expansion tube is slightly larger than the diameter of the narrowing. For complete recovery, the patient may require from 2 to 14 sessions. They must take breaks between them, the interval must be at least 8 hours and not more than two days.
The urinary tract stricture in a child is most often congenital. At the same time eliminate this anomaly as early as possible. In boys and girls, the process is the same as in adults. However, general anesthesia is always used. For the procedure, select the tools of appropriate size and shape. Preparation and recovery in children occurs in the same way as in adults.
After the procedure
For the prevention of infection during the procedure, after it prescribed a course of antibiotic therapy. Depending on the clinical picture, other medications may be prescribed to reduce the risk of recurrent relapses. At first, after the procedure, it is necessary to periodically measure the temperature, monitor the amount and color of urine, and check for impurities. Also, the patient is prescribed a plan of visits to the urologist, the doctor must conduct several follow-up examinations to ensure the effectiveness of bougaining. For this purpose, it may be sent for additional ultrasound or urethrography.
Often after bougienage, the patient is forced to re-take the procedure several times a year. This is due to the fact that very often there are recurrences of stenosis. Sometimes the patient is even taught to do it on his own with the condition of a periodic visit to the urologist.
Despite the fact that such manipulations are bloodless, they are sometimes complicated by unpleasant consequences.
Complications after the procedure:
- damage to the walls or mucous canal instrument;
- aggravation of stricture;
- urethral fever.
It is important during the course of treatment and the first time after him to monitor their state of health. With the appearance of high fever, swelling and redness of the genital organs, blotches of pus or blood in the urine - an urgent need to come to your doctor. Parents of children who have undergone a similar process, also need to carefully monitor the condition of the baby. If the child is too restless, edema and redness appear on the genitals, he refuses to eat and sleep - this is a reason to contact a pediatrician.
Where to make a bougaining and how much it costs
Such treatment is carried out in private and public institutions, in the Department of Urology. In the state segment, this service is free, at least officially. Informally, the cost of bougaining at a clinic or a state hospital will be “voluntary”. In a private institution, prices range from 20 to 100 dollars. The cost is affected by the status of the clinic, the complexity of the work, the localization of the stricture. But progressive medical centers practically do not use this technique, replacing it with plastic.
Bougienage of the urethra is widely used, although the tendency for its use is reduced. There are fewer indications for its implementation, since recurrence of stenosis after the procedure is a frequent occurrence. Reviews of doctors show that the treatment itself can provoke scarring of tissues and the formation of new narrowings. Before agreeing on its implementation, it is worthwhile to assess all the risks, ask the doctor about alternative treatments. However, if other therapies are contraindicated or do not produce a result, it is this technique that comes to the rescue.