As a result of banal hypothermia, exposure to pathogenic microflora or an autoimmune reaction, such an annoying disease as urethritis can begin. One of the most unpleasant consequences of the disease is the stricture of the urethral canal. Often, urethral bougienage is prescribed to diagnose and fix the problem. It will be helpful for the patient to know what this means.
What is bougienage
The word "bougie" came to medicine from the French language. The literal meaning is "candle". In fact, this is a special tool for diagnosing and expanding hollow tubular organs. There are varieties of bougie for the urethra, esophagus and larynx, intestines, uterus and others.
Types of urethral bougies
Bougienage of the urethra can be carried out with instruments of various shapes. In addition, they can be made of metal or synthetic.
Thus, devices for bougienage of the urethra can be as follows:
- Straight and curved. With straight instruments, urethral bougienage is performed in women, with the help of curved instruments, diagnostics are performed or the cervical canal is expanded inmen.
- Short and long. Devices for manipulation at different depths of the urethra. Short bougies are more often used during procedures in women, long ones in men.
- Devices without extensions and with extensions of the final or any other part.
Specialists increasingly prefer synthetic devices, especially when bougienage of the urethra in men. This is due to the fact that the instrument is able to bend without damaging the canal.
Preparing for the procedure
A qualified doctor will never prescribe bougienage without prior diagnosis and preparation. It is necessary to pass tests, determine the number of scars and the location of the stricture (narrowing), determine the diameter of the urethra.
Before manipulation, hygiene procedures and treatment with disinfectants must be performed. Disinfection is carried out with special swabs. This is necessary to prevent the penetration of pathogenic microflora into the urethra from the outside.
Performing a therapeutic procedure for women
Women tolerate urethral bougienage much easier. The procedure itself is easier than for men. Predominantly for manipulation, straight metal instruments with an oval thickening at the end are chosen. For the procedure, several bougie of different caliber are used.
Bougienage of urethral stricture is performed as follows:
- The patient is placed on her back in a special urological chair. Tools are lubricated with gel orvaseline.
- The first bougie is inserted into the urethra, the diameter of which is slightly larger than the diameter of the stricture site.
- The first bougie is removed, the next one is inserted in its place, the diameter of which is larger.
- The number of tools and their maximum diameter is determined by the specialist. The final bougie remains in the urethra for several minutes, after which it is slowly removed.
Between the procedures there is a break of at least 12 hours, but it is important that it does not drag on for a day or more. The diameter of the first bougie of each subsequent procedure must be equal to the diameter of the final device in the previous manipulation.
If the doctor has difficulty stretching the stricture, then he repeats the introduction of bougie of the same diameter several times. In this case, not 2-3 procedures will be required, but at least five.
Procedure for men
If a set of straight metal bougie is used for the procedure, then the technology is practically the same as that described above. It should be borne in mind that the urinary organ is a bit shaped like the Latin letter S.
Narrowing can be localized in the posterior urethra, then manipulation becomes more difficult:
- The doctor lays the patient down and inserts the first curved bougie into the urethra. The tool can be metal or synthetic. Sometimes a flexible synthetic conductor of small diameter is required for its introduction. A bent bougie with an expansion of the required thickness is screwed to the end of the conductor.
- Thick partthe instrument is rotated clockwise as it passes through the narrowed portion of the urethra.
- The bougie moves slowly and gently down the urethra to the bladder.
- After the procedure, the canal is treated with antiseptics.
The metal instrument stays in the urethra for 5-10 minutes. If a synthetic balloon bougie is used, then it is gradually filled with saline, stretching in the designated place. The balloon must remain in the constriction for the same amount of time.
To restore the urinary canal, men need more procedures than women (from 5 to 15 manipulations). Often patients are afraid of pain if urethral bougienage in men is prescribed. Reviews about the procedure are very different. At the same time, everyone agrees that this manipulation is unpleasant, but quite tolerable. If necessary, the patient is given local anesthesia.
Therapeutic procedure in children
Children are often diagnosed with congenital narrowing of the urethra, which makes it difficult to urinate and can lead to atony of the bladder. Boys mostly have problems in the back of the urethra or at the external opening. In girls - in the distal section. Urethral bougienage in children should be started as early as possible. This will avoid complications in the future.
If a narrowing of the external opening is detected, then it is dissected on an outpatient basis, without anesthesia. The tissues in this place are thinned, and painminimal. If a distal narrowing is detected in girls, the patients are prescribed a course of bougienage without placement in a hospital. The remaining types of strictures are treated in stationary conditions.
Diagnostic procedure
Diagnostic bougienage of the urethra is performed once, without repeated manipulations. For carrying out, flexible synthetic capitate-shaped devices are used. The bougie is introduced into the lumen very slowly, the presence of strictures is determined by the patient's reaction. When passing through the narrowed area, the patient experiences discomfort, with pathological changes, the bougie moves forward with noticeable difficulty.
Contraindications
Despite the narrowing of the urethra, there are a number of conditions in which bougienage is contraindicated. These are benign and malignant tumors of the genitourinary system and other organs, exacerbated inflammatory processes, including inflammation of the prostate. Contraindications also include kidney failure and injuries of the urinary system.
It is often necessary to cancel the procedure, because the patient is not psychologically ready for it. When urethral bougienage is prescribed, reviews can frighten the patient. It is important to explain that manipulation is necessary to restore he alth, and discomfort can be avoided by using local anesthesia.
State assessment
Even with careful preparation for the procedure, the medical staff is obliged to monitor the patient's condition after the manipulation so that there are no complications. It is important to control the followingindicators:
- have body temperature changed;
- quantity and color of urine during the day;
- general condition;
- presence of pain;
- discomfort in the abdomen.
If the symptoms of deterioration are noticed in time, the doctor will be able to recognize urethral rupture, the initial stage of inflammation, and sepsis.
