As a result of banal hypothermia, exposure to a pathogenic microflora or autoimmune reaction, an annoying disease such as urethritis can begin. One of the most unpleasant consequences of the disease is considered to be stricture of the urethral canal. Often, to diagnose and correct the problem, urethral bougienage is prescribed. It will be useful for the patient to find out 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 the diagnosis and expansion of hollow tubular organs. There are varieties of bougie for the urethra, esophagus and larynx, intestines, uterus and others.
Types of urethral bougie
Urethral bougienage can be carried out with different forms of instruments. In addition, they can be made of metal or synthetics.
Thus, devices for bougienage of the urethra can be as follows:
- Straight and curved. Direct instruments perform ugly urethra in women, using curved to diagnose or expand the cervical canal in men.
- Short and long. Devices for manipulation at different depths of the urethra. Short bougie is more often used during procedures for women, long ones for men.
- Devices without extensions and with extensions of the final or any other part.
Experts increasingly prefer synthetic devices, especially when performing urethral bougienage in men. This is due to the fact that the tool is able to bend without injuring the channel.
Preparation for the procedure
A qualified doctor will never prescribe bougienage without prior diagnosis and preparation. It is necessary to take tests, determine the number of scars and the place of stricture (narrowing), establish the diameter of the urethra.
Before manipulation, hygiene procedures and disinfectant treatment are mandatory. Disinfection is carried out with special tampons. This is necessary to prevent the penetration of pathogenic microflora into the urethra from the outside.
Conducting a therapeutic procedure in women
Women tolerate urethral bugging much easier. The procedure itself is easier than for men. Mostly for manipulation choose straight metal tools with an oval thickening at the end. For the procedure, several bougie of different caliber are used.
Urethral stricture is performed as follows:
- The patient is laid on his back in a special urological chair. Tools are lubricated with gel or petroleum jelly.
- The first bougie is introduced into the urethra, the diameter of which slightly exceeds the diameter of the stricture site.
- The first bougie is removed, the next one is introduced in its place, the diameter of which is larger.
- The number of tools and their maximum diameter is determined by a specialist. The final bougie remains in the urethra for several minutes, after which it is slowly removed.
A break of at least 12 hours is maintained between the procedures, 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 should be equal to the diameter of the final device during 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 are required, but not less than five.
The procedure in men
If a set of direct metal bougie is used for the procedure, then the technology is practically no different from the above. It should be borne in mind that the urinary organ resembles a little the Latin letter S.
The narrowing can be localized in the posterior part of the urethra, then the manipulation becomes more difficult:
- The doctor puts the patient in and inserts the first curved bougie into the urethra. The tool may be metallic or synthetic. Sometimes for its introduction a flexible synthetic conductor of small diameter is required. A curved bougie with an extension of the required thickness is screwed to the end of the conductor.
- The thickened part of the instrument scrolls clockwise as it passes through the narrowed portion of the urethra.
- The bougie slowly and carefully moves along the urethra to the bladder.
- After the procedure, the canal is treated with antiseptics.
The metal instrument remains in the urethra for 5-10 minutes. If a synthetic balloon bougie is used, then it is gradually filled with physiological saline, stretching in the designated place. The balloon should remain at the narrowing point for the same amount of time.
To restore the urinary canal, men require 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 bearable. If necessary, the patient is given local anesthesia.
Therapeutic procedure in children
In children, congenital narrowing of the urethra is often diagnosed, which makes urination difficult and can lead to atony of the bladder. In boys, problems mostly arise in the back of the urethra or at the external opening. In girls, in the distal section. Urethral prowling 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 outpatiently, without pain relief. The tissues in this place are thinned and the pain is minimal. If distal constriction is detected in girls, patients are prescribed a course of bougieurage without placement in a hospital. The remaining types of strictures are treated under stationary conditions.
Diagnostic procedure
Diagnostic urethral bougienage is performed once, without repeated manipulations. For carrying out use flexible synthetic devices capitate form. The bougie is introduced into the lumen very slowly, the presence of strictures is determined by the reaction of the patient. When passing through the narrowed area, the patient experiences discomfort, with pathological changes, the bougie moves forward with tangible difficulty.
Contraindications
Despite the narrowing of the urethra, there are a number of conditions in which the conduct of 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 renal failure and injuries of the urethra.
Often you have to cancel the procedure, because the patient is not psychologically ready for it. When urethral bougienage is prescribed, reviews can scare the patient. It is important to explain that manipulation is necessary to restore health, and discomfort can be avoided using local anesthesia.
Condition assessment
Even with careful preparation for the procedure, medical personnel are required to monitor the patient's condition after manipulation so that there are no complications. It is important to monitor the following indicators:
- whether the body temperature has changed;
- the amount and color of urine during the day;
- general state;
- the presence of pain;
- discomfort in the abdomen.
If symptoms of worsening are noticed on time, then the doctor will be able to recognize the rupture of the urethra, and the initial stage of inflammation, and sepsis.