Cicatricial narrowing of the urethra can be caused by prolonged inflammation, trauma, or tumor. The narrowness of the urethra causes difficulty emptying the bladder. To restore this ability to the patient, the urologist performs bougienage.
The main indication for bougienage is the presence of urethral stricture.
How is urethral instillation performed?
The patient is placed in a urological chair. A catheter is inserted into the urethra, to the tip of which a syringe with a preheated medicinal solution is connected. By gently pressing on the piston, the doctor distributes the drug along the walls of the urethra. To prevent the solution from leaking out, the patient is asked to close the urethral opening for 10-15 minutes. After instillation, you must refrain from urinating for 30-60 minutes. The procedures are repeated daily or every other day. The course of treatment includes 7-10 procedures.
For instillations, various drugs are used that have antimicrobial, wound-healing and anti-inflammatory effects. The most common applications are:
- boric acid solution,
- methylene blue,
- collargol,
- dioxidine,
- ozonated chloride nitrate solution,
- chlorhexidine,
- sea buckthorn oil,
- "Rivanol"
- "Katejel"
- "Instillagel".
The medicine is prescribed by a urologist taking into account the patient’s clinical situation.
At the Spectra clinic, urethral instillations are performed by qualified specialists with extensive work experience. The high professional level of our doctors guarantees a painless procedure and the absence of complications in the future. On the eve of therapy, the patient undergoes a full urological examination, based on the results of which the most suitable drug is selected for him.
The essence of the procedure
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The procedure involves stretching or expanding the lumen of the opening of the urethra using a special elongated instrument - a bougie. In appearance, it resembles a metal catheter that is used to release urine when urine is retained or difficult to pass, but the two instruments are slightly different in shape.
Like every medical procedure, bougienage has indications and contraindications for its implementation; it requires the urologist to have a thorough knowledge of the anatomy of the urinary system and skillful use of the technique.
Pros and cons of instillation of medicinal substances
Due to the fact that medications are injected directly into the affected area, the procedure has a number of significant advantages. These include the following:
- a high concentration of the drug in the affected area allows for a local effect, excluding the effect on the entire body;
- prolonged impact and rapid achievement of the desired effect;
- penetration of the drug into the deep layers of the walls of the bladder makes it possible to obtain the desired effect even in the treatment of chronic pathologies.
As for the negative aspects, they are associated with the risk of developing an allergic reaction to a high concentration of the drug and the need for invasive intervention to deliver the drug to the affected area. The latter increases the risk of infection.
Preparations for instillation
This procedure requires the use of special pharmacological agents that can relieve inflammatory processes and ensure rapid healing and restoration of the mucous membrane. As a rule, these are antiseptic agents, sometimes oil solutions or special ozonated solutions that stimulate the regeneration of damaged tissues. So, for chronic cystitis, a urologist can prescribe Furacilin or Hydrocortisone. It is also possible to use Collargol or Dioxidin.
It is important to understand that the procedure cannot be performed at home, since its technique requires the performer to have the appropriate knowledge, skills and experience. The procedure must be carried out under sterile conditions in a specially equipped room using medications that were individually selected by the attending physician.
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Instillation into the urethra in men is performed to treat chronic urethritis and prostatitis. The administration of drugs to women is used for chronic cystitis. Medicines penetrate into the site of inflammation and lead to the death of pathogenic microorganisms. Instillation is highly effective: it promotes a speedy recovery and reduces the burden on the body as a result of taking antibiotics.
Contraindications to instillation include urethral stricture (narrowing of the urethra), trauma to the urethra, and urinary tract infections.
Urethritis in men
Manifestations of urethritis in men (photo 2) and the time of their occurrence largely depend on the type of pathogen. Allergic urethritis shows its first signs within a few hours. Inflammation of the urethra in men, provoked by a tuberculosis agent, may not be felt for several years.
At the same time, symptoms of urethritis in men are often provoked by specific pathogenic microorganisms that cause STDs - they provoke the appearance of symptoms mainly within 1-2 weeks after infection. Urethritis does not always provoke typical inflammatory signs, such as increased body temperature, fever and other manifestations.
The acute form of urethritis is manifested by the following symptoms:
- burning and stinging when urinating, and patients feel them along the entire length of the urethra;
- discharge from the urethra of a mucopurulent nature, mainly in the morning, and having an unpleasant odor;
- frequent urge to go to the toilet;
- weak stream of urine;
- incomplete emptying of the bladder;
- pain during sexual intercourse;
- irritation of the foreskin and glans penis.
Usually, when such symptoms appear, patients go to the clinic because they suspect prostatitis, but a urine test and other tests confirm inflammation of the urethra.
Indications
The indication for bougienage is the presence of narrowing along the urethra and scar tissue on the walls of the urethra, preventing the excretion of urine.
Pathological conditions are formed as a result of:
- pelvic and pelvic floor injuries;
- sexually transmitted diseases;
- diagnostic and therapeutic interventions (catheter installation, etc.);
- surgeries in the genital area;
- congenital deformations of the excretory system.
ATTENTION! Bougienage of the urethra can be performed to diagnose the excretory canal.
Types of bougies
Based on the material of manufacture, all bougies can be divided into two types:
- metal;
- synthetic.
Synthetic ones are much more delicate than metal instruments. Synthetics allow you to carefully insert the bougie without injuring the mucous membranes.
Metal devices can damage the walls of the urethra and create punctures. But metal does not provoke allergic reactions.
The shape of the bougie can be different. The instrument is selected depending on the characteristics of the patient’s body and what problem the procedure is intended to solve.
- Curved and straight. Direct bougies are used for the procedure for female and male patients whose pathological changes are localized in the lower part of the urethra. The curved bougie is designed to explore and widen the cervical canal in men.
- Short and long. Short bougies are used for the procedure in women, long bougies are used for deep insertion of the instrument into the urethra of male patients (up to the bladder).
- Bougies with and without expanders. Such instruments are selected based on the goals of the procedure, location and characteristics of the narrowing site.
On the topic of bougienage, you can also read - What is bougienage of the esophagus, who is it prescribed for and how it is performed
The structure of the female urethra
The duct used for urination looks like a straight tube. It is located in the lower part of the pelvic cavity: it originates above the pelvic floor, passes the anterior vaginal wall, and the upper pubic bones. The posterior surface of the urethra is connected to the vaginal wall. Its external opening is placed between the clitoris and the entrance to the vagina, covered by the labia.
The urethra contains a connective outer layer consisting of fibers, a muscular layer, and then a mucous membrane lining the walls of the duct inside. Along the entire canal there are periurethral glands that produce mucus, the amount of which increases in a state of excitement.
The purpose of the urethra is not only to remove urine, but also to retain urine thanks to the internal and external sphincters that block the canal.
The anatomical features of the urethra - a short length of 3 to 5 cm, a diameter of about 1.5 cm - predispose to infection, inflammation of the genitourinary organs, and weakening of the pelvic floor muscles.
Urethritis in women
Urethritis in women looks (photo 3) somewhat erased, because... the disease has the ability to become chronic. And urethritis appears more often in women. The female urethra is wider and shorter, therefore, taking into account all the factors causing the disease, it is clear that cystitis in women and urethritis are the most common pathologies.
And inflammation of the urethra in women, which occurs with mild symptoms, may not bother the patient at all. The chronic form of urethritis is the most common diagnosis given to women in the clinic.
With an exacerbation of cystitis, when the symptoms of urethritis in women are most noticeable, patients develop the following symptoms:
- problems with urination;
- discomfort in the lower abdomen;
- pain in the pubic area;
- discharge from the urethra;
- Difficulty with morning urine output.
Inflammation of the urethra in women requires examination not only by a urologist, but also by a gynecologist. Signs of urethritis in women must be differentiated from gynecological diseases, since they may have similar manifestations, but require fundamentally different approaches to therapy.
How does inflammation of the urethra occur?
Inflammation of the urethra in women and men may not occur separately, but may be associated with other diseases of the genitourinary system. Most often, urethritis is their consequence, and since the causative agent of the disease is the same, several types of urethritis are distinguished:
- candidal urethritis (photo 4) – the disease is the activation of the candida fungus in the genitourinary organs. It usually appears in women, but there is also male candidiasis - it is transmitted through sexual contact. Typical symptoms of urethritis are the appearance of discharge characteristic of thrush: off-white mucus with cheesy inclusions and a sharp sour odor. Candidal urethritis in men is additionally characterized by the appearance of a white coating on the glans penis;
- herpetic urethritis - the genital area with this type of urethritis is covered with typical vesicles, which are painful to the touch and go through the entire development cycle of herpes. Herpetic urethritis in men manifests itself as painful ulcers on the surface of the glans penis;
- chlamydial urethritis - a disease caused by chlamydial infection. It is registered quite often and requires treatment of both sexual partners. Characteristic signs are purulent discharge from the genitals of varying intensity, pain in the lower abdomen.
Treatment of urethritis
Treatment of urethritis in men and women requires a systematic approach, since therapy is often required not only by the patient, but also by the sexual partner. In half of the cases of registered urethritis, sexually transmitted infections are to blame - gonorrhea and chlamydia, which means there is a need to treat the sexual partner, otherwise therapy will not produce results and there will be relapses of the disease.
The basis of treatment for inflammation of the urethra is antibacterial drugs. They are prescribed after submitting urine for analysis and identifying the pathogen. In this case, the treatment will be much more effective. To minimize the negative impact of antibiotics on the body, so that thrush does not occur in girls and women, drugs that protect the mucous membrane are also recommended.
In parallel, for the purpose of recovery, antihistamines are prescribed - they will help relieve inflammation of the urethral mucosa and improve urination. In the treatment of urethritis, immunomodulators are also useful, especially if there are frequent relapses.
Treatment of urethritis in women also involves physiotherapeutic techniques - these are various kinds of baths and applications that help restore the microflora in the genital area. With complex therapy, success in the treatment of urethritis is achieved faster, but we should not forget about further prevention of the disease.
Indications and contraindications for bougienage
The urologist suggests bougienage if the patient has a urethral stricture, in other words, there are scar tissue lesions that narrow the lumen of the urethra. This is the only and direct indication for manipulation.
As with every medical intervention, there are certain conditions that exclude the possibility of carrying out the procedure in question. The most important contraindication is the presence of a tumor. Even a correctly performed procedure does not eliminate the possibility of microscopic cracks occurring. Damage to tumor tissue by the instrument causes the tumor cells to spread through the blood circulation. Also, bougienage should not be performed if a tumor is suspected.
Other contraindications include:
- inflammatory processes in the acute stage (prostatitis, cystitis, pyelonephritis, orchiepididymitis);
- presence of renal failure;
- previous injuries to the urinary system;
- phimosis, paraphimosis;
- psychological unpreparedness of the patient for manipulation.
Bougienage of the canal involves hospitalization. Since the patient must be under medical supervision for a certain time, the manipulation is not carried out on an outpatient basis. The approximate length of hospital stay is up to several weeks. This time is enough to fully examine the patient - perform laboratory tests, conduct an ultrasound. Also, during the specified period, the effectiveness of the recovery process of the man’s body is observed to ensure that there are no complications (both from the anesthesia and as a result of the bougienage procedure itself).
Such a long period of hospital stay is necessary for the gradual expansion of the urethra - performing the procedure only once and with the goal of achieving normal indicators immediately, you can damage the organ. The optimal interval between episodes of stricture stretching should be at least 8 hours and no longer than 1 day.
Diagnostics
Treatment is not difficult if the patient is able to independently talk about what happened. Otherwise, a number of instrumental methods will be required to identify the object, establish its size and localize.
It is important to correctly establish the causes of the inflammatory process, since without eliminating the source, the prescription of antiseptics will only give a temporary result. The following methods are used for research:
- cystoscopy;
- plain radiography;
- Ultrasound of the bladder.
When a foreign body remains in the bladder for a long time, it takes on the appearance of a stone. With radiography, it is possible not only to estimate the size, but also to recognize the object itself.
