URETROSKOPIYa (Greek urethra an urethra + skopeo to consider, investigate) — a method of visual examination of an urethra by means of special devices — urethroscopes.
At retroospreys consists of a set of hollow metal tubes (tubes), lighting and optical systems. The first urethroscope was offered A. J. De-sormeaux in 1853. It represented a funneled metal tube and had bulky lighting system. Gryunfeld's urethroscope with a tiny electric lamp on the distal end was the closest on a design to modern; need for a special cooler complicated the device. In a crust, time use urethroscopes of two types, for dry At. and the irrigational, produced at a direct current liquid stretching an urethra and straightening folds of a mucous membrane. A prototype of modern urethroscopes for dry At. Valentin's urethroscope is. In it a little heating up electric lamp was for the first time applied, edges was located on a distal tubus end. Goldshmidt (N. of Goldschmidt) offered irrigational At., liquid is entered into Krom through a tube in an urethra. In * the USSR is issued the combined urethroscope for dry At. with a length of tubes of 151 mm (for carrying out an uretroskopiya at men) and 113 mm (for carrying out an uretroskopiya at women). The distal tubus end of the urethroscope is slantwise cut off; at introduction to an urethra to it insert the obturator to exclude traumatization of a mucous membrane. Lighting is provided with the tiny electric lamp of 2,5 in located on a long core. The urethroscope has optical system.
In the modern urethroscopes and uretro-cystoscopes allowing to carry out irrigational At, apply the optical tubes supplied with fiber light guides to survey of an urethra (see Optip). By means of these urethroscopes it is possible to examine all urethra to an internal sphincter, and also to make various manipulations with the tools which are carried out through a tube of the urethroscope under control of an optical tube — a biopsy, electrothermic coagulation of the bleeding hemangiomas of an urethra, extraction of a foreign body, etc. Use the special urethroscope to a section of strictures of an urethra — an optical ureterotome, through a tube to-rogo under control of an optical tube carry out a special rassekatel. The electroresection concerning multiple papillomas, valves of a back urethra is carried out by means of an elektrorezektosko-pas (see Tsistoskopiya).
Urethroscopes will sterilize by cold methods: liquid sterilization in
6% penozone or gas — ethylene oxide in special cameras.
The indication for At. are hron. inflammatory changes, tumors, foreign bodys, strictures of an urethra, a disease of a seminal hillock, anatomic changes of a back urethra after operative measures on a neck of a bladder, carrying out various to lay down. actions.
Contraindications to At. — acute inflammatory diseases of an urethra, prostate, small egg and its appendage, seed bubbles. The intensive urethremorrhagia at tumors of an urethra is not an essential contraindication for irrigational
more preferable to make U. Uretroskopiya at men under a short-term anesthesia, napr, intravenous, with isiolzovaniyekhm Propanididum (Sombrevinum). At women apply parenteral administration of narcotic analgetics in a combination with sedative drugs more often.
Position of the patient during the research — horizontal, on an urological chair (table). At., as well as all endoscopic interventions, carry out with observance of rules of an asepsis and antiseptics. The field of manipulation after processing with solution of an antiseptic agent (Iodonatum, chlorine-geksidin) is delimited sterile linen. The penis is held for a head fingers of the left hand and raised up. The urethroscope greased with sterile vaseline or glycerin, the right hand enter into an outside opening of an urethra. Under the influence of own weight the tool moves ahead in depth of an urethra, gets into its bulbous part to an outside sphincter where usually meets a nek-swarm an obstacle; in the course of carrying out examine a mucous membrane of an urethra. After that the urethroscope is carefully transferred from vertical to horizontal position and examine the remained tail of an urethra. At At. the site of a mucous membrane, adjacent by the end of the urethroscope is visible. It is necessary for orientation that in sight of the urethroscope there was «the central figure», i.e. a gleam of an urethra with radiarno the meeting folds of a mucous membrane.
Sometimes at introduction of the urethroscope difficulties because of discrepancy of its size to size of an outside opening of an urethra meet. In these cases make dilatation of an urethra a special conic buzh or a meatotomiya (see. Urethral dripped). Certain difficulties arise at a stricture of an urethra, its proksimalny does not allow to examine edges. This obstacle is overcome a section of the narrowed site of an urethra by means of entered through an optical ureterotome under control of sight of a special knife or lanceolated electrode, through to-ry pass electric current of high frequency.
At dry At. the mucous membrane is examined during extraction of the urethroscope from an urethra (antegrade At.).
Normal mucous membrane of an urethra brilliant, wet, smooth (tsvetn. tab., Art. 208, fig. 1).
Specific and nonspecific inflammatory processes are characterized by a hyperemia, is injected-nostyyu a mucous membrane, bleeding; at far come inflammatory processes it opaque, dry. At a leukoplakia of an urethra on a mucous membrane grayish-white plaques are visible. After administration of solution of silver nitrate in an urethra sometimes define bluish-black an iyatn of irregular shape, especially in a zone of lacunas of Morganyi and glands Littre (see M ocheis start-up the telny channel). In the place of a stricture an urethra rigid, concentrically narrowed, whitish color with a dark pinhole (tsvetn. tab., Art. 208, fig. 2). Primary cancer of an urethra proceeds more often as an urethritis, and only timely diagnostic At. with a biopsy of the suspicious site of a mucous membrane allows to establish the correct diagnosis. At the same time find new growths of two types: papillary,
reminding a cauliflower, or infiltriruyushchy, hilly, places with ulcerations. At At. it is possible to see polyps (tsvetn. the tab., Art. 208, fig. 4), condylomas, foreign bodys, diverticulums which are localized in an urethra.
In a crust, time the wide experience is accumulated At. at the diseases of an urethra proceeding with defeat of a seminal hillock (tsvetn. tab., Art. 208, fig. 3). Irrigational At. allows to reveal increase in average and side shares of a prostate, characteristic of adenoma of a prostate (see). In cases of disturbance of an urination after an adeiomektomiya it is possible to find the valves formed later operations and crossing points of a back urethra. At a prostate cancer (see) a zone of a seminal hillock it is hardly differentiated, a mucous membrane of dirty-gray color. At Marion's disease — obstructive damage of a neck of a bladder (see the Bladder, malformations) — concentric narrowing in a neck of a bladder at removal of the urethroscope from a bladder in a back urethra is defined.
Later At. at men it is reasonable to appoint during 4 — 6 days anti-and a kta of RIA of l ny p re parata.
A serious complication of an uretroskopiya is perforation of an urethra, edges arises during the carrying out, violent without direct vision, of the urethroscope on it. Also complications of inflammatory character (an urethritis, prostatitis, cystitis, a vesiculitis, an epididimo-orchitis) are possible.
Bibliography: You and l e in A. I. Uret
a roskopiya p zidouretralny operations, L.,
1955; And y with and N with to and y B. E., at -
dynek and y Ya. V. and X about x l about in and N. M.
Urological endoscopy, M., 1978;
Tsuchida S. Sugawara H. A new flexible fibercystocope for visualization of the bladder neck, J. Urol. (Baltimore), v. 109, p. 830, 1973;
Wal-t h e of of P. C., Parsons C.
L. a. Schmidt J. D. Direct vision internal urethrotomy in the management of urethral strictures, ibid., v. 123, p. 497, 1980.
V. Ya. Simonov, V. A. Kozlov;
H. M. Khokhlova (tekhn.).