The dissertation was aimed at improving the quality of treatment of patients with urethral strictures and obliterations by developing and implementing an improved method of fixing the buccal flap during urethroplasty and evaluating its effectiveness.
The observation period covered the years 2005-2023. The clinical material is presented by 204 patients who underwent UUA (urethrourethroanastomosis), BPU (buccal urethral plasticity) or PSHPL (skin-fascial flap plasticity).
The design of the study involved the implementation of several interconnected, essentially sequential stages. The retrospective component included: a comparative analysis of the results of UUA, BPU, PSFL for the period from 2005 to 2024. The prospective component included: development of a modification of buccal flap fixation during urethroplasty with proof of its effectiveness.
9 observation groups were formed. The first group (n=69) is represented by patients who were operated on in the clinic in the volume of UUA from 2005 to 2021; the second group (n=89) – BPU for the same period; the third group (n=16) – PSHFL from 2005 to 2021. The fourth group (n=108) included patients after urethroplasty in the same period (2005-2021) and they had complications in the postoperative period according to the Clavien classification Dindo class 0-I, the fifth group (n=36) included patients with p/o complications of class II-IIIa according to Clavien-Dindo; the sixth group (n=30) with p/o complications according to Clavien-Dindo class IIIb-IV classification. Group seven (n=49) included patients who underwent urethroplasty in the years of implementation (2005-2014); while up to the eighth group (n=125) - in the period of their formation (2014-2021). The ninth group consisted of patients with strictures of the urethra, in whom a modified method of fixation of the buccal flap was used during buccal plastic surgery of the urethra.
The essence of the proposed modification of buccal flap fixation is as follows. After excision of the buccal flap, it was prepared for fixation in the stricture zone. At the same time, from the Surgecell fibrillar measuring 2.5x5.1 cm or 5.1x10.2 cm, depending on the size of the SU, a similar in shape, but larger in size, was cut from the buccal flap, 0.5 mm on all sides, piece. An oval-shaped incision was made in the middle, and this is how the Surgecell ring was formed. Surgecell, prepared according to the dimensions, was connected to the buccal flap and moved into the area of the urethral defect. First, the formed flap was fixed at 12 and 6 o'clock of the conventional dial to the edges of the normal urethra with vicryl 4/0 knotted sutures.
At the 1st phase of the retrospective stage, after studying and analyzing the results of UUA, BPU and PSHFL (groups 1, 2 and 3, respectively), it was determined that there is a significant difference in localization (р=0.0001), etiology (р=0.0001) and average length of SU (р=0.0001) in intergroup comparison.
At the II phase of the retrospective stage, the results of urethroplasty were studied in cases of their implementation during the period of implementation and formation, that is, in the 6th and 7th observation groups.
The next stage of the work consisted of a prospective phase and was devoted to the development of a modification of the fixation of the buccal flap during urethroplasty and the evaluation of its results in clinical practice.
The scientific novelty of the study consists in substantiating and proposing a modification of surgical tactics for fixing plastic material for urethral reconstruction, which ensures the tightness (tightness) of the junction of mucous membranes, reduces the risk of hematoma and flap detachment, and does not increase the risk of postoperative complications.
The key components of surgical tactics that contribute to better fixation of plastic material during urethroplasty are defined.
For the first time, the risk factors for the occurrence of various classes of postoperative complications during urethroplasty have been identified, namely, the localization of SU in the penile and bulbar regions, the duration of the disease, the score of complexity of SU, the type of urethroplasty performed.
The study of the results of various types of open urethroplasty in patients with SU was further developed, their features were revealed depending on the type of operation performed, and problematic issues related to ensuring a high level of appropriate specialized care for patients were highlighted.
Key words: urine, non-oncological urological diseases, urethroplasty, urethra, risk factors, prognostic factors, quality of life, risk stratification, prostatectomy, program, fast-track surgery.
