RU2790762C1 - Urethral speculum female (options) - Google Patents

Abstract

FIELD: medical equipment.

SUBSTANCE: group of inventions relates to the field of medical technology and can be used in urology, for examination and operations on the female urethra. Female urethral mirror is made cone-shaped with a smooth decrease in diameter from a ring with an inner diameter of 7 to 15 mm and a width of 3-5 mm, to which four stiffening ribs are attached, located around the circumference at 12, 3, 6 and 9 o'clock of the conditional dial, the length of said ribs is 25-35 mm and an obturator tip 5-10 m long is fixed to the said ribs. The diameter of the obturator tip is 2 times smaller than the diameter of the inner ring. The obturator tip is made with a smooth rounding at the end. In the second embodiment, the female urethral mirror is made cylindrical with a ring made at one end with an inner diameter of 7 to 15 mm and a width of 3-5 mm, to which four stiffening ribs are attached, located around the circumference at 12, 3, 6 and 9 hours of the conditional dial, the length of the said ribs is 25-35 mm and an obturator tip 5-10 m long is fixed to the said ribs. The obturator tip is made with a smooth rounding at the end.

EFFECT: improved visualization not only when examining the paraurethral glands, but also during surgery thereon, directly affecting the result of surgical treatment and reducing the risk of re-interventions.

2 cl, 1 dwg

Description

The invention relates to the field of medical technology and can be used in urology, for examination and operations on the female urethra.

A device for expanding a urethral stricture is known, including a dilator having an elongated body provided with a distal end converging on a cone in the direction of the distal tip, a proximal end and a conduction channel passing through it; a conductor passing through the conduction channel for holding the dilator upon insertion; and a lubrication port at the proximal end of the elongate body for introducing liquid conductor lubricant into the conduction channel; wherein the guidewire is provided with a plug preventing the passage of the proximal end of the guidewire through the guideway towards the distal tip of the dilator, the plug being adapted to receive a syringe for injecting liquid lubricant of the guidewire into the guideway when the plug is inserted into the lubrication port; moreover, the distal end of the dilator is bent towards the distal tip and narrows in diameter from a value in the range of 14-24 units on the French scale (French) to 2 units on the French scale (French) (RF patent No. 2675991, A61M 29/00, A61M 25 /09, published on December 25, 2018).

The disadvantage of this device is its inability to examine the female urethra.

Currently, there are no special instruments for examining the female urethra in general, and the paraurethral glands in particular. The available endoscopic equipment is intended for the most part for examining the male urethra, and examining the female urethra in the proximal part with their help is clearly limited, and in the distal part it is simply impossible. This is due to the fact that the female urethra is short and wide, in contrast to the male one, and the irrigation solution introduced into the urethra during urethrocystoscopy and necessary for its straightening under the flow of fluid flows out. Visual inspection is also impossible, since the urethra is not an open gaping tube, but a canal that has “slept down” outside the urination. Therefore, for a full inspection, it is necessary to “straighten” it.

The prototype of the invention is a method for the treatment of inflammatory lesions of the urethra in women proposed by C. Rieser (Rieser, C. 1968. A New Method of Treatment of Inflammatory Lesions of the Female Urethra. JAMA: The Journal of the American Medical Association, 204(5), 378 .). According to the C. Reeser method during operations on the paraurethral glands, to improve the visualization of the ducts of these glands located in the distal part of the female urethra, two mosquito-type clamps are applied along the edge of the meatus at 5 and 7 o'clock of the conditional dial and parted to the sides . The ducts of the paraurethral glands are visualized and opened using an electrode of an electrosurgical apparatus inserted to the entire depth of the duct.

Currently, to improve visualization, various surgical instruments (usually tweezers or a clamp) are also used, introduced into the distal third of the female urethra and diluted in it.

However, these instruments, as well as the use of “mosquito” clamps in the Ch. inadequate. And since it is in the distal third of the female urethra that most of the outlet openings of the ducts of the paraurethral glands are located, the impossibility of their full examination and surgical intervention is a significant problem.

The present invention solves the problem of improving visualization not only when examining the female urethra and ducts of the paraurethral glands, but also during surgery on them directly affects the result of surgical treatment and reduces the risk of re-interventions.

The solution to this problem is ensured by the fact that the urethral mirror is made cone-shaped with a smooth decrease in diameter from a ring with an inner diameter of 7 to 15 mm and a width of 3-5 mm, to which four stiffening ribs are attached, arranged around the circumference at 12, 3, 6 and 9 hours of a conditional dial, the length of which is 25-35 mm and on which the tip-obturator 5-10 mm long is fixed, while the diameter of the tip-obturator is 2 times smaller than the diameter of the inner ring, and the tip-obturator is also made with a smooth rounding at the end. In the second version, the urethral mirror is made cylindrical with a ring made at one end with an inner diameter of 7 to 15 mm and a width of 3-5 mm, to which four stiffening ribs are attached, located around the circumference at 12, 3, 6 and 9 o'clock of the conditional dial, the length of which is 25-35 mm and on which the tip-obturator 5-10 mm long is fixed, while the tip-obturator is made with a smooth rounding at the end.

The female urethral mirror stretches the urethra from the inside along its entire length in four directions. This is achieved with the help of 4 stiffening ribs located around the circumference at 12, 3, 6 and 9 o'clock of the conventional dial, respectively. During inspection or surgery, the mirror can be rotated to view that part of the mucosa that is initially hidden behind the stiffeners. The urethral mirror can be made cone-shaped, with a smooth decrease in diameter from the outer to the inner ring or cylindrical.

The female urethral speculum is a complete medical instrument consisting of a ring, 4 stiffeners and an obturator tip. The ring is necessary to exclude the migration of the entire instrument during examination or surgery into the urethra or bladder cavity, and also, if necessary, during the operation, for its additional fixation to the paraurethral tissues. The stiffeners stretch the urethra from the inside along its entire length in four directions, allowing you to examine between them the urethral mucosa, the openings of the ducts of the paraurethral glands or other structures of the urethra, and in the future, if necessary, perform a surgical manual. The obturator tip ensures safe and atraumatic insertion and removal of the instrument from the female urethra.

The invention is illustrated in figure 1, which shows a cylindrical and cone-shaped urethral mirror.

Two types of instrument are proposed: cone-shaped, with a smooth decrease in diameter from the inner part of the ring 1 to the tip-obturator 3, and cylindrical (Fig. 1). At the same time, the length of the tool is from 25 to 45 mm (the length of the stiffeners is 20-35 mm, the tip is 5-10 mm). Ring width 3-5 mm. The inner diameter of the ring is from 7 to 15 mm (from 21 to 45 Ch). Two types of instrument and the variability of their sizes is dictated, firstly, by the individual features of the structure of the female urethra, and secondly, by the need to use a cone-shaped instrument of a smaller diameter during examination to minimize pain, and during operations performed under anesthesia, use a cylindrical instrument of a larger diameter for maximum visualization. In a cone-shaped mirror, the diameter of the obturator tip is 2 times smaller than the inner diameter of the ring. The tip-obturator has a smooth rounding at the end to ensure atraumatic insertion and removal of the instrument.

Method: before the examination, the patient needs to empty the bladder, in order to exclude the release of urine after the introduction of the instrument. The examination is carried out in the lithotomy position under aseptic conditions. The female urethral speculum is inserted into the urethra, having previously lubricated the obturator tip with a lubricant to improve gliding and minimize tissue trauma. When administered, the patient may experience discomfort. After insertion, the obturator tip is located in the proximal part of the urethra or may reach the bladder. The ring serves as a restrictor, preventing the entire instrument from migrating into the urethra or bladder cavity. After the insertion of the instrument, the urethral mucosa located between the stiffeners becomes visible. Also, using the ring, you can slightly change the inclination of the instrument, for better visualization of the dorsal surface of the urethra, and rotate the instrument to examine that part of the mucosa that is initially hidden under the stiffeners.

Example 1. T-va G.N. 27 years. Complaints of constant pain, burning in the urethra, pain during intercourse in the urethra and on the anterior wall of the vagina. On examination by a gynecologist, no pathology was found. Urinalysis and urine culture for flora and sensitivity to antibiotics are normal. When viewed in a gynecological chair, point pain was determined along the anterior wall of the vagina in the projection of the distal third of the urethra. According to MRI of the pelvic organs, MR signs of periurethritis. Urethrocystoscopy revealed no bladder pathology.

After emptying the bladder, in the lithotomy position under aseptic conditions, a cone-shaped female urethral speculum 21 Ch (7 mm) was introduced into the urethra. The mucous membrane of the urethra is hyperemic, at 5 and 7 o'clock of the conditional dial, 3 mm from the meatus, two edematous, hyperemic openings of the ducts of the paraurethral glands are visualized. With the introduction of the probe 3 Ch into the mouth of the ducts, the patient noted severe pain, when the probe was removed, a drop of purulent contents was released from the ducts of the paraurethral glands. Upon further examination of the urethra and turning the mirror clockwise, a third hyperemic and edematous duct was revealed along the right lateral surface.

Under intravenous anesthesia in a lithotomy position under aseptic conditions, a cylindrical urethral speculum 30 CH (10 mm) was introduced into the urethra. 3 ducts of the paraurethral glands were visualized and opened with the help of an electrocoagulator. The Foley catheter was removed for 1 day. Restored spontaneous urination. She was discharged for outpatient observation by a urologist for 1 day. No complications of the operation were noted.

The use of the female urethral speculum in clinical practice allows not only to clarify the diagnosis with minimal tissue trauma, but also to perform, if necessary, minimally invasive surgical interventions on the urethra, as well as to carry out postoperative monitoring.

Claims (2)

1. The urethral mirror is female, characterized by the fact that it is made cone-shaped with a smooth decrease in diameter from a ring with an inner diameter of 7 to 15 mm and a width of 3-5 mm, to which four stiffeners are attached, located along the circumference at 12, 3, 6 and 9 hours of a conventional dial, the length of which is 25-35 mm and on which the tip-obturator is fixed 5-10 mm long, while the diameter of the tip-obturator is 2 times smaller than the diameter of the inner ring, also the tip-obturator is made with a smooth rounding at the end . 2. The female urethral mirror, characterized by the fact that it is made cylindrical with a ring made at one end with an inner diameter of 7 to 15 mm and a width of 3-5 mm, to which four stiffeners are attached, located along the circumference at 12, 3, 6 and 9 hours of a conditional dial, the length of which is 25-35 mm and on which the tip-obturator 5-10 mm long is fixed, while the tip-obturator is made with a smooth rounding at the end.

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