Urethral bougienage

Infections, hypothermia, autoimmune disorders often affect the health of the genitourinary system of men and women. One of the most common phenomena is the narrowing of the urethral canal. This condition is difficult to tolerate, accompanied by frequent attacks, complicated by fever and psychological stress. A similar disease occurs even in infants in the form of congenital anomalies. To restore the lumen of the urethra in urology, the method of bougienage is used. This is a long-known and used technique that many patients are afraid of. In order to properly prepare yourself for the procedure, it is better to learn about bougienage in advance.

The essence of the procedure

The bougienage technique consists in inserting a special tool in the form of a rod into a hollow tubular organ – a bougie. This allows doctors to eliminate stenoses (places of narrowing in the organs). Bougies are urethral, ​​for the Eustachian tube, for the esophagus, etc. Urethral are designed to penetrate the urethra and rehabilitate its patency.

Distinguish women’s, men’s and children’s bougie. They also differ in shape and material, they are rigid and straight, flexible from synthetics, metal curved. For each patient, the diameter of the rod is selected depending on the width and length of the urethra. For example, in women the urethra is short and wide, while in men it is narrow and long. Depending on the anatomy and localization of the stenosis, an instrument of the right size and shape is selected.

The bougie is inserted into the urethra using local anesthesia or general anesthesia. Most often, local anesthesia is sufficient, anesthesia is used mainly for children and mentally unbalanced adults. By moving the tube along the canal, the doctor can accurately determine the place of narrowing or localization of the stone, and with the help of a set of bougies with different diameters, the normal patency of the canal is restored. Stenosis can occur in any part of the urethra, which leads to difficulty urinating, constant pain and discomfort. It cannot be eliminated in one procedure, since a sharp expansion of the walls can lead to a rupture of the channel.

The patient is prescribed several sessions, during each of them the doctor inserts a slightly larger rod than the previous time. At the end of each bougie there is an oval extension in the form of a cone, a drop or a synthetic balloon. When the doctor reaches the site of stenosis, the instrument is left in this position for 5-15 minutes. During this time, the balloon or “drop” expands the narrowed lumen. As a result of such actions, patency is restored, bouts of pain and discomfort disappear.

Indications and contraindications for bougienage

The procedure is used for diagnosis and treatment. During the diagnosis, the doctor, advancing the bougie, reaches the point of maximum constriction. A stone in the urethra can also impede progress. This establishes the exact location of the stenosis or stone. The treatment procedure begins immediately after the diagnosis, it goes the same way, but lasts longer. The only indication for such manipulations is urethral stenosis in adults and children.

This happens for various reasons:

• congenital anomalies;
• after infections and inflammations, sexually transmitted diseases;
• from mechanical injuries of the pelvis and lower abdomen;
• after incorrectly performed medical procedures with penetration into the urethra;
• tissue scarring after surgery.

Not all types of narrowing can carry out such treatment. Bougienage of the urethra is not prescribed for:

• cystitis;
• suspicion and presence of tumors;
• pyelonephritis;
• acute course of inflammation;
• narrowing of the foreskin;
• too low blood clotting;
• chronic and acute renal failure.

In addition, the patient himself may refuse treatment in favor of other methods. The main competition for bougienage today is urethral plastic surgery. For various reasons, women may be prohibited from carrying out such manipulations by an obstetrician-gynecologist or gynecologist. In order to accurately determine whether the patient needs such a procedure and to exclude the presence of contraindications, a series of examinations are first carried out. Careful preparation of the patient reduces the likelihood of complications.

Patient preparation

The main part of the preparation is tests and diagnostics before bougienage. The patient must undergo an ultrasound examination. During ultrasound, the diameter of the urethra, the place of formation of the stricture, or the localization of the stone are determined. Also, the examination can completely exclude the possibility of bougienage, for example, if a tumor is detected. According to the ultrasound data, the urologist will select the diameter and shape of the bougie for the first session.

In addition, the patient must undergo:

1. Urine and blood tests.
2. Retrograde urethrography. A contrast agent is injected into the cavity of the urinary duct and several pictures are taken.
3. Computed tomography.

Consultations with other doctors can also be scheduled: a neurologist, a therapist, a gynecologist. If no contraindications are found, the doctor calls the date of the procedure. A few days before it, you need to give up alcohol, it is recommended not to eat on the eve and on the day of the event. Before the process itself, the patient is asked to empty the bladder if he can do it himself.

Therapeutic and diagnostic bougienage

The procedure is carried out on an outpatient basis or in a hospital if the patient is already in the department. Outwardly, this process looks quite traumatic, but it is quite tolerable, which is confirmed by the reviews of patients. It is very important that the patient is not tense, as anxiety causes excessive muscle contraction. Such a phenomenon can greatly interfere with the doctor during manipulations and cause more discomfort to the patient himself. Therefore, when entering the office, it is better to think about the positive results of the procedure, and the patient is also offered sedatives if he is too anxious. In extreme cases, bougienage is performed under general anesthesia. The patient is dressed in sterile clothes and transferred to the room where the process will take place. It can be an operating room or just a urologist’s office. The doctor himself and his assistants will take part. The procedure is slightly different for men and women.

Women

Since the female urinary tract is much shorter and wider than the male, the process of bougienage is easier for ladies. However, this anatomy leads to the fact that infections reach the bladder faster, so urethral stenosis is also not uncommon for women. For the diagnosis and treatment of female organs, mainly hard and straight bougie is used. This is a thin tube, at the end of which there is an extension in the form of a drop. This tube is treated with glycerin or petroleum jelly for easy sliding. An anesthetic is injected into the cavity of the urinary canal. Then the doctor inserts the rod into the urethra to the site of stenosis, the tube is left for some time in this position. At the end, the instruments are removed, the external genitalia are treated with antiseptics.

After 8-48 hours, you need to re-session. At the second appointment, the doctor first uses a bougie of the diameter that was used last time. Then take a slightly larger bougie, leave the widest for a few minutes. A woman may need two to five of these procedures to fully restore the lumen.

In men

The principle of bougienage for men is the same as for women. However, given the anatomy of the male urethra, this takes longer and requires more care. For manipulations take rigid or flexible bougie. Rigid ones are straight and curved, the latter are used to eliminate stenosis in the posterior part of the urinary duct, straight lines are suitable for stenosis of the anterior part. Bougienage is most easily tolerated with a flexible tube, this is a rod made of synthetic material, at the end of which there can be the same extension or balloon. A balloon is a hollow insert on a tube, which, upon reaching a stricture, is filled with water. As a result, such a tool is easier to promote through the channel. But the type of bougie used depends on the situation, only the doctor can decide how he will manipulate.

The course of the procedure:

1. The patient lies down on a table that looks like a gynecological chair. I put my legs on special stands so that they are divorced and slightly bent.
2. If necessary, the patient is administered sedatives intravenously. An anesthetic in the form of a gel or liquid is injected into the urethral cavity. When using flexible instruments and localizing the narrowing in the anterior part of the canal, anesthesia may not be required at all. In rare cases, local anesthesia is used.
3. The genital area and instruments are treated with antiseptics. The bougie rod is additionally lubricated with slip gel.
4. The doctor slowly inserts the bougie into the urinary tract. Forcible advancement can damage the organs, so the doctor monitors the patient’s condition. If at some point the patient panicked, the process is stopped until he calms down. If the patient feels pain or strong pressure, he must definitely tell the doctor about it. In this way, the site of the stenosis can be calculated.
5. The extended part of the tool should be in the place of narrowing. The bougie is left for a few minutes in this position, then slowly withdrawn. The organs are again treated with an antiseptic substance.

During one session, the doctor can change several bougies, this is necessary so that the diameter of the expansion of the tube is slightly larger than the diameter of the narrowing. For a complete recovery, the patient may need from 2 to 14 sessions. There must be breaks between them, the interval should be at least 8 hours and no more than two days.

Children

The stricture of the urinary tract in a child is most often congenital. At the same time, such an anomaly is eliminated as early as possible. In boys and girls, the process occurs in the same way as in adults. However, general anesthesia is always used. For the procedure, instruments of appropriate size and shape are selected. Preparation and recovery in children occurs in the same way as in adults.

After the procedure

To prevent infection during the procedure, after it, a course of antibiotic therapy is prescribed. Depending on the clinical picture, other medications may be prescribed to reduce the risk of relapses. For the first time after the procedure, you need to periodically measure the temperature, monitor the amount and color of urine, and check for impurities. Also, the patient is assigned a plan to visit the urologist, the doctor must conduct several follow-up examinations to make sure that the bougienage is effective. For these purposes, they may be referred for additional ultrasound or urethrography.

Often, after bougienage, the patient is forced to undergo the procedure again several times a year. This is due to the fact that relapses of stenoses are very common. Sometimes the patient is even taught to do it on his own with the condition of periodic visits to the urologist.

Despite the fact that such manipulations are bloodless, they are sometimes complicated by unpleasant consequences.

Complications after the procedure:

• damage to the walls or mucosa of the canal with a tool;
• infection;
• worsening stricture;
• bleeding;
• urethral fever.

It is important during the course of treatment and the first time after it to monitor your well-being. With the appearance of high temperature, swelling and redness of the genital organs, interspersed with pus or blood in the urine, you need to urgently come to your doctor. Parents of children who have gone through a similar process also need to carefully monitor the condition of the baby. If the child is too restless, swelling and redness appear on the genitals, he refuses to eat and sleep – this is the reason to contact the pediatrician.

Where to get bougienage and how much does it cost

Such treatment is carried out in private and public institutions, in the department of urology. In the state segment, such a service is free, at least officially. Unofficially, the cost of bougienage in a polyclinic or state hospital will be “voluntary”. In a private institution, prices range from $20 to $100. The cost is affected by the status of the clinic, the complexity of the work, the localization of the stricture. But progressive medical centers practically do not use this technique, replacing it with plastic surgery.

Urethral bougienage is widely used, although the trend towards its use is declining. There are fewer and fewer indications for its implementation, since the recurrence of stenosis after the procedure is a frequent occurrence. Reviews of doctors show that the treatment itself can provoke scarring of tissues and the formation of new narrowings. Before agreeing to conduct it, it is worth assessing all the risks, asking the doctor about alternative types of treatment. However, in the event that other methods of therapy are contraindicated or do not give a result, this technique comes to the rescue.