Ultrasonic mixing cystourethroscopy

The possibilities of the ultrasound method in the diagnosis of obstructive diseases of the lower urinary tract (NFM) have significantly expanded with the introduction of the practice of ultrasonic microciliary cystourethroscopy (RMTC). The study is performed by the transrectal method during the act of urination, which allows you to visualize the neck of the bladder (MP), the prostate and membranous parts of the urethra. In contrast to the mixed X-ray cystourethrography, the RMTC makes it possible to simultaneously obtain information on both the urethral lumen status and the structure of the paraurethral tissues, which significantly expands the diagnostic capabilities of the method. In this case, the introduction of contrast material into the urethra and irradiation of the patient is excluded. RMTC allows you to visualize the areas of constriction and deformation of the urethra caused by prostate adenoma. Realization of ultrasonic cystourethroscopy in real time with parallel video recording gives this study a functional character.

In this study, the lumen of the urethra is evaluated at the time of urination, the relationship of the IVO with the pathological changes in the prostate, the areas of constriction and deformation of the urethra from its inner opening to the bulbous area, is determined. With urethral stricture in the membrane department, the very fact of constriction is established, and in a number of cases an echogenic evaluation of this zone is made. They study the magnitude and nature of the change in the diameter of the urethra in various phases of urination.

It should be noted that in 24.7% of cases, ultrasound cystourethroscopy is poorly informative. The reason for the unsatisfactory results of the study is the impossibility of visualizing the urethra, which may be due to the following factors:

• the inability to urinate at the time of the study;
• urination with a weak jet (Q _max <4-6 ml / s);
• a sub-tubular form of prostate growth - imaging of the bladder neck (vesicle-prostatic segment) is difficult;
• displaced form of prostate growth without an average lobe, which worsens the visualization of the neck of the bladder (vesicle-prostatic segment);
• deviation of the urethra in the transverse direction due to an asymmetric increase in the lateral lobes of the prostate, which makes it difficult to visualize the prostatic section of the urethra during sagittal scans.

As a result of ultrasonic microciliary cystourethroscopy with prostate adenoma, the following data can be obtained:

• narrowing of the prostatic part of the urethra from 0.1 to 0.4 cm due to the hyperplastic tissue entering into its lumen;
• an increase in the angles of the S-shaped bend of the urethra;
• valvular effect of the middle lobe;
• Valve effect of "horns" of enlarged lateral lobes into the neck of the bladder;
• valvular effect of enlarged lateral lobes of the prostate into the prostatic urethra;
• enlargement of the prostatic part of the urethra, which is characteristic of stricture, whose level is distal (pretenotomy).

The most common cause of infravesical obstruction in patients with prostatic hyperplasia, detected with ultrasound cysto-urethrocopy, is the average proportion that closes the lumen of the vesicle-prostatic segment in the form of a valve at the time of urination. Given the fact that this study is performed at the time of urination, which gives an opportunity to assess the lumen of the urethra in real time, it is extremely useful for determining the causes and level of infravesical obstruction and planning of the volume of TURP.

A more complete picture of the anatomical and functional processes occurring at the time of urination is given by the combination of ultrasound-induced cystourethroscopy with uroflowmetry, M.A. Gazimiev, together with the staff of the Urology Clinic of MMA named after. R.M. Fronstein, developed and implemented in practice an echo urodynamic study (EDI) - the measurement of the minimum urethral section when comparing it with the volume flow rate of urine and the recording of intra-abdominal pressure. EDI allows to estimate the calculated value of intravesical pressure by mathematical means, nsynvazivno. Which is key in assessing the urodynamics of NRMs.

However, the uneven narrowing of the lumen of the urethra with IVO creates objective difficulties in the reliable establishment of the degree and place of the smallest section of the urethra, which increases the error in the calculation of intravesical pressure. Nevertheless, the South. Alyaev et al. Consider that the comparison of the EDI data and the complex urodynamic study is not entirely legitimate due to the fact that they are based on different, almost indistinguishable indicators of the process of urination. Despite this, the complete absence of invasion in NRM and associated complications, low time and cost, fairly high accuracy and sensitivity of the technique allow using it in the examination of patients with urinary disorders. This can be especially relevant in those cases when the application of traditional invasive methods of urodynamic examination is not possible for a number of reasons.

Considerable interest in studying disorders of urination is represented by the technique of ultrasound cystourethroscopy with color Doppler mapping of the urine flow. The use of ultrasonic microciliary cystourethroscopy made it possible to compare the data of the dynamic activity of the urethra with the indices of the linear flow rate of urine in different parts of the urethra for various diseases of the prostate and urethra. The relationship between the linear flow rate of urine and the degree of narrowing of the urethra was revealed, which undoubtedly is of some interest. However, it is impossible to judge the detrusor contractile activity and the degree of infravesical obstruction at the present stage of development.