In the absence of natural urination, the process of removing urine from the human body is performed using a care. Such a need may arise after surgical intervention to remove bladder Due to injuries or cancers. As a container for urine accumulation, a urinary, which is carried by the method of gluing or placing it on a special belt. It is also possible to create an internal reservoir and the use of the digestive tract, then we will not need the wearing of the urinary.

What is a steady?

The hole created by the surgeon on the abdominal wall, during operational intervention, designed to eliminate urine from the body, is called a street. After the operation, it looks red and swollen, for several weeks or months (individually) it is reduced in size and acquires more muted color. Outwardly, the urgeth is similar to the inside of the cheek, has a mucous membrane. Sometimes it can be bleeding, not sensitive and does not hurt, if we bind.

Types of streets

There are two types of streets:

• ileum-kondiit - removal of the segment fine intestine and the subsequent restoration of intestinal integrity for its functioning, one end of the segment is connected to the skin of the patient and thus creating the possibility of removal of urine;
• ureterostomom - the removal of ureters on the abdominal wall.

In two cases, the patient will need to carry the urinal with an exhaust valve.

Care of the Ugra - Algorithm

The patient with the urgeth need to establish a clear chart of a replacement of the sonar, always have an important accessories for the procedure, as well as to adhere to the following procedure during the bag replacement:

• wash your hands;
• prepared accessories (towel, paper, soft urine, soap, new tanks, scissors, trash can and other items, if there is a need for). Explore itself and make sure everything is in place and just enough;
• to wip the surface around the sticky leveling, use paper or napkins, clean the place with the help of soap, avoiding the region of the road itself;
• if the skin was covered with rash and found allergic reactions, it is necessary to apply a bit of therapeutic powder, but if irritations do not pass, you should consult a doctor, perhaps this is a fungus;
• when crystals are found on the skin around the road, neutralize them with a tampon, moistened in vinegar and report them to the precedence of the doctor;
• prepare a container if you need to cut a hole on it, do it;
• apply a means to protect the skin to the placement of the container (if glued) - paste-sealant;
• secure the container;
• keeping a concentration, you can carry out in a couple of minutes this procedure By cauting behind the stoma, wash your hands again and continue to do your affairs.

Care care at home

After the operation, the patient helps to get used to the new duties for care of the street, nurse. After some time (at the discretion of the doctor), the patient receives an extract and he will have to care for himself. Caring for the urgethous at home does not take much time and does not cause discomfort. The focus should be given to the skin around the urgeth, for its processing, use soft cotton swabs, moistened in special hypoallergenic lotions.

When the bag is filled with ½ of its volume, the time of its empties comes. To do this, clamping the drain tube, take out the plug and direct the tube into the toilet. It should be noted that the urine is not directed back in the steady. The walls of the bag must be clean, without a fall, otherwise, the bag must be replaced. It is not accepted that the bag is not taken, it should be pulled out and wrapped into the package. Usually the bag is replaced once every four or five days, the patient is important to record records for accuracy.

Life with Ugra and Life with an artificial bladder

Life with a Ugra - a new event for a person, he needs to feel support and understanding from the side of close to get used to such a change. The first time of discomfort (psychological and physical) patient cannot be avoided, but it has all the possibilities for continuing the former life: sports, sex life, visiting rest sites and so on.

A man with a street can return to work when he feels the strength for this, but excessive physical Loads It should be avoided, in order to avoid falling out of the steady (prolapse). Associated disability can change the function of the patient. If the leader has doubts about the working capacity of a person with this diagnosis, it is recommended to provide him with a certificate from a doctor in which it will be indicated which works are permissible for implementation.

Clear forecasts as you can live with a street, not available. There are cases of patient life within 20-30 or more years with full observance of hygiene and the rules for the affected area.

Is it possible to get rid of the steady?

There are two types of urgeth - temporary (if the bladder is injured) and constant. In the first case, a person after a certain time, after holding a re-operation, completely returns to the usual life. If the street is constant, then get rid of it will not work.

In cases where the bladder cannot perform its functions, it is replaced by artificial. Sometimes an artificial urea is formed by connecting urinary tract with the intestine. The bubble itself is replaced by a thick, sigmoid, straight or iliac. In the latter case, form a reservoir similar to a real bladder. This method is only being developed. Usually, preference is given to those methods, based on the use of natural sphincters of the body - the sphincter of the urine channel and the anal hole.

How do surgery?

The easiest method is the elimination of both ureters on the skin. Ureterals are sewn into the front abdominal wall, and urine is displayed through a hole existing in the wall. Water is collected in a plastic package attached to the abdomen's skin. However, this method has one drawback - over time, the narrowing of ureters may occur.

More complex operational method is the replacement of the bladder with a segment of iliac, thick or sigmid gut. In this case, during surgery, ureterals are implanted in the intestinal loop. Watering is moving in the intestinal loop and through the hole in the abdominal wall is displayed out. Most often used segment of the ileum.

Reservoir

Ureterals are sewn into the rectum where urine is going. This process is controlled by the patient and is carried out with the participation of the sphincter of the rectum. This method has one disadvantage - a bacterial flora from the rectum, falling into the urinary tract, can cause inflammation.

The reservoir from the iliac

The reservoir from the ileum is ideal for replacing the bladder. For its formation, the segment of the ileum is used, the ends of which are sorted. The formed reservoir is connected to the ureters and the urethra. The urevere is replaced by a bag-shaped reservoir formed from thin gutwhich is going to urine. Then through the urethra dyeing the urine is displayed out.

The reservoir, even from the segment of the ileum, cannot fully replace the natural urea. In a patient with artificial bladder There are no urinary calls. The process of removal of urine is controlled by consciousness and is carried out due to the tension of the muscles of the abdominal press. To solve this problem, use a bunch of hole. From the reservoir formed from the segment of the ileum, the urine is derived from the urethra, but through the urinary hole to which the plastic tube is attached. Before the operation of the patient inspect and evaluate its condition. Great importance Has a study of kidney activities. After the operation, you must comply with the diet, use nutritional supplements. Sometimes B. postoperative period In the intestines open wounds, spikes and hernia appear. Frequent complication is also pyelonephritis.

Indications for the operation

Indications for this operation are: malignant urinary bubble tumors, injuries, severe congenital anomalies, paralysis, sharp decrease in the size of the bubble.

Through the mucous membrane of the small intestine from urine can resist substances that can cause a serious disruption of metabolism. Exchange processes These patients need to be explored monthly. In case of disorders, prescribe medicia treatment. In addition, the risk of developing urinary tract infection increases.

Every 4 hours from the small intestine, from which the urevere is formed, it is necessary to output urine because It may happen to its extract.

Operation in urinary incontinence is a serious surgical intervention. When the doctor sends a woman to such a procedure, he is obliged to know her about everyone possible complications Procedures, as well as that there is a chance of a relapse of an existing problem.

To save a woman from stressing urinary incontinence, modern surgery offers more than 250 species different operations. Their goal is to be completely compensated, or to adjust the reason that led to the impossibility of deterring urine. With regard to the effectiveness of such interventions, the indicators vary in the range of 70-95%.

When urinary incontinence can be carried out the following types of operational intervention:

Sling operations (suspending operations);

Plastic vagina;

Installation of an artificial sphincter;

Introduction of injections of volume-forming substances into the periurethral zone.

Indications for the operation

Indications for operational intervention in urinary incontinence can be called the following:

Acquired stress incontinence.

Mixed urine incontinencies with a predominance of a stress component.

Fast progression of pathology.

The ineffectiveness of conservative therapy in patients with the second and third degree of incontinencies.

Sling operation when urinary incontinence in women (TVT)

Effective I. safe method The treatment of stressing urinary incontinence is sling operations (TVT and TVT-O). They relate to minimally invasive techniques that are conducted under the control of modern equipment. The essence of the intervention is reduced to the fact that under the middle part of the urethra is injected with a loop, which is designed to support the urethra and not to give urine to flow at the voltage. The loop is made of synthetic material and is placed in the space between the urethra and the front vaginal wall. As a result, the angle of inclination between the bladder and the urethra is restored, and urine does not flow.

The sling operation is carried out in stress incontinence of urine, as well as with a combination of stress incontinence with urgent. That is, in cases where the uncontrolled urine yield is accompanied by an increase in intra-abdominal pressure (this occurs during sneezing, laughter, etc.).

Contraindications to carry out this type of surgical intervention are:

The battery period of the child.

Stage of pregnancy planning.

Infectious inflammatory diseases of the organs of the urogenital system.

Reception medicinesDreaming blood in less than 10 days before the start of operational intervention.

The sling operation can be implemented even with the preceding surgery Not crowned with success.

Before the patient is guided by the operation, it must pass a comprehensive urodynamic examination.

As for the alternative to a sling operation, then at easy degree of urinary incontinence can help special exercises. However, when conservative therapy It turns out ineffective, then get rid of the existing problem in other ways it will not be possible. Minitvt installation, tranpporto loops (TOT) and NEEDLELESS (Needleless) are also possible.

When a woman has other pathologies in parallel, such as the loss of the pelvic bottom, it is possible to install a mesh, and not a small loop implant. If urinary incontinence is mixed, then drug correction is carried out in parallel. That is, the imperative cause is eliminated by drugs, and stress incontinence with surgical intervention.

Preparation for the operation takes place in several stages:

Consultation of specialists: urologist, therapist, anesthesiologist, gynecologist. If there are any inflammatory processes, then they are treated.

Hospitalization in the hospital on the eve of operational intervention, testing and assessment of the patient's condition.

Inspection by anesthesiologist, prescribing premedication.

The formulation of the enema before surgery, or the reception of laxatives in order to purify the intestine.

Sharing the pubic zone and outdoor genital organs.

Refuse to eat and any liquid should be on the eve of the operation.

Progress of operational intervention:

The patient is introduced a spinal anesthesia, in which consciousness persists, but the sensitivity of the body below the lower back disappears.

On the front wall of the vagina make a cut and form the tunnels for the passage and the installation sang.

A loop is carried out through the tunnels, its side ends are outward. The central part of the loop will be located under the urethra.

The surgeon pulls the loop until the channel does not come in touch with the bladder.

By filling the bladder, they check the normal degree of urine deduction.

The side pieces of the loop are removed.

The cut over the vagina is styled.

A catheter is installed in the bladder.

Tampon is installed in the vagina.

As a rule, complications after the transferred operation are developing extremely rarely. Perhaps during her perforation of the bladder. In this case, damage is embedded, and the catheter is set for a period of 5 to 10 days. Sometimes in the early postoperative period, minor pains in the area of \u200b\u200bthe cut appear and appear.

As for the remote postoperative period, it is possible that the urinary incontinence will not be fully utilized, or, urination may be difficult.

Complications of anesthesia are:, nausea. These negative phenomena are independently held in 5-7 days.

Front colophia is an operational intervention, which is aimed at eliminating urine incontinence in women. During the operation, the front wall of the vagina is dissected, the bladder and urethra are isolated, then the vagina is screwed again. In this case, its walls would be tightened, which makes it possible to stabilize the urethra and the neck of the bladder. The vagina itself also turns out to be strengthened.

This operation is conjugate with the risk of vaginal tissues. In addition, the effect of it is difficult to be called stable, and the frequency of unsuccessful outcomes of intervention is quite high.

Colposuspension on Beach is reduced to tissue hanging that surround the urethra. They hang them to inguinal ligaments, which are located on the front abdominal wall and are very durable.

Access is obtained through the incision in the stomach. The operation can be open and closed type. The latter is carried out using laparoscopic equipment.

Over the years, Kolposuszenzia on Bell was used to treat stress incontinence of urine in women in overwhelming majority. The effectiveness of such a procedure was up to 70-80%.

As for the deficiencies of the technique, then among them can be allocated: the need to introduce common anesthesia, the connection of the patient to the machine artificial ventilation lungs. In addition, the procedure will be successful, it was supposed to conduct a surgeon having high qualifications. It is worth noting that the Sling Operations at the moment was practically suppressed by the colposuenzia according to Beach, since they are safer and effective methods for the treatment of urinary incontinence in women.

Implantation of an artificial sphincter bladder

Implanting urine is negatively reflected on the quality of life of any person, since its involuntary leakage always delivers a lot of inconvenience. From various shapes Urinary incontinence suffers from 5 to 10% of the entire population of the world, and 70% of them are women.

Urinary incontinence can be urgent or neurogenic. In this case, a person has an increased reduction in the bladder, as well as the mechanism of the restraint of the fluid in it turns out to be broken. This may arise due to the insufficiency of the bladder sphincter.

Separately, stressful incontinence of urine, which is associated with the true deficiency of the sphincter. It is classified as a third type of stress incontinence of urine (classification of international urine retention society).

It is known that no more than 50% of people appeal about the problems they have for qualified medical help. It often happens because of the false feeling of shame, or because of the wrong conviction about the impossibility of therapy. As a rule, from the moment when a person first experienced urinary incontinence and until his appeal to a specialist passes an average of 5 years. Meanwhile, modern medicine has effective methods of treating incontinence and is able to help almost every person with this problem.

Urgent incontinence is treated most often with medicinal preparationsBut the stress incontinence of the urine of the third type always requires the operation. One of the leading methods of surgical intervention is the implantation of the artificial sphincter of the bladder.

What is an artificial bladder sphincter?The artificial sphincter is a prosthesis that is implanted into the human body. It is necessary for keeping urine in the case when its own sphincter does not cope with this task.

When and why was it created?The first prototype of the modern device was designed in the 47th of the last century by scientists and a Urologist F. B. Foley. He had a kind of cuff, which was placed around the human urethra. This cuff connected to the syringe-pump, which was stored in the pocket of the underwear. The idea was very innovative and loyal from a medical point of view. However, the level of surgery of that time did not allow to completely remove the implant into the human body, so its installation was often complicated by purulent processes.

In 72 of the last century, the device was improved by a Urologist F. B. Scott. This one american doctor Created a prototype of a modern artificial sphincter. It consisted of three elements: cuffs, which wrapped and squeezed urethra, two pumps that inflated and blown it, as well as a tank for collecting liquid. The success of the operational intervention in the installation of the first three-component sphincter in those times reached 60%.

In the future, the device was improved by American Medical System, which happened in 83. To date, the doctors are successfully used by artificial Sphinters AMS, which passed only minor refinement.

Efficiency of operation.The success of the installation of a modern artificial sphincter of the bladder is equal to 75%. Moreover, 90% of people who use these devices are absolutely satisfied with their work. Not more than 20% of cases require a re-operation, which is carried out in order to eliminate disadvantages in the device.

Indications and contraindications.Indications for the installation of an artificial sphincter of the bladder differ. Absolute indication is irreversible violations in their own sphincter, against the background of the normal operation of the bladder. At the same time, the patient should not have the infection of urinary tract, and violations of the passability of urethra.

In men and women, various testimony can be distinguished for the operation, which are presented in the table.

Absolute contraindications to the operation are:

Stricting urethra disease.

Recurrent stricture.

Urinary tract infections.

Diverticulus of urethra.

Unstable or hyperactive bladder.

Wrinkled bladder.

Low bladder volume.

Relative contraindications include:

Bubble-ureteral cast of the second stage and above.

Urolithiasis disease, bladder cancer and other states that require surgical treatment.

Stenosis of the neck of the bladder, his contracture.

If you manage to eliminate relative contraindications, then the installation of an artificial sphincter becomes possible. It is important that a person possesses the necessary mental and physical abilities that would allow him to control the work of the pump. Before conducting the operation, a detailed consultation with a doctor about all the nuances of the Sphinteer is required.

What needs to be examined before the implantation of the bladder sphincter?First, the patient discusses all the nuances of the upcoming intervention with the doctor. Secondly, it takes place physical examination, which is aimed at identifying testimony and contraindications to the operation.

Mandatory need to pass general analysis urine, urine sowing, blood tests, it is possible to pass the ECG.

In some cases, cystography, urethrography, urethroscopy, cystoscopy and other highly specialized tests are required. The better the patient will be examined, the higher the chance that the operation will be successful.

Procedure surgery.The operation can be carried out through the angle of the penis and the scrotum (foam-ended access), or through the crotch section (performed under the scrotum). If the access is foaming, then one section is enough to install the implant. If the perix is \u200b\u200baccessible, then the complementary section is required to install the reservoir. The patient in this case spends in the hospital from 1 to 3 days. The catheter from the urethra will be removed for the next day after the operation.

Activate the sphincter after installing it after 6 weeks. This time is necessary in order for it to take root. Under the control of the urologist, a person learns working with the device. Attending the doctor in the future will need once a year.

Periurethral injections of volume-forming drugs

Periurethral injections are carried out by introducing into the space around the urethra of various biological and synthetic preparations. As a result, how an additional outer sphincter is created, which narrows the urinary channel and prevents urine flowing. This procedure is the most small-acting for the patient.

Indication to injection is the insufficiency of the sphincter. The procedure is carried out under local anesthesia. Most often it is prescribed to those women who refuse the operation by more invasive methods.

The main disadvantage of the procedure is the recurrence of urinary incontinence, which happens after 1-2 years. After the introduction of a substance at the injection site, tangible pain occurs. In addition, urine delay and disorders in the emptying of the bladder are possible.

The European Association of Urologists recognizes the periurethral injection by the effective method of eliminating urine incontinence in women, but experts note the temporary effect of the procedure. In some cases, it can last no more than 3 months. Therefore, the injection will need to be introduced again. The sling operation is more effective compared to this treatment method.

Some operations can be carried out on government quotas. To obtain them, you need to apply and wait for the queue.

Under quotas fall:

Sling operations.

Live abdominal and laparoscopic operations.

The installation of prostheses of sphincter men (it is possible that the prosthesis will have to pay independently).

If a person does not want to wait for the queue, he can contact private clinic And independently pay the procedure you need.

The installation of a sling is 80,000-100,000 rubles. If a sling is used for operation last generation, the price may increase several times.

Plastic Vagina costs women at 50,000-200,000 rubles.

Colposuspenzia Liaparaskopic method costs about 150,000 rubles.

The implantation of the bladder sphincter can cost about 500 00 rubles.

The bladder is not a vital organ (in contrast to the heart or brain), with a loss of which a person's life stops. But it is needed to hold the continuous stream of urine coming from the kidneys, and the subsequent removal from the body. In some cases (with, the refusal of the body and other diseases) there is a need for surgical intervention to remove the bladder (), and at the same time in creating a new way for removal of excrement. In the clinics of Israel, this applies the most different methods for the restoration of the bladder.

Depending on each individual case, the doctors of the Israeli clinics perform this or that procedure, the main purpose of which is to restore the process of urinary.

Turning to our coordination service "Site" you can get best treatment in one of the hospitals of Israel for the most affordable prices and get rid of the problems associated with the choice of a specialist, flight, with accommodation, ignorance of the language, thanks to the fast and cohesive work of employees of the service.

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Depending on the individual factors, the amount of tissue removed during operation, general status The health and age of the patient is chosen by one or another method of removal of urine from the body.

Ugra in Israel - the formation of Ileal Conduita

The surgeon performs a steady, redirecting the patient's urine to the hole (stoma) made on the skin of the abdominal wall. In order to create an Ileal Condiit, the doctor uses a short segment of the small intestine, after which it restores its integrity by imposing anastomosis. One end of the intestine segment is displayed on the skin surface to create a stoma, and the second is attached to the ureters performing the function of transporting urine from the kidney to the bladder. Thus, after performing the urgeth, the urine is displayed through the formed ileal conditis in a one-time bag attached to the hole in the abdominal wall.

Disadvantages of the method:

• Permanent use of an external bag for collecting urine, which can start leaking or distribute an unpleasant odor.
• Psychological problemsassociated with an unnatural way to remove urine from the body.
• The change external view Body.
• Water can go back to the kidneys, and cause infections, stone formation, as well as damage to the internal organs.

Advantages of the method:

• It is a fairly simple operation, which implies a smaller risk of developing complications.
• Wrestomium takes the minimum amount of time (compared to other surgical methods).
• The patient does not need to constantly carry out catheterization (use a special tube to empty the artificially created bladder).

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Restoration of the bladder in Israel - continent urine lead

The continent dilution of urine (retaining, ortotopic) is to create a tank to which urine is transported from ureters, inside the patient's body from a part of the stomach or thin or colon. Depending on the type of procedure, the patient may have or not have one.

Reconstruction of the bladder in Israel - the formation of artificial "pocket"

To replace the bladder, the doctor creates an internal reservoir, one end of which is joined to ureters, and the second to the urethra. This procedure is possible only in cases where cancer cells were not affected by the mouth of the urethra. Through our service, you can connect with the best specialist in the field of urology.

Due to the fact that urine falls into the reservoir (Neobladder) as naturally as possible - through the kidneys to the ureters, after which - in an artificial bladder and urethra, the patient maintains normal urination, which is a significant plus of this type of bladder reconstruction, as well as Lack of stoma (unlike Rostomy).

But, unfortunately, the functioning of the "Pocket" differs from the work of this body - sometimes a person has to introduce a special catheter through the urethra in the tank to completely empty it. It also occurs a high probability of unconscious urine release - about 20% of patients at night and from 5% to 10% in daytime suffer incontinence.

Restoration of the bladder - Creating a permanent tank with an abdominal wall

This method involves regular use of a catheter to remove urine from the body. It is applied in cases where the urethra or part of it has been removed during cystectomy and is to summarize the tank to a small stoma (less than 1 inches in diameter) made in the anterior abdominal wall. The accumulation of urine occurs inside the body, so the patient does not have the need for a constant carrying bag in which excrement gather.

The Israeli clinics use modern reconstructive technologies, from creating a waste of an external gloof before the formation of an internal reservoir depending on the spread of the disease and other factors.

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If the bladder has lost the ability to perform natural functions, and medicine is powerless to restore them, the bladder plastic applies.

Plastic bladder is an operation, the purpose of which is the complete substitution of the organ or its part. Most often, replacement surgery is used in cancer urine system, in particular, the bladder, and is the only way to preserve the life of the patient and noticeably increase its quality.

Types of preoperative examination

To clarify the diagnosis, determine where the defeat is located, determine the tumor dimensions carry out the following types of research:

• Ultrasound of a small pelvis. The most common and affordable study. Determines the size, shape, a mass of the kidney.
• Cystoscopy. With the help of a cystoscope introduced into the bladder through the urethra, the doctor is overlooked the inner surface of the organ. There is also the possibility of taking the scope of tumors for histology.
• CT. It is used to clarify the dimensions and localization of not only the bladder, but also nearby organs.
• Intravenous Urography urinary tract. It makes it possible to find out what state is the overlying urinary tract departments.

Ultrasound examination makes it possible to identify the causes of pathology

The application of these types of research is not obligatory for all patients, they are prescribed individually. In addition to instrumental research, blood tests are assigned before carrying out the operation:

• on biochemical indicators;
• on blood clotting;
• on HIV infection;
• on the reaction of Wasserman.

Urine analysis is also carried out for the presence of atypical cells. If the preoperative period is detected inflammatory processThe doctor appoints urine bakposev with further treatment with antibiotics.

Plastic at Extrophy

Extrophy of the bladder - the hardest disease. In pathology, there is no lack of anterior wall of the bladder and peritoneum. If the newborn has atrophy of the bladder, it is necessary to carry out an operation for 5 days.

In this case, the bladder plastic consists of several operations:

• At the first stage, the impact of the front wall of the bladder is eliminated.
• The pathology of the abdominal wall is eliminated.
• To improve the retention of urin, the lands are reduced.
• Form the cervix and sphincter to achieve the ability to control urination.
• Pereparing the ureters in order to prevent urine reflux in the kidneys.

Plastic for Extrophy - the only chance for a newborn

Replacement treatment for tumors

If the bladder is removed, with the help of plastics achieve the ability to remove urine. The method of removal of urin from the body is selected, based on the indicators: individual factors, age peculiarities The patient, the health status is operated as well as the fabric has been removed during the operation. Self effective methods Plastics are considered below.

Ugratomy

The method of redirecting the patient's urong surgeon in the urinary in the abdominal cavity using a portion of the small intestine. After the urctomy urine comes out through the educated Ileal Conditis, getting into the urefactor attached near the hole in the peritonean wall.

The positive parties of the method consider the simplicity of operational intervention, the minimum time of time in comparison with other methods. After the operation, there is no need for catheterization.

The disadvantages of the method are: inconvenience in connection with the use of an external gloof, from which a specific smell sometimes occurs. Difficulty psychological about the unnatural urination process. Sometimes Urina returns back to the kidneys, causing infections and stone formation.

Method for creating artificial pocket

The internal reservoir is created, to one side of which the ureters are attached, to the other - the urethra. It is advisable to use the plastic method if the tumor is not affected by the mouth of the urethra. Urina enters the reservoir similar to the natural way.

The patient retains normal urination. But the method has its drawbacks: occasionally you have to use the catheter to completely empty the bladder. At night, there is sometimes incontinence of urine.

Formation of a tank for the withdrawal of urin through the abdominal wall

The method is to apply a catheter in the derivation of urin from the body. The method is used with a remote urethra. The internal tank is supplied to the stoma of the miniature size in the front abdominal wall. Constantly wear the bag does not make sense, since the urine is accumulated inside.

Tolstock plastic technique

Recent years, doctors speak in favor of sigmoplasty. In sygmelasty, the segment of the colon is used, the characteristics of the structure of which give rise to it more suitable than thin. In the preoperative period, special attention is paid to the intestine of the patient.

The diet of the last week limits the intake of fiber, the siphon enema is set, enteroseptol is assigned, it is assigned to antibacterial therapy To suppress the urinary infection. Abdominal cavity Opened under endotracheal anesthesia. The intestinal loop is residated with a length of no more than 12 cm. The longer the transplant is, the harder the emptying passes.

Before close the intestinal lumen, it is treated with vaseline oil to prevent coprostase in the period after the operation. The lumen of the transplant is disinfected and dried. If the place has a wrinkled bladder and bubble - ureter reflux, the ureter is transplanted into the intestinal transplant.

Replacement therapy is carried out under general anesthesia

Recovery after surgery

During the first two weeks of the postoperative period, urine is collected in the tank through the hole in the abdominal wall. This period is necessary in order to be healing the place where the artificial bubble is connected to the ureters and the blade. After 2-3 days begin to wash the artificial bladder.

To this end, saline is used. Due to the involvement of intestinal intervention, 2 days is not allowed to eat, which is replaced by intravenous power.

After two weeks, the early postoperative period is coming to an end:

• drainages are extracted;
• catheters are cleaned;
• remove seams.

The organism proceeds to natural feed and urination processes. In the postoperative period, special attention is paid to the correctness of the urination process. Urination pass when pressing the front abdominal wall hand. Important! It is impossible to allow the urinary bubble to completely, otherwise the risk of breaks, in which urine will fall into the abdominal cavity.

The first 3 months of the postoperative period of urination should occur every 2-3 hours around the clock. During the recovery period, the incontinence of urine is characterized, with the appearance of which it is necessary to immediately receive the consultation of the doctor. At the end of the three-month period, urination is carried out in 4-6 hours.

The fourth part of the operated patients suffers from diarrhea, to stop which is easy: medicines for slowing the intestines of intestines. According to doctors, no special changes in lifestyle in the postoperative period are not required. You just need to regularly monitor urination processes.

Optimism - the key to the rapid recovery

Psychological rehabilitation

Within 2 months of the postoperative period, the patient is not allowed lifting weights, driving a car. At this time, the patient gets used to its new position, gets rid of fears. A special problem in men after surgery - recovery of sexual function.

Modern approaches to plastic technique take into account the need to save it. Unfortunately, a complete guarantee of restoring the functioning of the sexual system is not possible. If the sexual function is restored, then not earlier than a year.

What is and how much to drink after surgery

In the postoperative period, the diet has minimal limitations. Fried and spicy dishes are prohibited, contributing to the acceleration of blood flow, which slows down the healing of the seams. Fish and bean dishes contribute to the appearance of a specific smell of urin.

Drinking mode after plastic bladder should be changed to the direction of increasing fluid intake. Daily fluid intake should not be less than 3 liters, including juices, compotes, tea.

Physiotherapy

Exercises of therapeutic physical education must begin to be carried out when postoperative wounds heal, after a monthly period from the date of operation. Medical gymnastics The patient will have to do through the remaining life.

Therapeutic physical education - an integral attribute of life after the bladder plastle

Exercises are performed to strengthen the muscles of the pelvic bottom, which contribute to the removal of urin. The most effective when rehabilitated after plastle of the bladder is recognized as Kegel exercises. The essence of them is as follows:

• Exercises for slow motion muscles. The patient makes an effort similar to such as trying to suspend urination. It should be enhanced increasing gradually. At the maximum, the muscle tension is held for 5 seconds. After that, slow relaxation occurs. Repeated exercise 10 times.
• Performing quick alternation of cuts and muscle relaxation. Repeat exercise up to 10 times.

In the first days of the medical physical education, the exercise complex is performed 3 times, then gradually increases. Plastic therapy can not be considered as a complete disposal of pathology. The bladder plastic does not lead to a full replacement of natural. But if the doctor's advice is strictly performed, the deterioration of the body will not be observed. Over time, the execution of procedures becomes an integral part of life.