|
| FTS protocol for the urethroplasty: |
| Preoperative period | Intraoperative period | Postoperative period |
|
| Informing the patient about the disease, treatment options, and possible outcomes, indicating the average effectiveness, risks of complications, typical post-operative condition, timing of catheterization, hospitalization, possible methods of prerehabilitation, and further rehabilitation methods | Preferred method of anesthesia-local anesthesia/multimodal anesthesia | Early fluids intake (2-3 hours after surgery) and food (6 hours after surgery) |
|
| One-day concept-the patient undergoes most of the preoperative examinations in one day, without the need for multiple repreparation. The order of examinations and tests is optimized and sorted to achieve the desired outcome | | |
|
Rigorous evaluation of indications for surgical treatment: Qmax < 12 ml/s
Urethral lumen diameter <4 mm
Presence of residual urine
Presence of urethral distraction defect | Heating of the patient during the operation with the control of normothermia | Early activation (6–8 hours after surgery, after evaluation by an anesthesiologist) |
|
| Assessment of the possibility of patient compliance with the protocol and its feasibility in the medical institution | Heating of infusion solutions and inhalation gases | Physical therapy (breathing exercises, walking, and other exercises) |
|
| Preventive administration of antihistamines and antacids drugs | Minimally invasive surgical approaches | Multimodal prevention of nausea and vomiting (metoclopramide + ondansetron) |
|
| Refusal of preoperative sedation | The rejection of the use of monopolar coagulation and resection | Removal of the urethral catheter after performing pericatheter urethrography no later than the seventh day after surgery |
|
Prerehabilitation based on indications:
Age group
Obesity
Exhaustion
The sarcopenia
Impaired carbohydrate tolerance or diabetes mellitus | Application of bipolar coagulation | Use of drugs that improve microcirculation, reparants, and hyperbaric oxygenation (in the mode of 1.0–1.5 ATM, for 45 minutes, 5–10 sessions; in the absence of contraindications) |
|
Preoperative antibiotic therapy according to the testimony:
the presence of latent or obvious infection of the genitourinary system (according to the results of bacteriological research, real-time PCR, and infection of other organs | The rejection of coagulation on the spongy body of the urethra | The use of enzyme drugs (longidase, rectal suppositories) after 14 days after surgery in courses of 20 pieces with an interval of 2 days every 6 months |
|
Multidisciplinary examination of patients:
Urologist
Anesthetist
ENT doctor
Dentist
General practitioner/Cardiologist
The radiologist physical therapy doctor
And other specialists as needed | Sealed continuous urethral suture with 4–6/0 monofilament thread | Continuation of prevention of thromboembolic complications by compression of the lower extremities and the use of low-molecular-weight heparins |
|
| Performing CT/MRI of the small pelvis, CT/RI MRI of the urinary system, CT/RI MRI-urethrography with 3D-modeling, assessment of the state of the bone and joint apparatus of the pelvis, organs | Use of platelet-rich plasma as injections into the submucosal layer of the urethra and surrounding tissues | Multimodal analgesia for pain control (Dexketoprofen + paracetomol) |
|
| A rich carbohydrate diet (if there are no contraindications) and 200 ml of liquid protein 2.5 hours before surgery | Use fibrin glue locally at the urethral seam | Use of chewing gum on the first and second day after surgery |
|
| The last meal during the operation in the morning hours at 21-22 hours the day before, during the operation in the afternoon no later than 6 hours before the operation | Use of silicone urethral catheters 14–16 ch | Monitoring of blood and urine parameters on the first day after surgery |
|
| Antibiotic prophylaxis 60 minutes before surgery with 3rd generation cephalosporins | The rejection of the use of drains | Strict glycemic control in patients with impaired carbohydrate tolerance and diabetes mellitus |
|
| Shaving of the surgical field with subsequent treatment with solutions of skin antiseptics | Sealed cosmetic skin seam with no loose ends or knots on the skin | A detailed discussion of the behavior of the patient and the rehabilitation plan before the discharge |
|
| Oral rinsing with an aqueous solution of chlorhexidine during planned urethroplasty using buccal mucosa graft | The adhesive bandage on the skin | Detailed written instructions in the discharge documents |
|
| Prevention of thromboembolic complications by compression of the lower extremities and administration of low-molecular-weight heparins | Intraoperative euvolemia | Strict plan of follow-up examinations in the post-operative period |
|
| Avoiding the use of cleansing enemas | | Strict adherence to postoperative hygiene of the genitals (when using an adhesive bandage, the patient is recommended to take a hygienic shower daily from the second day) |
|
| Transfer of the patient to a slageless diet 2-3 days before surgery | | Discharge from the hospital 1–3 days after the operation with the transfer of the patient to outpatient observation |
|
| Preparation of the intestines with laxatives or once microclysters | | Recommended return to work 2 days after removal of urethral catheter |
|
