Vezikulografiya

Description:

Diseases of seed bubbles both by the anatomic situation, and on lack of specific displays of a disease often present considerable difficulty for diagnosis. Such methods of a research of seed bubbles as their palpation through a rectum and a research of contents of bubbles, are very imperfect. Therefore great practical value is attached to a X-ray analysis of seed bubbles (vezikulografiya).

Vezikulografiya allows to find such pathological changes in seed bubbles which at other ways of a research remain unnoticed. The X-ray analysis of the seed bubbles filled with a contrast agent gives a fair idea of details of an anatomic structure of a bubble, of existence or absence in it destructive and other changes.

There are two types of a vezikulografiya: the ascending vezikulografiya which is carried out by means of catheterization of ejaculatory channels, introduction to them of a contrast agent with the subsequent X-ray analysis, and descending, at which a contrast agent is entered into deferent ducts by a puncture of the last, with the subsequent X-ray analysis.

For the first time Picker in 1911 undertook X-ray inspection of seed bubbles on corpses. Next year A. I. Vasilyev carried out the ascending vezikulografiya by catheterization of ejaculatory channels. Lichtenberg and Heineman (1928) offered the special irrigational urethroscope for catheterization of ejaculatory channels. In 1929 in the Soviet literature V. E. Subotsky for the first time published the vezikulogramma made in the endourethral way. However, despite some progress, the ascending vezikulografiya did not find practical application in view of great difficulty, and at times and impossibility of catheterization of ejaculatory channels, especially when they open on a back slope of a seminal hillock. The ascending vezikulografiya for the specified motives is almost not applied now.

The simplest and at the same time reliable method is the descending vezikulografiya which is carried out by either a vasotomy, or a vazopunktion. The first descending vezikulografiya was made in 1913 by Belfield. In our country the first vezikulogramma by a puncture of a naked deferent duct were made in 1922 by P. D. Solovov. The first thesis at us devoted to a vezikulografiya belongs to I. P. Pogorelko (1953).

Now the descending vezikulografiya found broad application in diagnosis of diseases not only seed bubbles, but also a prostate gland and a bladder, close to them. Sometimes the vezikulografiya is the only method allowing to establish the correct diagnosis.

For the descending vezikulografiya oily contrast agents (yodipin20% and Iodolipolum of 30%), and also aqueous solutions of contrast agents are used (50% solution of Sergosinum, 70% solution of a triyotrast, etc.). As aqueous solutions of contrast agents are quickly brought out of seed bubbles, owing to this fact the X-ray analysis has to be made immediately after their introduction to deferent ducts. However, as the descending vezikulografiya is connected with an operative measure on deferent ducts which is carried out in the conditions of the operating room, bigger application was found by oily contrast agents which are late in seed bubbles within several days. In addition, water-soluble contrast agents give less accurate vezikulogramma, than oily substances.

The equipment of the descending vezikulografiya. On a back surface of a seed cord fingers grope a deferent duct and bring closer it to scrotum skin. The deferent duct is held fingers and produces novocainic anesthesia throughout 2 — 3 cm. Then on the scrotum skin covering a seed channel impose a hoe so that the channel remained shrouded from all directions in skin of a scrotum and it was isolated from elements of a seed cord. Over a channel make a slit of skin 2 cm long. After a section of skin the deferent duct is visible bluish and whitish color. The last is released from covers and taken on a provisional ligature. Enter an acute needle which then is taken into a gleam of a channel and on its place enter into a channel gleam other needle with a blunt end which is advanced on depth of 2 — 3 cm towards a seed bubble.

On a needle into the canal slowly enter a contrast agent (Iodolipolum which is warmed up 30% or 50% трийотраст) in number of 2 — 3 ml. Excess of contrast medium usually is thrown out through a deferent duct a back urethra. After administration of contrast medium to the seed canal the needle is taken, delete a provisional ligature and a channel lower in a scrotum. On a skin scrototomy impose 1 — 2 seam.

When using of Iodolipolum the picture can be made several hours later after introduction to a channel of a contrast agent. At the use of a triyotrast the X-ray analysis needs to be made immediately after administration of contrast medium.

When the vasotomy is shown to the patient, it can be used for a vezikulografiya if in it there is a need, instead of a vazopunktion.

It is not recommended to enter into vas deferens a large amount of contrast medium as it is removed on an ejaculatory channel in a back urethra and a bladder, giving the additional shadows complicating interpretation везикулограмм on the roentgenogram.

It is necessary before administration of contrast medium in a deferent duct to empty a bladder as it to a lesser extent promotes penetration of a contrast agent into a back urethra and a bubble.

On a normal vezikulogramma the deferent duct in the form of a loop rising up the inguinal channel and going to a small pelvis is usually visible. Approaching a back wall of a bladder, the deferent duct connects to an ampoule of a seed bubble which ejaculatory channel opens in a gleam of a back urethra (sinus ejaculatorius).
For judgment of a condition of seed bubbles it is necessary to have a bilateral vezikulogramma which can be received by a puncture of deferent ducts on both sides in one step or, more rare, at different times. Need to have bilateral vezikulogramma to compare the received image of one seed bubble to another, is dictated by the fact that there is a set of options of a structure of seed bubbles. The bilateral vezikulografiya in diagnosis of tumoral processes is of particular importance.

Vezikulografiya is shown at suspicion of a tumor of seed bubbles, for diagnosis of some types of tuberculosis of seed bubbles and a prostate, cancer of a bottom and a neck of a bladder, at differentiation of tubercular and nonspecific prostatitis and epididymite, and also for establishment of extent of germination of a prostate cancer. At patients with prostate adenoma the vezikulografiya has relative value as usual methods of a research at this disease allow to distinguish it quite easily.

At interpretation везикулограмм it is necessary to pay attention not only to a structure of seed bubbles, but also to height of their arrangement, and also to a corner between them, in normal conditions equal 90 — 95 °. For the correct assessment of the location of seed bubbles it is necessary to be guided not by pubic bones, and by shadows of sacral and coccygeal vertebrae. Usually normal shadows of seed bubbles are projected on area V sacral and the I coccygeal vertebrae.

At chronic inflammatory processes in a prostate and seed bubbles due to distribution of infiltrate on output canals there is their prelum therefore on vezikulogramma seed bubbles are expanded and pushed a little aside in the lateral party.

I. P. Pogorelko (1953) on the basis of studying везикулограмм at patients with urinogenital tuberculosis established that in the beginning the prostate and seed bubbles, and in the subsequent — an epididymis are surprised. Therefore in hard cases of diagnosis when it is impossible to resolve clinically an issue of the nature of inflammatory changes in an epididymis, the vezikulografiya can clear up because at a tubercular epididymite there are always specific changes in a prostate and seed bubbles. At defeat tuberculosis of the men's sexual sphere on vezikulogramma observes destruction of a bottom and a body of seed bubbles in the form of formation of separate additional cavities with corroded contours.

The vezikulografiya in differential diagnosis of cancer and adenoma of a prostate has great practical value.

I. P. Pogorelko (1953) and V. V. Goldberg (1955) on the basis of data of a vezikulografiya showed that approximately at 3/4 patients with cancer of a prostate germination of a tumor in seed bubbles takes place. At a prostate cancer on vezikulogramma sharp deformation, asymmetry of an arrangement of seed bubbles, existence of defects of filling along with separate sharply expanded cavities is noted. Along with changes in seed bubbles lengthening and narrowing of output channels usually takes place.

In some stages of tumoral process pressure is noted by a tumor of a seed bubble almost full "that on a vezikulogramma comes to light in the form of separate spots of a contrast agent with simultaneous penetration of contrast liquid out of limits of seed bubbles, in surrounding cellulose.

At prostate adenoma on vezikulogramma seed bubbles are not be deformed, however their elation and increase in a corner between them which comes nearer to 180 ° (the more adenoma is, as a rule, observed, the corner is more). This difference in a X-ray pattern of seed bubbles at cancer and adenoma of a prostate considerably facilitates recognition of these diseases in hard cases.

If in the presence of the changes in a prostate, characteristic of cancer, established by means of other methods of a research, the vezikulografiya excludes a possibility of germination by a tumor of seed bubbles, an opportunity to undertake radical operation — a prostatectomy is represented.

For obtaining clearer images of certain sites of seed bubbles combine a vezikulografiya with a tomography. The tomographic main cut is at distance of 6 — 8 cm from a horizontal surface of a table.

Vezikulografiya is method, valuable and at the same time safe for the patient. As show Yu. S. Tashchiyev (1961) observations, at patients is after a vezikulografiya if it is executed by a vazopunktion, there does not come the obliteration of seed ways. Slight increase of temperature is occasionally observed after the research.

However the descending vezikulografiya can be not always executed that generally depends on passability of a deferent duct. Very often there comes vas deferens gleam obliteration after inflammatory processes in the sexual sphere.

Though the vezikulografiya is only an auxiliary method of a research, it in some cases can give very essential help in the correct recognition of a disease.