Urethral transposition
Urethral transposition according to Komjakov – is an advanced procedure that has proven its effectiveness over 14 years in the radical treatment of post-coital cystitis, which arises due to the close proximity of the external urethral opening to the vagina.
On average, we perform 83-85 such operations per year. It is important to note that we perform surgery only on those women for whom conservative therapy has not been effective.
In order to assist women suffering from cystitis after each sexual intercourse, we have established an interdisciplinary team of specialists deeply knowledgeable about this issue.
OUR RESULTS
Planning treatment in our clinic
During the consultation, we discuss in detail the onset and progression of the condition, conduct a gynecological examination, inform the patient about the existing issue, and determine whether conservative therapy is effective or if urethral meatus transposition is necessary.
Preparation for surgery typically lasts 6 days, during which the patient takes prescribed medications at home. During this period, the patient can continue working but is advised to abstain from sexual activity. Additionally, the patient undergoes a series of pre-operative tests to ensure the safety of anesthesia and the procedure.
Usually, we admit the patient the day before the surgery, as we administer a sedative the night before to alleviate anxiety and ensure a good night's rest. Additionally, before the surgery, a preliminary antibiotic therapy is administered to prevent inflammatory complications.
On the day of the surgery. The operation is conducted under general anesthesia; in this case, we prefer not to use spinal anesthesia. Immediately after the operation, the patient is under the supervision of doctors, and any complaints of postoperative pain are promptly relieved with pain medication. Following this, there are approximately three days of hospitalization, observation, and dressing changes.
At the follow-up appointment, we assess the healing of stitches, the condition of the mucous membranes, and the degree of wound healing. If slow healing is observed, appropriate medications are prescribed.
The second examination is necessary to ensure that the patient can resume sexual activity. It includes a gynecological examination and provides preventive recommendations.
Who needs this surgery?
"I've had postcoital cystitis for 7 years. I've tried all antibiotics, infusions, vitamins, and immunotherapy – nothing helps. Can you solve this problem permanently?" This conversation occurs regularly with patients in our clinic.
The issue with postcoital cystitis is that... It's easily treated. Treating an isolated episode of cystitis involves standard antibiotics, and that's it – the episode resolves. However, preventing recurrence after each sexual act – requires knowledge, skills, and experience in diagnosing the causes of postcoital cystitis.
Surgery is recommended for women for whom conservative therapy has not been effective. In other words, if prophylactic antibiotics, immunotherapy, treatments by gynecologists, and behavioral therapy have not helped."
Main aspects
1. This surgery requires specific preparation: vaginal suppositories are used to prevent infection, along with medications to improve vaginal mucosa condition.
2. The operation can be performed from the 7th to the 17th day after the end of menstruation, with preparation typically taking 6 days during which the patient uses medications prescribed by the doctor. Hospitalization follows only after preparation.
3. For your safety, a preoperative set of tests and examinations is scheduled.
4. Hospitalization lasts 3-6 days, depending on the individual characteristics of each patient.
5. Anesthesia: in the vast majority of cases, we prefer general anesthesia as it is more controllable and well-tolerated.
6. The catheter is removed 2-4 days after the operation; there is no need to keep it for more than 10 days, as is often mentioned on the internet.
7. One month after the operation, the first outpatient visit with the operating surgeon occurs, and the second visit takes place three months after the operation.
8. During all three months following the operation, sexual activity is to be avoided until the second visit.
The essence of the operation is illustrated in the diagrams below
Side effects and complications
We strongly believe that any patient undergoing a particular surgery should have a complete understanding of the side effects, be aware of complication statistics, and only then make a decision. We present the statistics of 734 surgeries performed by our doctors by the end of 2020.
Our statistics
We always thoroughly discuss these important aspects of surgical treatment. Our main message to our patients is that the likelihood of complications is extremely low, but we are with you every step of the way through your treatment and will not leave you alone.
Essentially, if a woman experiences recurrent episodes of acute cystitis after sexual intercourse, the reasons are generally few: congenital or acquired urethral prolapse, meaning the external opening of the urethra is too close to the vagina, or its excessive mobility, known as hypermobility. In either case, bacteria can enter the urethra, take 12-36 hours to grow and develop, and... bingo, another episode of cystitis.
Thus, either the urethra is positioned too close to the vagina, or it shifts into the vagina during sexual intercourse
Surgical preparation: consultation with a urologist
There's a golden rule: "The surgeon who will perform the operation must examine the patient and determine all treatment"
What will be discussed with the patient? Firstly, we will identify any complaints. This will help us understand the cause of recurrent inflammations. It's not always the urethra that is responsible for cystitis; the underlying cause could be conditions like urinary tract stones.
Secondly, we will definitely discuss a range of very intimate questions. Why is this important? Consider this: if cystitis episodes started immediately after the onset of sexual activity, it suggests a congenital condition. If they began approximately a year or two later, it's more likely an acquired condition or hypermobility.
Believe me, "individualized approach" — are not just pretty words. While the operation itself may be the same, preparation for it can vary. Surgical nuances can differ significantly. Reconstructive and restorative surgery is always full of surprises, and only proper, well-planned surgical planning helps achieve truly good results.
And thirdly – the examination. Yes, a routine gynecological examination. This brief procedure allows us to:
a) assess the position of the external urethral opening
b) evaluate its mobility
c) assess the condition of the vaginal mucosa
d) plan the surgery.
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