Innovative urethral mirror in surgical treatment of women with chronic skineitis.

Introduction. Currently, when conservative therapy for chronic inflammation of the paraurethral glands in women is ineffective, the only surgical treatment is their electroresection (Reeser’s operation). However, despite the high overall effectiveness of this technique, a significant percentage of repeated interventions is noted due to the infected Skene's gland ducts missed (undisclosed) during the first intervention. The reason for this problem is their insufficient visualization due to the lack of a special urethral retractor. Aim. To improve the effectiveness of surgical treatment of patients with chronic skeneitis by developing and clinically testing a specialized urethral retractor. Materials and methods. The study involved 117 patients with chronic skeneitis aged 21 to 47 years who underwent electroresection of the paraurethral glands in the period 2010–2024. The first group of women underwent surgery using a standard technique, using tweezers to visualize the orifice of the Skene gland ducts; the second group underwent surgery using an original urethral retractor. To assess the effectiveness of the treatment, before, 1.5, 3 and 12 months after it, an assessment of complaints, the results of the QOL and PUF questionnaires, as well as urination diaries were carried out. In addition, the pain of the urethra during transvaginal palpation and the presence of unopened Skene's gland ducts during the first or repeated examination were analyzed. Results. To improve the visualization of the Skene gland ducts during surgical intervention, we have developed an original instrument – a urethral surgical speculum (patent for invention of the Russian Federation No. 2790762). Depending on the results of the examination conducted 3 months after the operation, the patients were divided into 3 subgroups of clinical effectiveness. Subgroup A included 45 (68,2%) women from the first group and 46 (90,2%) from the second group with pronounced positive dynamics of the studied parameters, as well as the absence of unopened inflammatory ducts of the Skene's glands and pain during palpation of the urethra. Subgroup B included 14 (21,2%) women who were operated on using tweezers and 2 (3,9%) in whose treatment the original instrument was used. They were united by a slight decrease in the parameters studied, however, during the instrumental examination, inflamed gland ducts that had not been opened during the first procedure were detected. All 16 patients in this category underwent repeat treatment. Subsequent assessment of the parameters studied 3 and 12 months after the second operation showed both a decrease in QOL, PUF and urinary frequency scores, as well as the absence of pain during transvaginal palpation of the urethra and residual paraurethral ducts. The lack of effect from electrocoagulation was noted by 7 (10,6%) women from the first group and 3 (5,9%) from the second. Instrumental examination of the urethra 3 months after treatment did not reveal any unopened infected ducts. Thus, the use of the original retractor made it possible to increase the effectiveness of the first surgical intervention by 22,2% (χ2=6,84; p=0,009) and reduce the frequency of repeated interventions by 5 times (χ2=5,89; p=0,016). Conclusion. The use of an urethral speculum is an innovative and effective way to visualize the orifices of the Skene’s glands ducts during surgical treatment, which can increase the overall effectiveness of electroresection to 93,6%.