Lesiones de uretra posterior secundarias a fractura pélvica tratadas a través de abordaje perineal progresivo. Breve revisión de la literatura
Pelvic fracture posterior urethral injury repaired by progressive perineal approach: A brief review of the literature
Barra lateral del artículo
PDF
FLIP
Cómo citar
Fernández Fernández, J. Ángel, Tocuyo Campero, Y. E., Suárez Montero, V. T., & Pérez Medina, M. M. (2017). Lesiones de uretra posterior secundarias a fractura pélvica tratadas a través de abordaje perineal progresivo. Breve revisión de la literatura. Revista Repertorio De Medicina Y Cirugía, 26(3), 131–137. Recuperado a partir de https://revistas.fucsalud.edu.co/index.php/repertorio/article/view/43
Publicado:
Sep 1, 2017
Sección
Artículo de revisión
Términos de Licencia
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.
Contenido principal del artículo
Resumen
Objetivo: Revisar los resultados operatorios de nuestros pacientes con rotura traumática de uretra posterior, tratados a través del abordaje perineal progresivo y realizar una breve revisión de la literatura.
Materiales y métodos: Fueron analizadas las historias médicas de 7 pacientes en edades comprendidas entre 2 y 12 años, con lesiones uretrales asociadas con fracturas pélvicas, producidas entre marzo de 2005 y enero de 2017. Después del diagnóstico de la lesión, se realizó cistostomía derivativa en los 7 casos; en 2 de ellos con lesión rectal asociada se realizó, además, colostomía tipo Hartman en el momento de la derivación urinaria. La evaluación urológica preoperatoria para la uretroplastia definitiva incluyó uretrografía anterógrada y retrograda simultánea para determinar la separación entre los segmentos uretrales. Se decidió la reparación retardada de la uretra a través de abordaje perineal progresivo con un mínimo de 6 meses posterior al trauma.
Resultados: El mecanismo de producción del trauma fue arrollamiento por vehículos a motor en 6 pacientes y aplastamiento por balancín petrolero en uno. La lesión uretral fue completa en todos. Tres presentaron complicaciones quirúrgicas; 2 estenosis uretrales que mejoraron con dilataciones y una fístula uretroperineal que cerró en forma espontánea sin consecuencias. Todos los pacientes se encuentran asintomáticos; ninguno ha requerido una nueva uretroplastia.
Comentarios: Nuestros hallazgos con la implementación de este abordaje terapéutico coinciden con lo reportado en la literatura.
Conclusiones: El abordaje perineal progresivo permite realizar la anastomosis uretral con resultados clínicos satisfactorios en la mayoría de los pacientes.
Palabras clave:
Descargas
Los datos de descargas todavía no están disponibles.
Detalles del artículo
Referencias
1. Martínez J, Tascón N. Experiencia en reconstrucción postraumática de uretra posterior en niños Hospital Universitario San Vicente de Paúl. Medellín 1987-2007. Actas Urol Esp. 2009;33:416–21.
2. Koraitim M. Pelvic fracture urethral injuries: the unresolved controversy. J Urol. 1999;161:1433–41.
3. Alwaal A, Zaid UB, Blaschko SD, Harris CR, Gaither TW, McAninch JW, et al. The incidence, causes, mechanism, risk factors, classification, diagnosis of pelvic fracture urethral injury. Arab J Urol. 2015;13:2–6. Epub 2015/05/29.
4. Koraitim M, Marzouk M, Atta M, Orabi S. Risk factors and mechanism of urethral injury in pelvic fractures. Br J Urol. 1996;77:876–80.
5. Koraitim M. Posttraumatic posterior urethral strictures in children: a 20-year experience. J Urol. 1997;157:641–5.
6. Boone T, Wilson W, Husmann D. Postpubertal genitourinary function following posterior urethral disruptions in children. J Urol. 1992;148:1232–4.
7. Bond S, Gotschall C, Eichelberger M. Predictors of abdominal injury in children with pelvic fracture. J Trauma. 1991;31:1169–73.
8. Tarman G, Kaplan G, Lerman S, Mcaleer I, Losasso B. Lower genitourinary injury and pelvic fractures in pediatric patients. Urology. 2002;59:123–6.
9. Webster G. Urethral injuries. En: Whitfield HN, Hendry WF, Kirby RS, Duckett JW, editores. Textbook of genito-urinary surgery. 2. nd edition. Oxford: Blackwell Scientific; 1998. p. 1323–40.
10. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96. Epub 2009/07/30.
11. Mcaninch J, Santucci R. Genitourinary trauma. En: Walsh PC, Wein AJ, Vaughan ED Jr, Retik AB, editores. Campbell’sUrology. 8 ed. Philadelphia: WB Saunders Company; 2002. p. 3707–44.
12. Ranjan P, Ansari M, Singh M, Chipde S, Singh R, Kapoor R. Post- traumatic urethral strictures in children, what have we learned over the years? J Pediatr Urol. 2012;8:234–9.
13. Avanoglu A, Ulman I, Herek O, Ozok G, Gökdemir A. Posterior urethral injuries in children. Br J Urol. 1996;77:597–600.
14. Clark S, Prudencio R. Lower urinary tract injuries associated with pelvic fractures Diagnosis management. Surg Clin N Am. 1972;52:183–201.
15. Pichler R, Fritsch H, Skradski V, Horninger W, Schlenck B, Rehder P, et al. Diagnosis and management of pediatric urethral injuries. Urol Int. 2012;89:136–42. Epub 2012/03/22.
16. Webster G, Mathes G, Selli C. Prostatomembranous urethral injuries. A review of the literature and a rational approach to their management. J Urol. 1983;130:898–902.
17. Pritchett T, Shapiro R, Hardy B. Surgical management of traumatic posterior urethral strictures in children. Urology. 1993;42:59–62.
18. Webster G, Guralnick M. Reconstruction of posterior urethral disruption. UrolClin North Am. 2002;29:429–41.
19. Morey A, Mcaninch J. Reconstruction of posterior urethral disruption injuries: outcome analysis in 82 patients. J Urol. 1997;157:506–10.
20. Griebling T, Kreder K. Urethral reconstruction after pelvic fracture with urethral disruption: the gold standard. SeminUrol. 1995;13:45–55.
21. Ennemoser O, Colleselli K, Reissigl A, Poisel S, Janetschek G, Bartsch G. Posttraumatic posterior urethral stricture repair: anatomy, surgical approach and long-term results. J Urol. 1997;157:499–505.
22. Martinez-Pineiro L, Djakovic N, Plas E, Mor Y, Santucci RA, Serafetinidis E, et al. EAU Guidelines on Urethral Trauma. Eur Urol. 2010;57:791–803. Epub 2010/02/04.
23. Kulkarni S, Joshi P, Hunter C, Surana S, Shahrour W, Alhajeri F. Complex posterior urethral injury. Arab J Urol. 2015;13: 43–52.
24. Webster G, Goldwasser B. Perinealtranspubic repair: a technique for treating post-traumatic prostatomembranous urethral strictures. J Urol. 1986;135:278–9.
25. Webster G, Ramon J. Repair of pelvic fracture posterior urethral defects using an elaborated perineal approach: experience with 74 cases. J Urol. 1991;145:744–8.
26. Webster G, Peterson A. Simple perineal and elaborated perineal posterior urethroplasty. Arab J Urol. 2015;13:17–23.
27. Flynn B, Delvecchio F, Webster G. Perineal repair of pelvic fracture urethral distraction defects: experience in 120 patients during the last 10 years. J Urol. 2003;170:1877–80.
28. Kizer W, Armenahas N, Brandes S, Cavalcanti A, Santucci A, Morey A. Simplified reconstruction of posterior urethral disruption defects: limited role of supracrural rerouting. J Urol. 2007;177:1378–82.
29. Koraitim M. On the art of anastomotic posterior urethroplasty: a 27-year experience. J Urol. 2005;173:135–9.
30. Aggarwal S, Sinha S, Kumar A, Pant N, Borkar N, Dhua A. Traumatic strictures of the posterior urethra in boys with special reference to recurrent strictures. J PediatrUrol. 2011;7:356–62.
31. Cooperberg M, Mcaninch J, Alsikafi N, Elliott S. Urethral reconstruction for traumatic posterior urethral disruption outcomes of a 25-year experience. J Urol. 2007;178:2006–10.
32. Onofre L, Leao J, Gomes A, Heinisch A, Leao F, Carnevale J. Pelvic fracture urethral distraction defects in children managed by anterior sagittal transanorectal approach a facilitating and safe access. J Pediatr Urol. 2011;7:349–55.
33. Subasi M, Arslan H, Necmioglu S, Onen A, Ozen S, Kava M. Long- term outcomes of conservatively treated paediatric pelvic fractures. Injury. 2004;35:771–81.
34. Mamdouh M, Koraitim M. Optimising the outcome after anastomotic posterior urethroplasty. Arab J Urol. 2015;13:27–31.
35. Koraitim M, Kamel M. Perineal repair of pelvic fracture urethral injury: in pursuit of a successful outcome. BJU Int. 2015;116:265–70.
36. Roehrborn C, Mcconnell J. Analysis of factors contributing to success or failure of one-stage urethroplasty for urethral stricture disease. J Urol. 1994;151:869–74.
37. Corriere J. 1-Stage delayed bulboprostatic anastomotic repair of posterior urethral rupture: 60 patients with 1-year follow up. J Urol. 2001;165:404–7.
38. Shenfeld O, Kiselgorf D, Gofrit O. The incidence and causes of erectile dysfunction after pelvic fractures associated with posterior urethral disruption. J Urol. 2003;169:2173–6.
39. Koraitim M. Predicting the risk of erectile dysfunction after pelvic fracture urethral injury in children. J Urol. 2014;192:519–23.
40. Onen A, Öztürk H, Kaya M, OtU S. Long-term outcome of posterior urethral rupture in boys: A comparison of different surgical modalities. Urology. 2005;65:1202–7.
41. Abdalla M. Posterior sagittal pararectal approach with rectal mobilization for repair of rectourethral fistula: an alternative approach. Urology. 2009;73:1110–4.
42. Helmy T, Sarhan O, Dawaba M, Wadie B. Urethrorectal fistula repair in children: urologic perspective. J Trauma. 2010;69:1300–3.
2. Koraitim M. Pelvic fracture urethral injuries: the unresolved controversy. J Urol. 1999;161:1433–41.
3. Alwaal A, Zaid UB, Blaschko SD, Harris CR, Gaither TW, McAninch JW, et al. The incidence, causes, mechanism, risk factors, classification, diagnosis of pelvic fracture urethral injury. Arab J Urol. 2015;13:2–6. Epub 2015/05/29.
4. Koraitim M, Marzouk M, Atta M, Orabi S. Risk factors and mechanism of urethral injury in pelvic fractures. Br J Urol. 1996;77:876–80.
5. Koraitim M. Posttraumatic posterior urethral strictures in children: a 20-year experience. J Urol. 1997;157:641–5.
6. Boone T, Wilson W, Husmann D. Postpubertal genitourinary function following posterior urethral disruptions in children. J Urol. 1992;148:1232–4.
7. Bond S, Gotschall C, Eichelberger M. Predictors of abdominal injury in children with pelvic fracture. J Trauma. 1991;31:1169–73.
8. Tarman G, Kaplan G, Lerman S, Mcaleer I, Losasso B. Lower genitourinary injury and pelvic fractures in pediatric patients. Urology. 2002;59:123–6.
9. Webster G. Urethral injuries. En: Whitfield HN, Hendry WF, Kirby RS, Duckett JW, editores. Textbook of genito-urinary surgery. 2. nd edition. Oxford: Blackwell Scientific; 1998. p. 1323–40.
10. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96. Epub 2009/07/30.
11. Mcaninch J, Santucci R. Genitourinary trauma. En: Walsh PC, Wein AJ, Vaughan ED Jr, Retik AB, editores. Campbell’sUrology. 8 ed. Philadelphia: WB Saunders Company; 2002. p. 3707–44.
12. Ranjan P, Ansari M, Singh M, Chipde S, Singh R, Kapoor R. Post- traumatic urethral strictures in children, what have we learned over the years? J Pediatr Urol. 2012;8:234–9.
13. Avanoglu A, Ulman I, Herek O, Ozok G, Gökdemir A. Posterior urethral injuries in children. Br J Urol. 1996;77:597–600.
14. Clark S, Prudencio R. Lower urinary tract injuries associated with pelvic fractures Diagnosis management. Surg Clin N Am. 1972;52:183–201.
15. Pichler R, Fritsch H, Skradski V, Horninger W, Schlenck B, Rehder P, et al. Diagnosis and management of pediatric urethral injuries. Urol Int. 2012;89:136–42. Epub 2012/03/22.
16. Webster G, Mathes G, Selli C. Prostatomembranous urethral injuries. A review of the literature and a rational approach to their management. J Urol. 1983;130:898–902.
17. Pritchett T, Shapiro R, Hardy B. Surgical management of traumatic posterior urethral strictures in children. Urology. 1993;42:59–62.
18. Webster G, Guralnick M. Reconstruction of posterior urethral disruption. UrolClin North Am. 2002;29:429–41.
19. Morey A, Mcaninch J. Reconstruction of posterior urethral disruption injuries: outcome analysis in 82 patients. J Urol. 1997;157:506–10.
20. Griebling T, Kreder K. Urethral reconstruction after pelvic fracture with urethral disruption: the gold standard. SeminUrol. 1995;13:45–55.
21. Ennemoser O, Colleselli K, Reissigl A, Poisel S, Janetschek G, Bartsch G. Posttraumatic posterior urethral stricture repair: anatomy, surgical approach and long-term results. J Urol. 1997;157:499–505.
22. Martinez-Pineiro L, Djakovic N, Plas E, Mor Y, Santucci RA, Serafetinidis E, et al. EAU Guidelines on Urethral Trauma. Eur Urol. 2010;57:791–803. Epub 2010/02/04.
23. Kulkarni S, Joshi P, Hunter C, Surana S, Shahrour W, Alhajeri F. Complex posterior urethral injury. Arab J Urol. 2015;13: 43–52.
24. Webster G, Goldwasser B. Perinealtranspubic repair: a technique for treating post-traumatic prostatomembranous urethral strictures. J Urol. 1986;135:278–9.
25. Webster G, Ramon J. Repair of pelvic fracture posterior urethral defects using an elaborated perineal approach: experience with 74 cases. J Urol. 1991;145:744–8.
26. Webster G, Peterson A. Simple perineal and elaborated perineal posterior urethroplasty. Arab J Urol. 2015;13:17–23.
27. Flynn B, Delvecchio F, Webster G. Perineal repair of pelvic fracture urethral distraction defects: experience in 120 patients during the last 10 years. J Urol. 2003;170:1877–80.
28. Kizer W, Armenahas N, Brandes S, Cavalcanti A, Santucci A, Morey A. Simplified reconstruction of posterior urethral disruption defects: limited role of supracrural rerouting. J Urol. 2007;177:1378–82.
29. Koraitim M. On the art of anastomotic posterior urethroplasty: a 27-year experience. J Urol. 2005;173:135–9.
30. Aggarwal S, Sinha S, Kumar A, Pant N, Borkar N, Dhua A. Traumatic strictures of the posterior urethra in boys with special reference to recurrent strictures. J PediatrUrol. 2011;7:356–62.
31. Cooperberg M, Mcaninch J, Alsikafi N, Elliott S. Urethral reconstruction for traumatic posterior urethral disruption outcomes of a 25-year experience. J Urol. 2007;178:2006–10.
32. Onofre L, Leao J, Gomes A, Heinisch A, Leao F, Carnevale J. Pelvic fracture urethral distraction defects in children managed by anterior sagittal transanorectal approach a facilitating and safe access. J Pediatr Urol. 2011;7:349–55.
33. Subasi M, Arslan H, Necmioglu S, Onen A, Ozen S, Kava M. Long- term outcomes of conservatively treated paediatric pelvic fractures. Injury. 2004;35:771–81.
34. Mamdouh M, Koraitim M. Optimising the outcome after anastomotic posterior urethroplasty. Arab J Urol. 2015;13:27–31.
35. Koraitim M, Kamel M. Perineal repair of pelvic fracture urethral injury: in pursuit of a successful outcome. BJU Int. 2015;116:265–70.
36. Roehrborn C, Mcconnell J. Analysis of factors contributing to success or failure of one-stage urethroplasty for urethral stricture disease. J Urol. 1994;151:869–74.
37. Corriere J. 1-Stage delayed bulboprostatic anastomotic repair of posterior urethral rupture: 60 patients with 1-year follow up. J Urol. 2001;165:404–7.
38. Shenfeld O, Kiselgorf D, Gofrit O. The incidence and causes of erectile dysfunction after pelvic fractures associated with posterior urethral disruption. J Urol. 2003;169:2173–6.
39. Koraitim M. Predicting the risk of erectile dysfunction after pelvic fracture urethral injury in children. J Urol. 2014;192:519–23.
40. Onen A, Öztürk H, Kaya M, OtU S. Long-term outcome of posterior urethral rupture in boys: A comparison of different surgical modalities. Urology. 2005;65:1202–7.
41. Abdalla M. Posterior sagittal pararectal approach with rectal mobilization for repair of rectourethral fistula: an alternative approach. Urology. 2009;73:1110–4.
42. Helmy T, Sarhan O, Dawaba M, Wadie B. Urethrorectal fistula repair in children: urologic perspective. J Trauma. 2010;69:1300–3.