Surgical atlas: anastomotic urethroplasty

Sharma, D.; Goetz, Lester; Rampaul, Michael; Bajrangee, Gobindrajh; Ayoungchee, P.; Ramsoobhag, Krishan

doi:10.1111/j.1464-410x.2006.06228_2.x

Cited by 3 publications

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“…El 62% de los pacientes habían sido sometidos a procedimientos previos y el 66% a más de un procedimiento. [1][2][3][4][5] Cuatro pacientes tenían antecedente de uretroplastia fallida.…”

Section: Resultsunclassified

“…Con eso se logra ganar hasta 5cm de longitud. 4,22 La cirugía ofrece tasas de éxito tan altas como el 98% como los describe Koraitim 9 en la serie descrita de 64 pacientes y que se relaciona con lo encontrado en el estudio. Por la relación anatómica de la uretra posterior con la vasculatura 23 y los mecanismos de continencia 24 la principal preocupación a parte de desobstruir al paciente, es dejarlo continente y sin disfunción eréctil.…”

Section: Discussionunclassified

“…1,2 Está indicado en los casos en los que se desea ganar longitud de la uretra por ser un defecto muy largo o en dónde no es posible visualizar el cabo proximal para poder realizar la anastomosis. 3,4 El abordaje empleado puede ser por vía abdominal, perineal o abdominoperineal 5,6 dependiendo de las características de la estenosis, los antecedentes del paciente y la preferencia del cirujano. 7,8 De acuerdo a los hallazgos en cirugía, se puede realizar infrapubectomía o pubectomía.…”

Section: Introductionunclassified

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Uretroplastia transpúbica como tratamiento de la estenosis de uretra proximal compleja: resultados de una intervención interdisciplinaria

et al. 2018

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Introducción La uretroplastia transpúbica es una técnica empleada para tratar la estenosis de uretra proximal compleja, permitiendo una mejor visualización del campo quirúrgico y una mayor facilidad al momento de realizar la anastomosis. Existen pocas descripciones en la literatura de los resultados quirúrgicos y funcionales en los pacientes sometidos a ese procedimiento, el propósito de este estudio es describir una serie de casos complejos tratados con ese abordaje, de una manera interdisciplinaria entre Urología y Ortopedia. Materiales y Métodos Estudio tipo serie de casos en un grupo de pacientes masculinos que ingresaron al hospital entre marzo de 2013 y mayo de 2017, con lesión de la uretra proximal secundaria a procedimientos quirúrgicos o trauma a los cuales se realizó uretroplastia transpúbica. Resultados 13 pacientes fueron sometidos a uretroplastia transpúbica. El 69% de los pacientes fueron de etiología traumática con edad promedio de 50 años y seguimiento promedio de 27 meses. Un 62% de los pacientes, habían sido sometidos a procedimientos como uretroplastia, uretotomías o dilataciones previamente y un 46% de los pacientes, presentaron estenosis a nivel de la uretra bulbomembranosa. El 61% no presentó complicaciones a corto plazo como infección urinaria, fistula por dehiscencia o no unión. El 30% presentó dolor crónico. Ninguno presentó alteraciones en la marcha y solo 2 pacientes requirieron procedimientos adicionales como resección transuretral de próstata (RTU). Conclusiones Pacientes con estenosis compleja de uretra posterior pueden requerir resección del pubis para una adecuada exposición y mejorar el resultado de la uretroplastia sin consecuencias o complicaciones derivadas de la pubectomía.

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“…El 62% de los pacientes habían sido sometidos a procedimientos previos y el 66% a más de un procedimiento. [1][2][3][4][5] Cuatro pacientes tenían antecedente de uretroplastia fallida.…”

Section: Resultsunclassified

Section: Discussionunclassified

Section: Introductionunclassified

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Uretroplastia transpúbica como tratamiento de la estenosis de uretra proximal compleja: resultados de una intervención interdisciplinaria

et al. 2018

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Use of human fibrinogen and human thrombin for urethral reconstructive surgery

2008

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The objective of the present study is to test the use of a haemostatic sponge for urethral reconstructive surgery and to assess the relevant benefits. METHODS. The haemostatic sponge is made up of collagen with human fibrinogen and human thrombin. When the sponge gets in contact with fluids, such as blood, lymph or saline solution, the fibrinogen and thrombin are activated and form a fibrin net able to achieve local haemostasis and tissue regeneration. This kind of product was used in 30 selected patients (pts.), aged 19 - 70 (mean age: 35), who underwent single-stage anastomotic urethroplasty from January 2006 to March 2007: 22 bulbar end-to-end anastomoses and 8 bulbo- prostatic anastomoses. All operations were performed due to post-traumatic stricture of bulbar and posterior urethra. The main selection criterion for the use of the haemostatic sponge has always been the tendency to and/or the presence of bleeding in the different surgical stages. The sponge imbibed in saline solution and suitably modeled for all specific requirements was differently placed: sleeve-shaped in the case of bulbar anastomoses (16 pts.); as a "patch" in the centre of spongioplasty in bulbo-prostatic anastomoses (8 pts.), and within the widening incisions of the urethral roof performed between the two cavernous bodies at level of the intercrural septum (5 pts.). In 1 case (obese patient) a single sponge was placed after the deep perineal reconstruction on the bulbo-cavernous muscle- subcutaneous layers because of massive bleeding. RESULTS. In all cases a perfect control of haemostasis could be achieved, with immediate end of bleeding in the points where the haemostatic sponges were used. The dressings performed on day 3 upon removal of the compressive scrotum-perineal bandages did not show any late post-operative bleeding. The follow-up visits at month 1 and 3 yielded positive outcomes for all 30 patients, who achieved complete wound healing by first intention, and a perfect anastomosis especially in the bulbar end-to-end urethroplasty, confirmed by urethrografy at one month. CONCLUSIONS. The association of human fibrinogen and human thrombin in haemostatic sponges represents a manageable, useful product, apparently sure, not negatively interfering in repairing and regenerating tissue processes, and allowing a simple and direct control of important bleeding events occurring during urethral reconstructive surgery as well as other operations. It is therefore advisable to more widely use the product after a suitable followup period.

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Combined Endoscopic and Surgical Technique for the Repair of Posterior Traumatic Urethral Stricture

2009

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The aim of this study is to show and evaluate the combined procedure, which uses an endoscopic suprapubic access and a surgical perineal access to repair posterior urethral stricture secondary to traumatic pelvis fracture. Material and Methods In the period from January 1989 to December 2007 eighty-nine patients underwent urethral surgery for post-traumatic posterior urethral stricture. From January 2003 all patients underwent combined endoscopic and surgical technique. According to this technique, the patient is placed in simple lithotomic position with the calves carefully placed in Allen stirrups. Two surgical teams work simultaneously. A middle-line perineal incision is made and the bulbar urethra is isolated proximally and the membranous urethra is transected at the strictured site. At the same time the second surgical team performs an endoscopic suprapubic access placing the “Amplatz” sheath, previous progressive dilation to 20/22 Ch. By using a rigid or flexible cystoscope the operator follows endoscopically the bladder neck and reaches the stenotic site performing an anterograde urethroscopy. At this point the perineum is transilluminated by the endoscope and the surgeon can easily identify the proximal urethral end. A soft guide wire is inserted at this point into the urethra through the endoscope to facilitate the dilation till a nose speculum can be inserted. At this point an end-to-end anastomosis is performed. A Foley 18 Fr catheter and a suprapubic cystostomy are left in place for 1 month; a voiding cystourethrography is then performed. Results The bulboprostatic anastomosis shows better results (65% of success) if compared with the other techniques (Badenoch, two stage urethroplasty, perineal urethrostomy). A definite increase in the success rate (10%) has been evident in the last five years, simultaneously to the use of combined technique. Conclusions The combined perineal and suprapubic access, in post-traumatic posterior urethral strictures repair, allows achieving a better and easy location and a better preparation of the proximal urethra. The final target is to obtain a better bulboprostatic anastomosis, with better results confirmed by long-term follow-up. In particular, the endoscopic management of the suprapubic access is possible and of minor invasiveness to the patient.

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Surgical atlas: anastomotic urethroplasty

Cited by 3 publications

References 1 publication

Uretroplastia transpúbica como tratamiento de la estenosis de uretra proximal compleja: resultados de una intervención interdisciplinaria

Uretroplastia transpúbica como tratamiento de la estenosis de uretra proximal compleja: resultados de una intervención interdisciplinaria

Use of human fibrinogen and human thrombin for urethral reconstructive surgery

Combined Endoscopic and Surgical Technique for the Repair of Posterior Traumatic Urethral Stricture

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