Uretroplastia término-terminal para el tratamiento primario de la estenosis de uretra: experiencia del Hospital General Dr. Manuel Gea González

Q4 Medicine

Revista mexicana de urologia Pub Date : 2016-09-01 DOI:10.1016/j.uromx.2016.06.001

L. Trujillo Ortiz, G. Garza-Sainz, E. Mayorga-Gómez, V. Osornio-Sánchez, V. Cornejo-Davila, I. Uberetagoyena-Tello, M.A. Palmeros-Rodríguez, J.E. Sedano-Basilio, J. Gómez-Sánchez, J.A. Herrera-Muñoz, D.A. Preciado-Estrella, M. Cantellano-Orozco, C. Martínez-Arroyo, G. Fernández-Noyola, J.G. Morales-Montor, C. Pacheco-Gahbler

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Abstract

Background

Urethral stricture is a urologic disease that has significant morbidity. Direct visual internal urethrotomy is used for the majority of cases in the United States, but end-to-end urethroplasty is the most successful technique. The choice of primary management is controversial. Direct visual internal urethrotomy is widely accepted in the majority of Mexican hospital centers. However, it is reported to have lower long-term success rates. Urethroplasty is indicated for long, densely fibrotic strictures. Diagnosis is based on radiologic studies (nuclear magnetic resonance or ultrasound, with contrast medium). Scales (Urethral Stricture Score) describing stricture complexity are employed to choose surgical treatment.

Aims

To communicate the results of primary treatment for urethral stricture in patients at the Hospital General Dr. Manuel Gea González that underwent end-to-end urethroplasty.

Materials and Methods

A descriptive study was conducted that reviewed the case records of 210 patients with urethral stricture, selecting the 58 cases that underwent end-to-end urethroplasty as primary treatment within the time frame of January 1, 2007 and December 31, 2013.

Results

The median age of the patients was 46.4 years. Stricture etiology: traumatic 23%, iatrogenic 58%, idiopathic 17%, and infectious 2%. The most frequent stricture location was at the bulbar level (87.9%) (51), mean length was 2.12 cm, 3 cases presented with double-site stricture, 11% (19) of the cases had urinary retention, and the mean urethral stricture score was 5.8. There were 10 recurrences, 9 re-interventions (urinary tract infection), and one augmented urethroplasty. Preoperative Qmax was 5.7-10 ml/sec and postoperative Qmax was 13-16 ml/sec. Cure was achieved in 82.7% of the cases.

Conclusions

Urethroplasty success rates worldwide are reported at 84-97%. Results are related to stricture complexity and surgical experience. There is still no consensus on success parameters. Urethroplasty presents less recurrence compared with direct visual internal urethrotomy, promoting long-term quality of life.

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初级尿道狭窄的终末期尿道成形术：曼努埃尔·赫亚·冈萨雷斯综合医院的经验

尿道狭窄是一种发病率较高的泌尿系统疾病。在美国，大多数病例使用直接视觉尿道内切开术，但端到端尿道成形术是最成功的技术。初级管理层的选择是有争议的。直接视觉尿道内切开术在大多数墨西哥医院中心被广泛接受。然而，据报道，它的长期成功率较低。尿道成形术适用于长而密集的纤维狭窄。诊断基于放射学研究（核磁共振或超声，使用造影剂）。使用描述狭窄复杂性的量表（尿道狭窄评分）来选择手术治疗。目的介绍在总医院接受端到端尿道成形术的Manuel Gea González医生治疗尿道狭窄的初步治疗结果。材料和方法回顾了210例尿道狭窄患者的病例记录，选择在2007年1月1日至2013年12月31日期间接受端到端尿道成形术作为主要治疗的58例患者。结果患者的中位年龄为46.4岁。狭窄病因：外伤性23%，医源性58%，特发性17%，感染性2%。最常见的狭窄部位在延髓水平（87.9%）（51），平均长度为2.12cm，3例出现双部位狭窄，11%（19）的病例出现尿潴留，平均尿道狭窄评分为5.8。有10例复发，9例再次干预（尿路感染），1例增强尿道成形术。术前Qmax为5.7-10毫升/秒，术后Qmax为13-16毫升/秒。治愈率为82.7%。结论全世界尿道成形术的成功率为84-97%。结果与狭窄的复杂性和手术经验有关。关于成功的参数仍然没有达成共识。与直接视觉尿道内切开术相比，尿道成形术的复发率较低，可提高长期生活质量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Revista mexicana de urologia Medicine-Urology

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0.20

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0.00%

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期刊介绍： Revista Mexicana de Urología (RMU) [Mexican Journal of Urology] (ISSN: 0185-4542 / ISSN electronic: 2007-4085) is bimonthly publication that disseminates research by academicians and professionals of the international medical community interested in urological subjects, in the format of original articles, clinical cases, review articles brief communications and letters to the editor. Owing to its nature, it is publication with international scope that disseminates contributions in Spanish and English that are rigorously reviewed by peers under the double blind modality. Neither journalistic documents nor those that lack rigorous medical or scientific support are suitable for publication.