bulbar urethra replacement (colgajos e injertos en la estenosis de uretra bulbar)
TRANSCRIPT
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Sustitución en uretra bulbar
Javier Belinky
Hospital Carlos G Durand
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Estenosis de uretra bulbar
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• Injertos
• Colgajos
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Cuando flap / graft ?
• Cuando no se pueda técnicamente una RAP
• Cuando no se desee seccionar la uretra…
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Injertos
• Boca
• Lengua
• Prepucio
• Piel
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Técnica
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Técnica
• Ventral
• Dorsal
• Lateral
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Técnica- injertos
• Ampliación uretral
• Resección y anastomosis ampliada
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Ampliación dorsal
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Resección y Anastomosis ampliada
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Tips
• Intentar preservar vasculatura
• Simplicidad ventral.
• En dorsal fijar a cavernosos.
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Colgajos
• Longitudinal• Transversal
• Tubo• Parche
• Pene• escroto
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longitudinales
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Transversal
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Flap . Parche ventral
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Flap. Parche dorsal
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Flap. Tubo
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Ventaja ??
• Mal lecho receptor.
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injerto colgajo
Tiempo cx similar
complejidad similar
Morbilidad lecho dador
menor mayor
Forma de transferencia
parche Parche tubo
recurrencia similar
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Re estenosis
1 año 5 años 10 años 15 años
RAPRAP 7% 12% 13% 14%
SustituciónSustitución 12% 21% 30% 42%
The Long-Term Results of Urethroplasty. Andrich DE. J Urol. 2003 Jul;170(1):90-2
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Estadios
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Cuando ?
• Inadecuado lecho receptorInadecuado lecho receptor– Fibrosis uretral y periuretral extensa– Fistulas asociadas– Uretroplastias o correccion de hipospadias
fallidas– Antecedente de celulitis genital– Falta de plato uretral
• BXOBXO
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• Johanson• Mucosa bucal• Schreiter• Denis Browne• Steward• Cecil• Wyland leadbetter• Turner Warwick
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Conclusiones y Tips
• Ante la duda de un mal lecho para 1 T…2T.
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Combinados