Repair of Traumatic Urethral Strictures: La Paz University Hospital Experience.

Autor: Ballesteros Ruiz C; Urology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain., Toribio-Vázquez C; Urology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain., Fernández-Pascual E; Urology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.; Instituto de Investigación Hospital Universitario La Paz (IDiPaz), Calle de Pedro Rico, 6, 28029 Madrid, Spain., Ríos E; Urology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain., Rodríguez Serrano A; Urology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain., Alonso Dorrego JM; Urology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain., Girón de Francisco M; Urology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain., Moreno JA; Urology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain., Cárcamo Valor P; Urology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain., Martínez-Piñeiro L; Urology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.; Instituto de Investigación Hospital Universitario La Paz (IDiPaz), Calle de Pedro Rico, 6, 28029 Madrid, Spain.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2022 Dec 21; Vol. 12 (1). Date of Electronic Publication: 2022 Dec 21.
DOI: 10.3390/jcm12010054
Abstrakt: Introduction: The management of traumatic urethral strictures remains a challenge for urologists. Alteration of the pelvic anatomy and the significant fibrosis generated by the trauma make surgical repair complex. In most cases, the existing defect between the urethral ends is small, and the ideal treatment is end-to-end perineal urethroplasty. Cases of extensive strictures that are left with long gap defects may require the use of different sequential maneuvers to achieve a tension-free anastomosis.
Objective: To describe the experience at our center with urethral strictures induced by closed perineal trauma.
Materials and Methods: A retrospective analysis of 116 patients who underwent urethroplasty for urethral stricture after blunt perineal trauma at our center between 1965 and 2020 was conducted. Demographic data, date, mechanism of action of the trauma, emergency management, previous urethral interventions, surgical technique carried out in our center, complications, presence of erectile dysfunction, and urinary incontinence were collected.
Results: 82 patients (70.7%) presented with pelvic fractures. The most frequent etiology of trauma was traffic accidents (68%), followed by crushing injuries (24%). Suprapubic cystostomy was placed in 50.2% of patients, and urethral realignment was performed in 25.3%. The mean stricture length was 2.2 cm, affecting mostly the membranous urethra (67%). During surgery, it was necessary to perform crural separation in 61.5% and partial pubectomy in 18.8% of the cases. Erectile dysfunction developed after trauma in 40.5% of cases, while new erectile dysfunction was noted in 4.3% of patients after surgery. Surgery was successful in 91.3% of cases, with a median follow-up of 16 (6-47) months.
Conclusion: Delayed anastomotic urethroplasty offers a high success rate in traumatic urethral strictures.
Databáze: MEDLINE
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