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Simposio de Avances en Simposio de Avances en Urología 2010Urología 2010
Dr. Javier Belinky
Sección Cirugía Reconstructiva
Hospital Carlos G. Durand
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Existe un standard para la Existe un standard para la estenosis de URETRA PENDULA ?estenosis de URETRA PENDULA ?
ColgajosColgajos
InjertosInjertos
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Tipos de estenosisTipos de estenosis
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Causas de estenosisCausas de estenosis
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Retrospective outcome analysis of one-stageRetrospective outcome analysis of one-stagepenile urethroplasty using a flap or graft in apenile urethroplasty using a flap or graft in a
homogeneous series of patientshomogeneous series of patientsGuido Barbagli. -2008Guido Barbagli. -2008
•N 63N 63•La técnica depende de la etiologíaLa técnica depende de la etiología
•Hipospadias fallidas/ BXO. Hipospadias fallidas/ BXO. 2 tiempos con imb2 tiempos con imb
•OtrosOtros1 tiempo1 tiempo
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Retrospective outcome analysis of one-stageRetrospective outcome analysis of one-stagepenile urethroplasty using a flap or graft in apenile urethroplasty using a flap or graft in a
homogeneous series of patientshomogeneous series of patientsGuido Barbagli. -2008Guido Barbagli. -2008
Flap 67%
IMB 81.8%
Graft piel 78.3%
•La decisión FLAP/GRAFTLa decisión FLAP/GRAFTplato uretralplato uretralexperiencia y preferencia del cirujanoexperiencia y preferencia del cirujano
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Dorsal Onlay Buccal Mucosa Versus PenileDorsal Onlay Buccal Mucosa Versus PenileSkin Flap Urethroplasty for Anterior UrethralSkin Flap Urethroplasty for Anterior Urethral
Strictures: Results From a Randomized Prospective TrialStrictures: Results From a Randomized Prospective TrialDeepak Dubey. 2007Deepak Dubey. 2007
tiempo goteo éxito
Flap 224 min 34% 85.6%
Graft 162 min 15% 89.9%
•N 55N 55
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What is the Best Technique for Urethroplasty?What is the Best Technique for Urethroplasty?Daniela E. Andrich, Anthony R. MundyDaniela E. Andrich, Anthony R. Mundy 2008 2008
• BXO. EtapasBXO. Etapas• Hipospadias recurridaHipospadias recurrida– Depende deDepende de• Dartos remanenteDartos remanente• FistulaFistula• CuerdaCuerda• Posicion del meatoPosicion del meato
– FlapFlap– 2 tiempos2 tiempos
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What is the Best Technique for Urethroplasty?What is the Best Technique for Urethroplasty?Daniela E. Andrich, Anthony R. MundyDaniela E. Andrich, Anthony R. Mundy 2008 2008
• No BXO No hipospadiasNo BXO No hipospadias– FlapFlap– Uretrotomia dorsal e injerto cavernosoUretrotomia dorsal e injerto cavernoso
– Depende de gusto y experienciaDepende de gusto y experiencia– Desventaja Graft…retraccion y corvoDesventaja Graft…retraccion y corvo
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Lecho receptorLecho receptor
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Disección uretralDisección uretral
• Mal sustento de injerto en Mal sustento de injerto en cara ventralcara ventral
• Disección cavernoso uretral Disección cavernoso uretral tediosa e innecesariatediosa e innecesaria
• Lecho móvil para un injertoLecho móvil para un injerto
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Flap Vs IMBFlap Vs IMB
• MecánicaMecánica– Flap: limitada (inicio de bulbo)Flap: limitada (inicio de bulbo)– IMB. ilimitadaIMB. ilimitada
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Flap Vs IMBFlap Vs IMB
• Flap: pelosFlap: pelos• IMBIMB lampiñolampiño
Fistula. Fistula.
FlapFlap
IMBIMB
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Flap Vs IMBFlap Vs IMB
Glande: tecnicamente complejo colocar injertoGlande: tecnicamente complejo colocar injerto
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Flap Vs IMBFlap Vs IMB
• NutriciónNutrición– Flap: depende del pedículo. DartosFlap: depende del pedículo. Dartos– Graft. Depende de lecho receptorGraft. Depende de lecho receptor
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Flap Vs IMB
• Tiempo quirúrgicoTiempo quirúrgico– FlapFlap– IMBIMB
• Alta sanatorialAlta sanatorial– flapflap– IMBIMB
• Falta de enfermería domiciliariaFalta de enfermería domiciliaria
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Utilidad de la piel genitalUtilidad de la piel genital
• Colgajos longitudinalesColgajos longitudinales
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Utilidad de la piel genitalUtilidad de la piel genital
• Colgajos transversalesColgajos transversales– Mejor llegada proximalMejor llegada proximal– No involucra pelo No involucra pelo – No involucra escroto en tomas ampliasNo involucra escroto en tomas amplias
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BXOBXO
• No útilesNo útiles• Tasa de éxito apróx 4-30%Tasa de éxito apróx 4-30%