Uretroplastia anastomótica de aumento en el manejo de la estenosis de uretra bulbar

ResumenAntecedentesDurante la uretroplastia de aumento, si la estenosis presenta una región de 1-2 cm que es demasiado estrecha o fibrosa, esa porción puede ser resecada con la subsecuente anastomosis de la región ventral o dorsal de la uretra con el fin de acortar, ampliar y optimizar la pared uretral sobre la cual se va a colocar el injerto de mucosa oral. Este procedimiento se denomina uretroplastia anastomótica de aumento y es una opción a considerar en casos de estenosis de uretras bulbares largas y estrechas.ObjetivoPresentar el caso de un paciente con estenosis de uretra bulbar manejado con uretroplastia anastomótica de aumento.Caso clínicoSe presenta el caso de paciente masculino de 51 años con antecedentes de tuberculosis genitourinaria en 2009, estenosis de uretra en 2011 manejado con cistostomía. Empieza en 2010 con síntomas del tracto urinario bajo secundario a la tuberculosis genitourinaria, diagnosticando una estenosis de uretra bulbar tratada con cistostomía. Dos meses después se realiza un abordaje perineal, encontrando una estenosis de uretra bulbar de 3 cm de longitud, con pared de la misma fibrosa y estrecha por lo que se decide realizar uretroplastia anastomótica de aumento, resecando la cara ventral de la uretra y realizando una anastomosis en esta cara y colocando injerto onlay de mucosa oral en cara dorsal de la misma. La cirugía se llevó a cabo sin complicaciones. Al mes de la cirugía se retira la sonda transuretral y el paciente presenta buena evolución sin evidencia de estenosis en la cistografía de control y en la uroflujometría.ConclusionesLa uretroplastia anastomótica de aumento es una técnica efectiva que permite el uso de injertos de mucosa oral de menor tamaño, lo que disminuye las complicaciones derivadas de la cosecha del mismo, y mejora los resultados ya que optimiza la pared uretral y el cuerpo esponjoso. Nosotros recomendamos que se aplique esta técnica a los pacientes con estenosis de uretra muy fibrosa o estrecha de hasta 2 cm.

BackgroundDuring augmented urethroplasty, if the stricture presents with a region of 1-2 cm that is too narrow or fibrous, that portion can be resected with the subsequent anastomosis of the ventral or dorsal region of the urethra in order to shorten, widen, and optimize the urethral wall over which the buccal mucosa graft will be placed. This procedure is known as augmented anastomotic urethroplasty and is an option to be considered in cases of long and narrow bulbar urethral stricture.ObjectiveWe present herein the case of a patient with bulbar urethral stricture managed with augmented anastomotic urethroplasty.Clinical caseA 51-year-old man had a past history of genitourinary tuberculosis in 2009 and urethral stricture in 2011 managed with cystostomy. He had onset of lower urinary tract symptoms in 2010 secondary to the genitourinary tuberculosis. The patient was diagnosed with bulbar urethral stricture and was treated with cystostomy. Two months later, through a perineal approach, a 3 cm long bulbar urethral stricture was encountered and the decision was made to perform an augmented anastomotic urethroplasty. The ventral surface of the urethra was resected and an anastomosis was carried out on that surface; a buccal mucosa onlay graft was then placed on the dorsal side of the anastomosis. No complications resulted from the surgery and the transurethral catheter was removed one month after the procedure. Patient progression was good and there was no evidence of stricture in the control cystography and uroflowmetry.ConclusionsAugmented anastomotic urethroplasty is an effective technique that enables the use of smaller-sized buccal mucosa grafts, reducing the complications derived from the graft harvest. Better results are obtained because the urethral wall and corpus spongiosum are optimized. We recommend this technique in patients with very fibrous or narrow urethral stricture up to 2 cm in length.