Lesiones de uretra posterior secundarias a fractura pélvica tratadas a través de abordaje perineal progresivo. Breve revisión de la literatura. / Pelvic fracture posterior urethral injury repaired by progressive perineal approach: A brief review of the literature

Objetivo: Revisar los resultados operatorios de nuestros pacientes con rotura traumática de uretra posterior, tratados a través del abordaje perineal progresivo y realizar una breve revisión de la literatura. Materiales y métodos: fueron analizadas las historias médicas de 7 pacientes en edades comprendidas entre 2 y 12 años, con lesiones uretrales asociadas con fracturas pélvicas, producidas entre marzo de 2005 y enero de 2017. Después del diagnóstico de la lesión, se realizó cistostomía derivativa en los 7 casos; en 2 de ellos con lesión rectal asociada se realizó, además, colostomía tipo Hartman en el momento de la derivación urinaria. La evaluación urológica preoperatoria para la uretroplastia definitiva incluyó uretrografía anterógrada y retrograda simultánea para determinar la separación entre los segmentos uretrales. Se decidió la reparación retardada de la uretra a través de abordaje perineal progresivo con un mínimo de 6 meses posterior al trauma. Resultados: El mecanismo de producción del trauma fue arrollamiento por vehículos a motor en 6 pacientes y aplastamiento por balancín petrolero en uno. La lesión uretral fue completa en todos. Tres presentaron complicaciones quirúrgicas; 2 estenosis uretrales que mejoraron con dilataciones y una fístula uretroperineal que cerró en forma espontánea sin consecuencias. Todos los pacientes se encuentran asintomáticos; ninguno ha requerido una nueva uretroplastia. Comentarios: Nuestros hallazgos con la implementación de este abordaje terapéutico coinciden con lo reportado en la literatura.

Objective: To evaluate the postoperative outcomes of our patients with posterior urethral traumatic rupture repaired by progressive perineal approach, and to conduct a brief review of the literature. Materials and methods: The clinical records of 7 patients aged between 2 to 12 years with urethral injuries due to pelvic fracture produced between March 2005 and January 2017, were reviewed. A suprapubic cystostomy for urinary drainage was constructed in the 7 patients immediately after diagnosis; two of them had concomitant rectum injuries thus a Hartmann's colostomy was also performed in them. The preliminary urologic appraisal for definite urethroplasty included a synchronous anterograde and retrograde cysto-urethrogram to determine separation of the urethral segments. The final selection of surgical procedure was delayed urethral repair by progressive perineal approach minimum 6 months after the trauma event. Results: The mechanism of injury was, blunt trauma after being struck by a moving vehicle in 6 patients and a crash injury caused by an oil rocker in one patient. The urethral disruption was complete in all patients. Three patients developed surgical complications: 2 urethral strictures which improved with dilatation and one urethral-perineal fistula with spontaneous closure and no associated complications. All patients remain asymptomatic; no patient has required a redo urethroplasty. Commentaries: Our findings through the implementation of this therapeutic approach are consistent with those reported in the literature. Conclusions: Progressive perineal access allows performing an anastomotic urethroplasty with good clinical outcomes in most patients.

[Congenital recto-vaginal fistula associated with a normal anus (type H fistula) and rectal atresia in a patient. Report of a case and a brief revision of the literature]. / Asociación de fistula rectovaginal congénita con ano normal (Fístulas Tipo H) y atresia rectal en una paciente. Reporte de un caso y breve revisi6n de la literatura.

Congenital recto-urogenital type fistulas with a normal anus and rectal atresia, represent both anorectal malformations that are infrequently seen in clinical practice. We describe the case of a girl with an association of these two anomalies, together with a double vagina who, on her seventh day of life, expelled feces through her genitals. The malformations were corrected by means of a posterior sagittal approach, descending from the rectum to the anus without perineal dissection. The vaginal septum was resected thru the vulva. There is no evidence of recurrence of the recto-vaginal fistula.

Asociación de fistula rectovaginal congénita con ano normal (Fístulas Tipo H) y atresia rectal en una paciente. Reporte de un caso y breve revisión de la literatura / Congenital recto-vaginal fistula associated with a normal anus (type H fistula) and rectal atresia in a patient. Report of a case and a brief revision of the literature.

Las malformaciones ano-rectales del tipo de fístulas recto-urogenitales congénitas con ano normal y atresia rectal son anomalías poco frecuentes. Se discute el caso de una niña con la asociación de estas dos entidades, acompañada además de una vagina doble, quien fue llevada a la consulta a los siete días de vida por la expulsión de heces a través de los genitales. Las malformaciones fueron corregidas a través de un abordaje sagital posterior, con descenso del recto hasta el ano sin disección perineal. El tabique vaginal fue resecado a través de la vulva. En la actualidad no hay evidencia de recurrencia de la fístula recto-vaginal.

Congenital recto-urogenital type fistulas with a normal anus and rectal atresia, represent both anorectal malformations that are infrequently seen in clinical practice. We describe the case of a girl with an association of these two anomalies, together with a double vagina who, on her seventh day of life, expelled feces through her genitals. The malformations were corrected by means of a posterior sagittal approach, descending from the rectum to the anus without perineal dissection. The vaginal septum was resected thru the vulva. There is no evidence of recurrence of the recto-vaginal fistula.

[Exstrophy of rectal duplication associated with anorectal malformation and penoscrotal transposition with perineal hypospadias. A case report]. / Duplicación rectal extrofiada asociada a malformación anorrectal y transposición pene-escrotal con hipospadias perineal. reporte de un caso clínico.

We present the case of a male patient who required treaatment due to anorectal agenesis with recto urethral fistula and penoscrotal transposition with perineal hypospadias, associated with a perineal tumor. The perineal tumor was found strongly adhered and contiguous to the rectum which makes it compatible with an exstrophy of rectal duplication. Surgical reconstruction of the birth defect was performed in stages until acceptable biological function and esthetic results were obtained.

Duplicación rectal extrofiada asociada a malformación anorrectal y transposición pene-escrotal con hipospadias perineal: Reporte de un caso clínico / Exstrophy of rectal duplication associated with anorectal malformation and penoscrotal transposition with perineal hypospadias: A case report

Se presenta el caso de un paciente masculino quien requirió tratamiento por agenesia anorrectal con fístula rectouretral y transposición pene-escrotal con hipospadias perineal, acompañados de una masa perineal. La tumoración perineal se encontró íntimamente adherida y en continuidad al recto, lo que la hace compatible con una duplicación rectal extrofiada. La reconstrucción quirúrgica de la anomalía se realizó en etapas hasta lograr resultados funcionales y estéticos aceptables.

We present the case of a male patient who required treaatment due to anorectal agenesis with recto urethral fistula and penoscrotal transposition with perineal hypospadias, associated with a perineal tumor. The perineal tumor was found strongly adhered and contiguous to the rectum which makes it compatible with an exstrophy of rectal duplication. Surgical reconstruction of the birth defect was performed in stages until acceptable biological function and esthetic results were obtained.

Laparoscopic-assisted correction of a retrocaval ureter.

Retrocaval ureter has been traditionally corrected surgically through an open retroperitoneal procedure; however, in recent years, the correction has been accomplished using laparoscopy. The great advantages of this procedure remain limited because of the prolonged time it takes to complete the intracorporeal suture of the ureter, besides the need for a highly experienced surgeon. We present a case in which the ureter was freed using laparoscopy, and the ureteral anastomosis was carried out extracorporeally, which notably diminished the duration of the surgery. This technique would have limited use in obese patients, patients with ureters of limited length, patients with very proximal obstructions of the ureter, and patients with risk of devascularization of both ureteral segments. However, the technique does appear effective and reproducible in adequately selected patients.

Hernia diafragmática post-traumática: reporte de un caso pediátrico / Hernia diaphragmatic traumatic: report of a pediatric case

Se presenta el caso de un paciente de siete años con ruptura diafragmática post-traumatica. Se hace una revisión de la fisiopatología, clínica, diagnóstico y tratamiento de esta entidad nosológica