Pelvik Kırık ile Posterior Üretrada Ayrılma Defekti Olan Çocuklarda Tübülerize Bukkal Mukoza Greft Üretroplastisi

Year 2019, Volume: 13 Issue: 3, 126 - 129, 24.05.2019

Doğuş Güney

https://doi.org/10.12956/tjpd.2018.338

Abstract

Amaç: Posterior üretra travması çocuklarda tedavisi güçlük arz eden nadir bir travma tipidir. Burada pelvik kırık ile posterior

üretrada ayrılma defekti olan çocuklarda tübülerize bukkal mukoza greft üretroplastisi deneyimlerimiz sunulacaktır.

Gereç ve Yöntemler: Kliniğimizde 2009-2016 yılları arasında pelvik kırık ile posterior üretrada ayrılma defekti olan

tübülerize bukkal mukoza greft üretroplastisi onarımı yaptığımız üç olgumuz geriye dönük değerlendirildi. Ortalama 3

cm uzunluğundaki bukkal mukozal greftler proksimal ve distal üretra uçları arasına dikildi. Bütün hastalar postoperatif

dönemde üretragrafi, üreteroskopi ve uroflovmetri ile değerlendirildi.

Bulgular: Üçü de erkek olan olgularımız ortalama 9 (6-14) yaşındaydı. İki olgumuz posterior üretra yaralanması nedeni

ile başka merkezlerde en az iki kez opere edilip merkezimize refere edildi. Üç olgumuza pelvik kırık ile posterior üretrada

ayrılma defekti nedeni ile tübülerize bukkal mukoza greft üretroplastisi işlemi uygulandı. İki olgumuzda tam kontinasla

beraber sistoskopik değerlendirmede üretra bütünlüğünün darlık olmadan sağlandığı görüldü. Üçüncü olgumuzda ise

revizyon gerektiren proksimal anastomotik darlık mevcut idi.

Sonuç: Tübülerize bukkal mukoza penil kısalığı ve anastomatik gerginliği önlemek için pelvik kırık ile posterior üretrada

ayrılma defektlerinde kullanılabilinir.

Keywords

Travma, Üretra

Tubularised Buccal Mucosal Graft Urethroplasty for Posterior Pelvic Fracture Urethral Distraction Defects in Children

Abstract

Objective: Posterior urethral trauma is rare type of trauma that is particularly difficult to treat in children. Here, we have

presented our experience with tubularised buccal mucosal graft (BMG) repairs for posterior pelvic fracture urethral

distraction defects (PFUDDs) in children.

Material and Methods: We retrospectively evaluated three cases of tubularised BMG repairs for PFUDDs in our

clinic between 2009 and 2016. The BMGs were 3 cm in length, on average, and sutured between the stump of the

proximal prostatic urethra and the distal bulbar urethra. All of the patients underwent urethrography, urethroscopy and

uroflowmetry assessments postoperatively.

Results: The mean patient age was 9 (6–14) years and all three patients were male. Two of the three patients with

posterior urethral injuries were operated on at least twice at another centre and referred to our clinic with PFUDDs. All

three patients underwent tubularised BMG urethroplasties for the PFUDDs. We noted urethral integrity in the cystoscopic

evaluations of two of the patients, with no strictures, and these two patients were fully continent. A proximal anastomotic

contracture was noted in the third patient and a revision was required.

Conclusion: A tubularised BMG should be used to prevent penile shortening and anastomotic tension in a PFUDD.

Keywords

Trauma, Urethra

References

• 1. Bariol SV, Stewart GD, Smith RD, Mc Keown DW, Tolley DA. An analysis of urinary tract trauma in Scotland: Impact on management and resource needs. Surgeon 2005;3:27-30.
• 2. Kashefi C, Messer K, Barden R, Sexton C, Parsons JK. Incidence and prevention of iatrogenic urethral injuries. J Urol 2008;179:2254- 7.
• 3. Trachta J, Moravek J, Kriz J, Padr R, Skaba R. Pediatric bulbar and posterior urethral injuries: Operative outcomes and long-term follow-up. Eur J Pediatr Surg 2016;26:86-90.
• 4. Singla M, Jha K, Muruganandam S, Srivastava A, Ansari MS, Mandhani A, et al. Posttraumatic posterior urethral strictures in children-management and intermediate-term follow-up in tertiary care centre. Urology 2008;72:540-4.
• 5. Koraitim MM. Posttraumatic posterior urethral strictures in children: A 20-year experience. J Urol 1997;157:641-5.
• 6. Voelzke BB, Breyer BN, McAninch JW. Blunt paediatric anterior and posterior urethral trauma: 32-year experience and outcomes. J Pediatr Urol 2012;8:258-63.
• 7. Aggarwal SK, Sinha SK, Kumar A, Pant N, Borkar NK, Dhua A. Traumatic strictures of the posterior urethra in boys with special reference to recurrent strictures. J Pediatr Urol 2011;7:356-62.
• 8. Xu YM, Qiao Y, Sa YL, Wu DL, Zhang XR, Zhang J, et al. Substitution urethroplasty of complex and long-segment urethral strictures: A rationale for procedure selection. Eur Urol 2007;51:1093-8.
• 9. Pansadoro V, Emiliozzi P. Which urethroplasty for which results? Curr Opin Urol 2002;12:223-7.
• 10. Pansadoro V, Emiliozzi P, Gaffi M, Scarpone P, DePaula F, Pizzo M. Buccal mucosa urethroplasty in the treatment of bulbar urethral stricture. Urology 2003;61:1008-10.