Estado de la urología reconstructiva en Colombia: Tratamiento de la estrechez uretral anterior, una encuesta nacional

Resumen

Purpose El tratamiento mínimamente invasivo de la estrechez uretral tiene altas tasas de recurrencia y re-operación a largo plazo, no obstante, encuestas realizadas en otros países han demostrado que los urólogos tienen poca experiencia con la uretroplastia abierta y hay una preferencia a la utilización de las terapias endoscópicas mínimamente invasivas. El objetivo de este estudio, es describir patrones de práctica del tratamiento de la estrechez de uretra anterior en nuestro país.

Métodos Se trata de un estudio observacional descriptivo y para ello se realizó un cuestionario adaptado a nuestro contexto nacional, basado en varios estudios previamente realizados acerca de la experiencia en Urología reconstructiva. Ese cuestionario incluía información sobre la edad, nivel de experiencia en urología general, la experiencia en urología reconstructiva, escenario de la práctica y las técnicas preferidas para el manejo de las estrecheces uretrales pendulares y bulbares. La información fue almacenada de forma anónima, los datos fueron analizados mediante el paquete estadístico SPSS y se realizó un análisis de distribución de frecuencias.

Resultados Se obtuvieron 106 respuestas de los urólogos encuestados. Para el tratamiento de la estrechez uretral pendular la mayoría de los urólogos prefiere el manejo endoscópico mínimamente invasivo, seguido de uretroplastia con injerto con porcentajes de 69,9% y 25,5% respectivamente. Solo el 5% prefiere derivar a sus pacientes a un centro especializado. Para la estrechez de la uretra bulbar se prefiere las técnicas mínimamente invasivas, uretroplastia y remisión a un centro especializado en un 44,3%, 41,5% y 14,2% respectivamente. La población más joven y con formación urológica más reciente tiende a hacer más a menudo la uretroplastia con injerto y menos manejo endoscópico, específicamente la uretrotomía interna. En las ciudades intermedias, hay una predilección por el tratamiento endoscópico, especialmente uretrotomía interna.

Conclusiones El enfoque de tratamiento mínimamente invasivo de la estrechez uretral es el más frecuentemente elegido a pesar de sus pobres tasas de éxito a largo plazo. Es de destacar que las nuevas generaciones de urólogos muestran más interés y dominio de las técnicas abiertas, tratamiento estándar hoy en día y con bajas tasas de recaídas y reoperación a largo plazo.

Abstract

The minimally invasive treatment of urethral stricture has higher recurrence and longterm re operation rates. Surveys in other countries have shown that urologists have little experience with open urethroplasty with a preference to the utilization of minimally invasive therapies. We applied a survey to obtain data about practice patterns of the anterior urethral stricture treatment in our country.

Methods A survey was performed with adapted questions to our national context based on several surveys previously conducted in other countries about experience in Reconstructive Urology. This questionnaire included information about age, experience level in general urology, experience in reconstructive urology, scenario of practice, and the preferred techniques handling the pendular and bulbar urethral strictures. All information was collected anonymous and data were analyzed using the statistical software package SPSS, and a frequency distribution analysis was performed.

Results A total of 106 answers from respondent urologists were obtained. For the treatment of pendular urethral strictures the vast majority of respondents prefer the minimally invasive endoscopic treatment, following by graft urethroplasty with percentages of 69.9% and 25.5% respectively. Only 5% prefer to refer their patients for care at a specialized center. Regarding the bulbar urethral the urologists prefers to perform minimally invasive management, followed by urethroplasty and refer to a specialized center in percentages of 44.3%, 41.5% and 14.2% respectively. The younger and more recent urological trained population tends to make more often graft urethroplasty and less endoscopic management, specifically internal urethrotomy. In the intermediate cities there is a predilection for endoscopic treatment especially internal urethrotomy.

Conclusions The minimally invasive treatment approach of urethral stricture is the most frequently chosen despite its poor long-term success rates. It is noteworthy that the new generations of urologists show more interest and mastery of open techniques, which today is the standard treatment with low relapse and long-term re operation rates.

Palabras clave

uretra - uretrotomía - dilatación uretral - estrechez uretral - uretroplastia - injerto

Keywords

urethra - urethrotomy - urethral dilation - urethral stricture urethroplasty - graft

Publication History

Received: 07 January 2020

Accepted: 02 May 2020

Article published online:
06 October 2020

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