Publication: Comparación de tratamientos endourológicos para la estenosis pieloureteral congénita en el niño
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2017-02-17
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Universidad Complutense de Madrid
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Abstract
La hidronefrosis es una de las malformaciones congénitas más frecuentemente diagnosticadas en el periodo prenatal. La estenosis pieloureteral es la causa más común de hidronefrosis prenatal clínicamente significativa, cifrándose en 1/500 fetos vivos. Además, la estenosis pieloureteral es la estenosis más frecuente del sistema urinario en cualquier grupo de edad. Por ello es una de las causas más frecuentes de consulta en cirugía pediátrica. El procedimiento quirúrgico más utilizado mundialmente es la pieloplastia desmembrada como fue descrita por Anderson y Hynes en 1949, teniendo reportados unos porcentajes de éxito cercanos al 95% en la actualidad. Pese a sus buenos resultados, en las últimas décadas se han descrito una serie de abordajes mínimamente invasivos que buscan conseguir los mismos resultados con menos agresión para el paciente. Entre ellas, destacan las técnicas laparoscópicas y endourológicas, definidas como el conjunto de maniobras diagnósticas o terapéuticas, transuretrales o percutáneas, endoscópicas o imagenológicas, realizadas en la luz de las vías urinarias. Las distintas técnicas endourológicas para tratar las malformaciones de la unión pieloureteral podrían ser divididas en anterógradas y retrógradas según avancemos por la luz urinaria a favor o en contra de la orina. Así, las técnicas anterógradas exigirán obligatoriamente la punción percutánea de riñón para acceder a los cálices renales, mientras que las técnicas retrógradas exigirán el abordaje del meato ureteral tras cistoscopia...
Hydronephrosis is one of the most frequently diagnosed congenital malformations in the prenatal period. Ureteropelvic junction obstruction is the most common cause of clinically significant prenatal hydronephrosis, being estimated to 1/500 live fetuses. In addition, ureteropelvic junction obstruction is the most common urinary tract stenosis in any age group. Therefore, it is one of the most frequent causes of consultation in pediatric surgery. The surgical procedure used worldwide is the dismembered pyeloplasty as was described by Anderson and Hynes in 1949, having reported a success rate close to 95%. Despite its success in recent decades they have described a series of minimally invasive approaches that seek to achieve the same results with less aggression to the patient. These projects include laparoscopic and endourological techniques, defined as set of percutaneous, endoscopic or imaging diagnostic or therapeutic maneuvers, transurethral or made inside of the urinary tract. Various endourological techniques for treating ureteropelvic junction malformations may be divided into antegrade and retrograde as we go inside urinary tract pro or against urine flow. Thus, antegrade techniques necessarily require kidney percutaneous puncture to access the renal chalices, while the retrograde techniques require to approach the ureteral orifice during cystoscopy...
Hydronephrosis is one of the most frequently diagnosed congenital malformations in the prenatal period. Ureteropelvic junction obstruction is the most common cause of clinically significant prenatal hydronephrosis, being estimated to 1/500 live fetuses. In addition, ureteropelvic junction obstruction is the most common urinary tract stenosis in any age group. Therefore, it is one of the most frequent causes of consultation in pediatric surgery. The surgical procedure used worldwide is the dismembered pyeloplasty as was described by Anderson and Hynes in 1949, having reported a success rate close to 95%. Despite its success in recent decades they have described a series of minimally invasive approaches that seek to achieve the same results with less aggression to the patient. These projects include laparoscopic and endourological techniques, defined as set of percutaneous, endoscopic or imaging diagnostic or therapeutic maneuvers, transurethral or made inside of the urinary tract. Various endourological techniques for treating ureteropelvic junction malformations may be divided into antegrade and retrograde as we go inside urinary tract pro or against urine flow. Thus, antegrade techniques necessarily require kidney percutaneous puncture to access the renal chalices, while the retrograde techniques require to approach the ureteral orifice during cystoscopy...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 02/12/2015