RESUMO
Objetivo Determinar los factores asociados a la reestrechez uretral en pacientes llevados a uretroplastia. Métodos Estudio observacional analítico retrospectivo. Se revisaron las historias clínicas de pacientes llevados a uretroplastia en el HSJ entre 2012-2017. Se realizó un análisis bivariado para estudiar las asociaciones entre la reestrechez uretral posterior a la uretroplastia y las caracteristicas preoperatorias, intraoperatorias y posoperatorias, así como un modelo de regresión logística múltiple. Resultados El total de pacientes llevados a uretroplastia fue de 82. La mediana de edad fue de 52 (RIQ = 35 -67) años. De todos los pacientes incluidos en el estudio 29 (36,2%) presentaron reestrechez. No se encontraron diferencias estadísticamente significativas en cuanto a los factores de riesgo en relación con reestrechez uretral en la población de estudio. Dentro de las técnicas quirúrgicas realizadas, los tipos de injerto utilizados en nuestros pacientes fueron la técnica con injerto de mucosa oral y con injerto de prepucio. De los pacientes a los cuales se les realizó uretroplastia con injerto de prepucio 13 (52%), presentaron reestrechez mostrando una diferencia estadísticamente significativa (p = 0,02). El tiempo quirúrgico fue mayor en los pacientes con reestrechez uretral (180 min RIQ = 120,0-189,0) comparado con los pacientes sin reestrechez (140 min RIQ = 120,0-198,0). En cuanto al modelo de regresión logística, pacientes llevados a uretroplastia con injerto de prepucio poseen más riesgo de presentar reestrechez uretral comparado con los pacientes a los cuales se les realizó la uretroplastia con otro tipo de injerto o con una tecnica terminoterminal sin injerto OR = 2,91 IC 95% (1,02-8,28). Conclusiones En nuestro estudio solo se encontró que el tipo de injerto utilizado es el único factor asociado al desarrollo de reestrechez uretral posterior a la realización de uretroplastia, otras variables clínicas descritas en la literatura no tuvieron asociación en nuestro estudio.
Objective To determine the association between risk factors, surgical procedure, and postoperative outcomes with stricture recurrence in patients who underwent urethroplasty. Methods An analytical observational study with retrospective data collection was conducted. We reviewed the medical records of all the patients who underwent urethroplasty at HSJ between the years 2012-2017. The analysis of the data included a bivariate model to study the association between the risk factors, surgical procedure, postoperative outcomes and stricture recurrence. Then, we used logistic regression analysis. Results 82 patients underwent urethroplasty: 29 (36.2%) presented stricture recurrence. The median age was 52 (IQR = 35-67) years old. There were no statistically significant differences between the risk factors, postoperative outcomes and stricture recurrence. In surgical technique we used buccal mucosal graft and penile skin graft. Stricture recurrence was observed in 13 patients who underwent penile skin graft urethroplasty showing a significant statistical difference (p = 0.02). The patients with stricture recurrence had longer operative time (180 minutes, IQR = 120.0-189.0) compared to patients without (140 minutes, IQR = 120-198). The logistic regression analysis showed that patients who underwent penile skin graft urethroplasty had a greater risk of stricture recurrence OR = 2,91 IC 95% (1,02-8,28). Conclusions The type of graft used is the only factor associated with the development of stricture recurrence after performing urethroplasty. Other clinical variables described in the literature have no association with our study.
Assuntos
Humanos , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Operatórios , Estreitamento Uretral , Constrição Patológica , Transplantes , Prepúcio do PênisRESUMO
BACKGROUND: There is a select group of women for whom mini-abdominoplasty techniques combined with 3-dimensional liposculpture and fat grafting can effectively correct postpartum deformities. OBJECTIVE: The authors describe a multilayer and 360-degree approach, dynamic definition mini-abdominoplasty (DDM), to create athletic definition and contour and to restore a feminine appearance postpartum. METHODS: A total of 181 consecutive women ages 20 to 56 years underwent DDM between January 2005 and May 2012. Patients who were a minimum of 6 months postpartum and in good health, with a body mass index below 30, were considered for inclusion in the study. Fat grafting was performed in select cases in the buttocks, deltoids, and/or calves. A satisfaction index (SI) was estimated based on patient survey responses. RESULTS: An overall SI of 91.5% was achieved. No major complications were reported. Twenty-nine minor complications included postoperative anemia, seroma, and infection in the surgical wound. In most patients, the postpartum abdomen was restored to an aesthetic and even athletic appearance. Athletic definition to the rectus, arms, trunk, thighs, and buttocks was also achieved. No burns or flap necrosis were reported. CONCLUSIONS: Dynamic definition mini-abdominoplasty is safe and reproducible. It serves as a viable alternative to a full abdominoplasty in selected cases and for women who wish to restore an athletic and feminine appearance after childbirth. LEVEL OF EVIDENCE: 4.