RESUMO
El tratamiento para la incontinencia urinaria masculina de esfuerzo severa es la colocación de un esfínter urinario artificial (EUA). La etiología de la incontinencia con frecuencia es la cirugía prostática previa. Los resultados funcionales son buenos con una tasa aceptable de complicaciones. Las complicaciones son más frecuentes si existe radioterapia previa o se realizan procedimientos transuretrales sin tener en cuenta la presencia del manguito del EUA. Cuando es necesaria la cirugía transuretral, por ejemplo por tumor vesical, es necesario realizar el desabrochado del manguito esfinteriano. Los sondajes uretrales precisan también desactivar el manguito y manipular la uretra con sumo cuidado, evitando su manipulación siempre que sea posible. Se presentan tres casos muy complejos de pacientes portadores de EUA que han precisado diversas soluciones ante manipulación uretral y presencia de complicaciones como estenosis de uretra (AU)
Artificial urinary sphincter (AS) is the gold standard treatment for severe male urinary stress incontinence. The etiology of incontinence is often previous prostate surgery as a radical prostatectomy. Functional results are good with an acceptable rate of complications. If there is prior radiotherapy complications are more frequent. When transurethral surgery, for example for bladder tumor is needed, it is necessary unbuttoned the sleeve. Urethral soundings need also turn off the sleeve and manipulate the urethra carefully, avoiding handling whenever possible. We present three very complex cases of patients with US showing several solutions to urethral manipulation and to resolve complications such as urethral perforation and stricture (AU)
Assuntos
Humanos , Masculino , Adulto , Ressecção Transuretral da Próstata/métodos , Esfíncter Urinário Artificial/classificação , Esfíncter Urinário Artificial/normas , Incontinência Urinária/metabolismo , Incontinência Urinária/patologia , Doenças da Bexiga Urinária/diagnóstico , Estreitamento Uretral/congênito , Estreitamento Uretral/metabolismo , Ressecção Transuretral da Próstata/normas , Esfíncter Urinário Artificial/provisão & distribuição , Esfíncter Urinário Artificial , Incontinência Urinária/complicações , Incontinência Urinária/diagnóstico , Doenças da Bexiga Urinária/metabolismo , Estreitamento Uretral/complicações , Estreitamento Uretral/diagnósticoRESUMO
Urinary incontinence has a tremendous impact on an individual's quality of life and self-esteem. A number of patients will fail both conservative medical as well as conservative surgical treatments in their pursuit to regain urinary control. The surgical implantation of an artificial urinary sphincter (AUS) is a definitive surgical option to reestablish continence. However, there are many challenges that may arise as a patient progresses through the rigorous preparation, surgical procedure, and recovery process. Understanding the history, various indications, and risks of AUS surgery will aid in counseling patients considering AUS.
