trauma ureterales
TRANSCRIPT
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Trauma ureterales
Dr. Gustavo HernandezR1 de Urologia
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Ureteres
• Estructuras tubulares bilaterales transpotan la orina de la pelvis hasta la vejiga
• 22-30 cms• Relaciones • UD: colon ascendente, ciego , mesenterio
colonico y el apendice• UI: colon descendente y sigmoides y sus
mesnterios
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• Cruzan sobre los vasos iliacos comunes en la bifurcacion a externa e interna
• Estrechamientos:• Union pieloureteral• Cruce con los vasos iliacos• Union ureterovesical
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causas
• Traumatismo externo• Cirugias• Laparoscopias• Ligaduras intraoperatorias• Avulsion• Desvascularizacion por cauterios , vibracion
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Complicaciones
• Lesiones inadvertidas:• Urinoma • Absceso• Estenosis• Fistula• Perdida potencial de la unidad renal
homolateral
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Clasificacion
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Diagnostico
• Tranquirurgico (observacion) • Azul de metileno• Inspeccion del retroperitoneo• Urografia excretora• TAC• Ureterrografia retrograda
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Tratamiento
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Principios
• Movilizar el ureter con precausion, mantener la adventicia
• Desbridar los bordes hasta que sangren los bordes• Reparar libre de tension• Material reabsorbible monofilamento 5-0• Retroperitonealizarse• Reparacion T-T hasta los 2/3 superiores• Tutor ureteral interno
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• Autotransplante de riñon• Interposicion de intestino
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Lesion de la porcion inferior
• Ureteroneocistostomia• Fijacion al psoas y la vejiga• Colgajo de Boari• reimplante
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Control de daño
• No hacer nada pero reoperar en 24 hrs• Tutor ureteral y nada mas• Exteriorizar el ureter• Ligarlo y realizar nefrostomia
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