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Válvula de uretra
posterior
Hélberte Fernandes Freitas
Residência de Urologia
HC-UFG
Goiânia, 24 de fevereiro de 2011.
Histórico
 Langenbeck, em 1802, foi o primeiro
a descrever a obstrução congênita da
uretra prostática
 Young, em 1919, d...
Embriologia
 Pregas mucosas na uretra posterior,
de origem congênita
 Obstrução
 Sexo masculino
Campbell’s Urology – 9t...
Classificação
 Tipo I:
 Mais freqüente (95% dos casos)
 Verumontano
 Paredes laterais
 Obstrutivas, mas permitem pass...
Classificação
Campbell’s Urology – 9th Edition; vol. 4; p. 3585.
Classificação
 Tipo II:
 Do colo ao verumontano
 Pouco interesse clínico
 Tipo III: Diafragma perfurado
centralmente
...
Classificação
Campbell’s Urology – 9th Edition; vol. 4; p. 3585.
Classificação
Campbell’s Urology – 9th Edition; vol. 4; p. 3584.
Fisiopatologia
 Alterações em trato urinário inferior:
 Dilatação da uretra posterior
 Uretra anterior normal ou estrei...
Fisiopatologia
 Alterações em trato urinário superior:
 Refluxo vesicoureteral uni- ou bilateral
 Dilatação ureteral se...
Fisiopatologia
Campbell’s Urology – 9th Edition; vol. 4; p. 3586.
Quadro clínico
 USG antenatal:
 Dilatação do trato urinário alto
 Esvaziamento incompleto da bexiga
 Hipertrofia da pa...
Quadro clínico
Campbell’s Urology – 9th Edition; vol. 4; p. 3590.
Quadro clínico
 Sintomatologia Urinária:
 Dificuldade miccional
 Incontinência por transbordamento
 Bexiga palpável co...
Quadro clínico
Campbell’s Urology – 9th Edition; vol. 4; p. 3596.
Quadro clínico
 Sintomatologia Urinária:
 Infecção urinária
 Hematúria
 Insuficiência renal
 Ascite urinária
Campbell...
Quadro clínico
Campbell’s Urology – 9th Edition; vol. 4; p. 3589.
Quadro clínico
 Sintomatologia Não Urinária:
 Distensão abdominal
 Diarréia ou constipação
 Vômitos
 Febre
 Desidrat...
Diagnóstico
 Uretrocistografia miccional
 Exame de escolha
 Pacientes sem infecção
 Achados radiológicos:
 Uretra
 B...
Diagnóstico
Campbell’s Urology – 9th Edition; vol. 4; p. 3591.
Diagnóstico
 Urografia Excretora:
 Alterações do trato urinário alto
 Ultra-sonografia:
 Avaliação global do trato uri...
Diagnóstico
Campbell’s Urology – 9th Edition; vol. 4; p. 3591.
Diagnóstico
 Cintilografia
 Exames Laboratoriais:
 EAS / Urocultura
 Hemograma
 Coagulograma
 Uréia e creatinina
 G...
Tratamento
 Pré-Operatório:
 Desequilíbrio hidroeletrolítico e ácido-
básico
 Sepse e anemia
 Infecção urinária
 Insu...
Tratamento
 Tratamento cirúrgico:
 Fulguração endoscópica por via uretral
retrógrada
 4 e 8 h
 Válvulas anteriores ou ...
Tratamento
Campbell’s Urology – 9th Edition; vol. 4; p. 3592.
Tratamento
Campbell’s Urology – 9th Edition; vol. 4; p. 3593.
Tratamento
Campbell’s Urology – 9th Edition; vol. 4; p. 3594.
Pós-operatório
 Hidronefrose e dilatação
 Refluxo
 Função renal
 Pressão arterial
 Crescimento e desenvolvimento
Camp...
Pós-operatório
 Bexiga da válvula:
 Hiper-reflexa
 Hipertônica de baixa capacidade
 Falência miogênica da bexiga
 Tra...
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Válvula de uretra posterior

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Válvula de uretra posterior

  1. 1. Válvula de uretra posterior Hélberte Fernandes Freitas Residência de Urologia HC-UFG Goiânia, 24 de fevereiro de 2011.
  2. 2. Histórico  Langenbeck, em 1802, foi o primeiro a descrever a obstrução congênita da uretra prostática  Young, em 1919, definiu a condição e a classificou em tipos Campbell’s Urology – 9th Edition; vol. 4; p. 3583.
  3. 3. Embriologia  Pregas mucosas na uretra posterior, de origem congênita  Obstrução  Sexo masculino Campbell’s Urology – 9th Edition; vol. 4; p. 3583.
  4. 4. Classificação  Tipo I:  Mais freqüente (95% dos casos)  Verumontano  Paredes laterais  Obstrutivas, mas permitem passagem de sonda Campbell’s Urology – 9th Edition; vol. 4; p. 3584.
  5. 5. Classificação Campbell’s Urology – 9th Edition; vol. 4; p. 3585.
  6. 6. Classificação  Tipo II:  Do colo ao verumontano  Pouco interesse clínico  Tipo III: Diafragma perfurado centralmente  Distal ao verumontano  Caráter obstrutivo  Dificuldade de sondagem Campbell’s Urology – 9th Edition; vol. 4; p. 3584.
  7. 7. Classificação Campbell’s Urology – 9th Edition; vol. 4; p. 3585.
  8. 8. Classificação Campbell’s Urology – 9th Edition; vol. 4; p. 3584.
  9. 9. Fisiopatologia  Alterações em trato urinário inferior:  Dilatação da uretra posterior  Uretra anterior normal ou estreitada  Hipertrofia do detrusor – trabéculas – pseudodivertículos ou divertículos  Colo vesical fechado ou aberto Campbell’s Urology – 9th Edition; vol. 4; p. 3585 e 3586.
  10. 10. Fisiopatologia  Alterações em trato urinário superior:  Refluxo vesicoureteral uni- ou bilateral  Dilatação ureteral sem refluxo  Estenose na junção ureterovesical  Hidronefrose  Acometimento renal primário ou secundário Campbell’s Urology – 9th Edition; vol. 4; p. 3586 e 3587.
  11. 11. Fisiopatologia Campbell’s Urology – 9th Edition; vol. 4; p. 3586.
  12. 12. Quadro clínico  USG antenatal:  Dilatação do trato urinário alto  Esvaziamento incompleto da bexiga  Hipertrofia da parede vesical  Dilatação da uretra posterior Campbell’s Urology – 9th Edition; vol. 4; p. 3588.
  13. 13. Quadro clínico Campbell’s Urology – 9th Edition; vol. 4; p. 3590.
  14. 14. Quadro clínico  Sintomatologia Urinária:  Dificuldade miccional  Incontinência por transbordamento  Bexiga palpável constantemente  Rins e ureteres palpáveis Campbell’s Urology – 9th Edition; vol. 4; p. 3588.
  15. 15. Quadro clínico Campbell’s Urology – 9th Edition; vol. 4; p. 3596.
  16. 16. Quadro clínico  Sintomatologia Urinária:  Infecção urinária  Hematúria  Insuficiência renal  Ascite urinária Campbell’s Urology – 9th Edition; vol. 4; p. 3588.
  17. 17. Quadro clínico Campbell’s Urology – 9th Edition; vol. 4; p. 3589.
  18. 18. Quadro clínico  Sintomatologia Não Urinária:  Distensão abdominal  Diarréia ou constipação  Vômitos  Febre  Desidratação e desnutrição  Hipertensão Campbell’s Urology – 9th Edition; vol. 4; p. 3588.
  19. 19. Diagnóstico  Uretrocistografia miccional  Exame de escolha  Pacientes sem infecção  Achados radiológicos:  Uretra  Bexiga Campbell’s Urology – 9th Edition; vol. 4; p. 3589.
  20. 20. Diagnóstico Campbell’s Urology – 9th Edition; vol. 4; p. 3591.
  21. 21. Diagnóstico  Urografia Excretora:  Alterações do trato urinário alto  Ultra-sonografia:  Avaliação global do trato urinário  Qualidade do parênquima renal  Avaliação antenatal Campbell’s Urology – 9th Edition; vol. 4; p. 3588.
  22. 22. Diagnóstico Campbell’s Urology – 9th Edition; vol. 4; p. 3591.
  23. 23. Diagnóstico  Cintilografia  Exames Laboratoriais:  EAS / Urocultura  Hemograma  Coagulograma  Uréia e creatinina  Gasometria  Clearances Campbell’s Urology – 9th Edition; vol. 4; p. 3590.
  24. 24. Tratamento  Pré-Operatório:  Desequilíbrio hidroeletrolítico e ácido- básico  Sepse e anemia  Infecção urinária  Insuficiência renal  Ascite urinária  Drenagem urinária provisória Campbell’s Urology – 9th Edition; vol. 4; p. 3590 e 3591.
  25. 25. Tratamento  Tratamento cirúrgico:  Fulguração endoscópica por via uretral retrógrada  4 e 8 h  Válvulas anteriores ou do tipo III: 12h  Vesicostomia  Crianças muito pequenas que não são passíveis de tto endoscópico Campbell’s Urology – 9th Edition; vol. 4; p. 3591 e 3592.
  26. 26. Tratamento Campbell’s Urology – 9th Edition; vol. 4; p. 3592.
  27. 27. Tratamento Campbell’s Urology – 9th Edition; vol. 4; p. 3593.
  28. 28. Tratamento Campbell’s Urology – 9th Edition; vol. 4; p. 3594.
  29. 29. Pós-operatório  Hidronefrose e dilatação  Refluxo  Função renal  Pressão arterial  Crescimento e desenvolvimento Campbell’s Urology – 9th Edition; vol. 4; p. 3595.
  30. 30. Pós-operatório  Bexiga da válvula:  Hiper-reflexa  Hipertônica de baixa capacidade  Falência miogênica da bexiga  Tratamento clínico ou cirúrgico Campbell’s Urology – 9th Edition; vol. 4; p. 3595.
  31. 31. OBRIGADO

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