Scientific Letter
The long walk of urethral injuries
La larga marcha de los traumatismos uretrales
Read
7309
Timeswas read the article
2259
Total PDF
5050
Total HTML
Share statistics
array:23 [ "pii" => "S2341287915000344" "issn" => "23412879" "doi" => "10.1016/j.anpede.2014.09.005" "estado" => "S300" "fechaPublicacion" => "2015-03-01" "aid" => "1732" "copyright" => "Asociación Española de Pediatría" "copyrightAnyo" => "2014" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "An Pediatr (Barc). 2015;82:192-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2172 "formatos" => array:3 [ "EPUB" => 145 "HTML" => 1617 "PDF" => 410 ] ] "Traduccion" => array:1 [ "es" => array:18 [ "pii" => "S1695403314004536" "issn" => "16954033" "doi" => "10.1016/j.anpedi.2014.09.015" "estado" => "S300" "fechaPublicacion" => "2015-03-01" "aid" => "1732" "copyright" => "Asociación Española de Pediatría" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "An Pediatr (Barc). 2015;82:192-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3156 "formatos" => array:3 [ "EPUB" => 114 "HTML" => 2560 "PDF" => 482 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">CARTA CIENTÍFICA</span>" "titulo" => "La larga marcha de los traumatismos uretrales" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "192" "paginaFinal" => "193" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "The long walk of urethral injuries" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 840 "Ancho" => 950 "Tamanyo" => 84341 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Estenosis de la uretra membranosa en imagen de cistoscopia y fulguración con láser.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Fernandez Ibieta, A. Bujons Tur, J. Caffaratti Sfulcini, L. Ayuso González, H. Villavicencio" "autores" => array:5 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Fernandez Ibieta" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Bujons Tur" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Caffaratti Sfulcini" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Ayuso González" ] 4 => array:2 [ "nombre" => "H." "apellidos" => "Villavicencio" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341287915000344" "doi" => "10.1016/j.anpede.2014.09.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915000344?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403314004536?idApp=UINPBA00005H" "url" => "/16954033/0000008200000003/v2_201502230153/S1695403314004536/v2_201502230153/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "S2341287915000290" "issn" => "23412879" "doi" => "10.1016/j.anpede.2014.07.002" "estado" => "S300" "fechaPublicacion" => "2015-03-01" "aid" => "1686" "copyright" => "Asociación Española de Pediatría" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "An Pediatr (Barc). 2015;82:193-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2504 "formatos" => array:3 [ "EPUB" => 161 "HTML" => 1886 "PDF" => 457 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Premature constriction of the ductus arteriosus" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "193" "paginaFinal" => "195" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Constricción precoz del ductus arterioso" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1128 "Ancho" => 1500 "Tamanyo" => 240047 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Severe premature constriction of the ductus arteriosus. (A) Four-chamber view showing dilatation of the right heart chambers with the foramen ovale flap bulging into the left atrium. (B) Doppler of the ductus arteriosus revealing a continuous blood flow with increased systolic and diastolic flow velocities. (C) Severe tricuspid regurgitation. (D) Three-vessel view showing a reduced ductal diameter.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Ayerza Casas, L. Jiménez Montañés, M. López Ramón, D. Lerma Puertas, M.D. García de la Calzada" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Ayerza Casas" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Jiménez Montañés" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "López Ramón" ] 3 => array:2 [ "nombre" => "D." "apellidos" => "Lerma Puertas" ] 4 => array:2 [ "nombre" => "M.D." "apellidos" => "García de la Calzada" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915000290?idApp=UINPBA00005H" "url" => "/23412879/0000008200000003/v2_201504151313/S2341287915000290/v2_201504151313/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2341287915000277" "issn" => "23412879" "doi" => "10.1016/j.anpede.2014.05.003" "estado" => "S300" "fechaPublicacion" => "2015-03-01" "aid" => "1643" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2015;82:183-91" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1441 "formatos" => array:3 [ "EPUB" => 120 "HTML" => 957 "PDF" => 364 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Motor behaviour of human foetuses during the second trimester of gestation: A longitudinal ultrasound study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "183" "paginaFinal" => "191" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Motricidad fetal durante el segundo trimestre de gestación: estudio ecográfico longitudinal" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 846 "Ancho" => 1604 "Tamanyo" => 90197 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">(a) Incidence of startle events (in vertical axis) in the 13 foetuses at the four observation times in the second trimester of gestation (in horizontal axis: weeks 12, 16, 20 and 24). (b) Incidence of general movements (in vertical axis) in the 13 foetuses at the four observation times in the second trimester of gestation (in horizontal axis: weeks 12, 16, 20 and 24).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Reynoso, N. Crespo-Eguílaz, J.L. Alcázar, J. Narbona" "autores" => array:4 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Reynoso" ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Crespo-Eguílaz" ] 2 => array:2 [ "nombre" => "J.L." "apellidos" => "Alcázar" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Narbona" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403314003002" "doi" => "10.1016/j.anpedi.2014.05.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403314003002?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915000277?idApp=UINPBA00005H" "url" => "/23412879/0000008200000003/v2_201504151313/S2341287915000277/v2_201504151313/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "The long walk of urethral injuries" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "192" "paginaFinal" => "193" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Fernandez Ibieta, A. Bujons Tur, J. Caffaratti Sfulcini, L. Ayuso González, H. Villavicencio" "autores" => array:5 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Fernandez Ibieta" "email" => array:1 [ 0 => "mfndezibieta@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Bujons Tur" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Caffaratti Sfulcini" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "L." "apellidos" => "Ayuso González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "H." "apellidos" => "Villavicencio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Cirugía Pediátrica, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Sección de Uropediatría, Fundación Puigvert, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Cirugía Pediátrica, Complejo Hospitalario de Navarra, Hospital Virgen del Camino, Pamplona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La larga marcha de los traumatismos uretrales" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 840 "Ancho" => 951 "Tamanyo" => 91716 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Stenosis of the membranous urethra in cystoscopy image and laser fulguration.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The urethra does not usually attract the interest of paediatricians during the initial management of a polytraumatised patient; so it is common that in patients with multiple trauma, especially those with pelvic fractures or perineal injuries, urologic lesions (present in 7.4–13.5% of paediatric pelvic trauma) are discovered when catheterisation cannot be performed or is extremely painful.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> Injuries of the anterior urethra (penile and bulbar) are caused by falls on the perineum (“straddle” falls); while injuries of the posterior urethra (membranous and prostatic) are associated with pelvic fractures, especially unstable ones (Malgaigne).<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–3</span></a> The diagnosis and classification of these injuries are based on retrograde urethrography. The initial procedure in childhood urethral injuries is suprapubic derivation (a tube cystostomy),<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–4</span></a> and it is convenient if feasible and Given enough experience to start management with endoscopic realignment within the first days.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–4</span></a> Early <span class="elsevierStyleItalic">open</span> urethral realignment is not recommended (there is risk of harming vascular and neural structures.)<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–4</span></a> The long-term sequelae of urethral injury are stricture, urethrocutaneous fistulae, urinary incontinence and erectile dysfunction (ED). Strictures require different interventions a few months after the trauma: open surgery (urethroplasty: tension-free end-to-end anastomosis or buccal mucosa graft urethroplasty using the transperineal—most frequently—or the transpubic approach), or endoscopic surgery (urethrotomy: resection of short strictures).<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–4</span></a> Strictures recur frequently after a first intervention (it may occur years after the procedure).</p><p id="par0010" class="elsevierStylePara elsevierViewall">In this paper we present a series of 3 cases that illustrate the complexity of the management of posterior urethral trauma and the importance of its sequelae.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Case 1. Male aged 13 years with pelvic trauma (motorcycle accident), pelvic fracture and rupture of the posterior urethra. The initial management was a suprapubic catheter. He developed a posterior urethral stricture and urethrocutaneous fistulae. End-to-end urethroplasties were performed at 6 and 9 months post-surgery, with full recurrence of the stricture after each. A surgery for continent urinary diversion (Mitrofanoff procedure) with surgical closure of the bladder neck was performed at 14 months post-surgery. Twelve years after the trauma, he was fitted with an intermittent catheterization but suffered from chronic orchidoepididymitis and severe ED.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Case 2. Male aged 9 years with pelvic and urethral trauma (bicycle fall). The initial management consisted of a permanent suprapubic catheter. End-to-end urethroplasty was performed at 2 months post-surgery, with the stricture recurring. A second urethroplasty (buccal mucosa graft) was performed one year later and was unsuccessful (the stricture recurred), with recurrent orchitis. Two and a half years after the accident, it was decided to perform an endoscopic urethrotomy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), and the stricture recurred again. Two end-to-end urethroplasties followed (bulbomembranous urethra) at 4 and 5 years post-surgery. Six years after the surgery, and one year after the latest urethroplasty, the patient was asymptomatic and the urethral stricture had not recurred.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Case 3. Male aged 12 years with pelvic trauma (crushing) and rupture of the prostatic urethra (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Primary endoscopic realignment was performed. Endoscopic internal urethrotomies were performed at 5, 6, 9 and 14 months post-surgery. Transurethral lithotripsies were performed at 5 and 18 months after the patient developed vesicular lithiasis. An end-to-end urethroplasty was performed at 2 years post-surgery, and since the stricture recurred, a transpubic urethroplasty was performed at 3 years post-surgery. At 14 years post-surgery, the patient suffered from urinary incontinence and retrograde ejaculation.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The management of urethral lesions in pelvic trauma survivors must focus on minimising the risk of future sequelae. There is still controversy surrounding its initial management in paediatric urology. Once urinary derivation by suprapubic catheterisation (vesicostomy) has been done, it is difficult to perform primary endoscopic realignment (the main approach in adults)<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–4</span></a> in young children due to lack of experience and of paediatric cystoscopic equipment (including a flexible cystoscope). Urethral stricture is the natural course of full ruptures, leading to difficult urination and often to post-void residual urine, lithiasis, urinary retention, and urinary tract infections. The rate of stricture recurrence is high for the endoscopic approach, and is also considerable after open urethroplasty (15–68%).<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Another possible sequela, urinary retention, occurs less frequently (3–24%), although it is the complication that has the greatest impact on the quality of life of a child or adolescent that has survived pelvic trauma.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–5</span></a> Last of all, ED is also a very prevalent sequela and it has only been studied recently in patients that presented with posterior urethral injury during childhood.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,6</span></a> In a recent retrospective study of 60 patients that had urethral injuries in childhood, 47% exhibited ED (severe in 82% of them), mainly due to damage to vascular structures (vasculogenic aetiology).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Posterior urethral injuries must not be underestimated in cases of pelvic trauma in children. While these injuries do not affect initial mortality, their treatment can be unsuccessful and impact the long-term quality of life in adulthood.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Fernandez Ibieta M, Bujons Tur A, Caffaratti Sfulcini J, Ayuso González L, Villavicencio H. La larga marcha de los traumatismos uretrales. An Pediatr (Barc). 2015;82:192–193.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 840 "Ancho" => 951 "Tamanyo" => 91716 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Stenosis of the membranous urethra in cystoscopy image and laser fulguration.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 712 "Ancho" => 995 "Tamanyo" => 38738 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Total rupture of the urethra at the prostatomembranous junction (combined retrograde and anterograde urethrogram with suprapubic cystostomy).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and management of pediatric urethral injuries" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Pichler" 1 => "H. Fritsch" 2 => "V. Skradski" 3 => "W. Horninger" 4 => "B. Schlenk" 5 => "P. Rehder" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000336291" "Revista" => array:6 [ "tituloSerie" => "Urol Int" "fecha" => "2012" "volumen" => "89" "paginaInicial" => "136" "paginaFinal" => "142" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22433843" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Post-traumatic urethral strictures in children: what have we learned over the years?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P. Ranjan" 1 => "M. Ansari" 2 => "M. Singh" 3 => "S. Chipre" 4 => "R. Singh" 5 => "R. Kapoor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jpurol.2011.06.004" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Urol" "fecha" => "2012" "volumen" => "8" "paginaInicial" => "234" "paginaFinal" => "239" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21764640" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary realignment vs suprapubic cystostomy for the management of pelvis fracture-associated urethral injuries: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Barret" 1 => "L.H. Braga" 2 => "F. Farrokhyar" 3 => "T.O. Davies" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Urol" "fecha" => "2014" "volumen" => "83" "paginaInicial" => "924" "paginaFinal" => "929" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Post-traumatic posterior urethral stricture in children: how to achieve a successful repair" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Orabi" 1 => "H. Badawy" 2 => "A. Saad" 3 => "M. Youssef" 4 => "A. Hanno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jpurol.2008.01.209" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Urol" "fecha" => "2008" "volumen" => "4" "paginaInicial" => "290" "paginaFinal" => "294" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18644532" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blunt pediatric anterior and posterior urethral trauma: 32-year experience and outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.B. Voelzke" 1 => "B. Breyer" 2 => "J.W. McAninch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jpurol.2011.05.010" "Revista" => array:6 [ "tituloSerie" => "J Pediatr Urol" "fecha" => "2012" "volumen" => "8" "paginaInicial" => "258" "paginaFinal" => "263" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21664873" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predicting risk of erectile dysfunction after pelvis fracture urethral injury in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.M. Koraitim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.juro.2014.02.094" "Revista" => array:6 [ "tituloSerie" => "J Urol" "fecha" => "2014" "volumen" => "192" "paginaInicial" => "519" "paginaFinal" => "523" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24603106" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008200000003/v2_201504151313/S2341287915000344/v2_201504151313/en/main.assets" "Apartado" => array:4 [ "identificador" => "38181" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008200000003/v2_201504151313/S2341287915000344/v2_201504151313/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915000344?idApp=UINPBA00005H" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 11 | 20 |
| 2024 October | 72 | 37 | 109 |
| 2024 September | 55 | 33 | 88 |
| 2024 August | 75 | 69 | 144 |
| 2024 July | 72 | 49 | 121 |
| 2024 June | 116 | 44 | 160 |
| 2024 May | 86 | 41 | 127 |
| 2024 April | 79 | 51 | 130 |
| 2024 March | 54 | 29 | 83 |
| 2024 February | 63 | 22 | 85 |
| 2024 January | 63 | 31 | 94 |
| 2023 December | 82 | 18 | 100 |
| 2023 November | 79 | 25 | 104 |
| 2023 October | 74 | 32 | 106 |
| 2023 September | 69 | 28 | 97 |
| 2023 August | 55 | 18 | 73 |
| 2023 July | 76 | 30 | 106 |
| 2023 June | 84 | 45 | 129 |
| 2023 May | 68 | 21 | 89 |
| 2023 April | 38 | 23 | 61 |
| 2023 March | 61 | 26 | 87 |
| 2023 February | 71 | 23 | 94 |
| 2023 January | 40 | 24 | 64 |
| 2022 December | 59 | 38 | 97 |
| 2022 November | 58 | 31 | 89 |
| 2022 October | 69 | 53 | 122 |
| 2022 September | 57 | 34 | 91 |
| 2022 August | 93 | 51 | 144 |
| 2022 July | 61 | 43 | 104 |
| 2022 June | 57 | 35 | 92 |
| 2022 May | 66 | 40 | 106 |
| 2022 April | 51 | 44 | 95 |
| 2022 March | 64 | 47 | 111 |
| 2022 February | 57 | 25 | 82 |
| 2022 January | 77 | 23 | 100 |
| 2021 December | 59 | 43 | 102 |
| 2021 November | 58 | 50 | 108 |
| 2021 October | 59 | 53 | 112 |
| 2021 September | 44 | 46 | 90 |
| 2021 August | 49 | 44 | 93 |
| 2021 July | 43 | 22 | 65 |
| 2021 June | 47 | 34 | 81 |
| 2021 May | 45 | 28 | 73 |
| 2021 April | 115 | 49 | 164 |
| 2021 March | 60 | 31 | 91 |
| 2021 February | 48 | 23 | 71 |
| 2021 January | 51 | 25 | 76 |
| 2020 December | 43 | 22 | 65 |
| 2020 November | 44 | 21 | 65 |
| 2020 October | 39 | 16 | 55 |
| 2020 September | 36 | 20 | 56 |
| 2020 August | 41 | 16 | 57 |
| 2020 July | 50 | 22 | 72 |
| 2020 June | 54 | 16 | 70 |
| 2020 May | 54 | 26 | 80 |
| 2020 April | 31 | 19 | 50 |
| 2020 March | 37 | 23 | 60 |
| 2020 February | 32 | 13 | 45 |
| 2020 January | 41 | 13 | 54 |
| 2019 December | 49 | 25 | 74 |
| 2019 November | 40 | 12 | 52 |
| 2019 October | 57 | 12 | 69 |
| 2019 September | 38 | 9 | 47 |
| 2019 August | 55 | 13 | 68 |
| 2019 July | 46 | 24 | 70 |
| 2019 June | 70 | 18 | 88 |
| 2019 May | 183 | 21 | 204 |
| 2019 April | 163 | 23 | 186 |
| 2019 March | 41 | 23 | 64 |
| 2019 February | 48 | 19 | 67 |
| 2019 January | 41 | 13 | 54 |
| 2018 December | 43 | 25 | 68 |
| 2018 November | 64 | 32 | 96 |
| 2018 October | 58 | 18 | 76 |
| 2018 September | 24 | 22 | 46 |
| 2018 August | 2 | 0 | 2 |
| 2018 June | 1 | 0 | 1 |
| 2018 May | 8 | 0 | 8 |
| 2018 April | 26 | 0 | 26 |
| 2018 March | 27 | 0 | 27 |
| 2018 February | 12 | 0 | 12 |
| 2018 January | 22 | 0 | 22 |
| 2017 December | 19 | 0 | 19 |
| 2017 November | 17 | 0 | 17 |
| 2017 October | 12 | 0 | 12 |
| 2017 September | 21 | 0 | 21 |
| 2017 August | 17 | 0 | 17 |
| 2017 July | 29 | 3 | 32 |
| 2017 June | 31 | 7 | 38 |
| 2017 May | 30 | 9 | 39 |
| 2017 April | 22 | 6 | 28 |
| 2017 March | 15 | 5 | 20 |
| 2017 February | 24 | 3 | 27 |
| 2017 January | 26 | 1 | 27 |
| 2016 December | 12 | 10 | 22 |
| 2016 November | 36 | 8 | 44 |
| 2016 October | 43 | 8 | 51 |
| 2016 September | 48 | 8 | 56 |
| 2016 August | 30 | 5 | 35 |
| 2016 July | 10 | 8 | 18 |
Show all
