Department of Urology, Kartal Training and Research Hospital, Istanbul, Turkey.
J Endourol. 2010 Apr;24(4):527-30. doi: 10.1089/end.2009.0398.
Dissection of the bladder neck is particularly important in patients who have previously had prostate surgery due to hyperplasia. We describe an endoscope-assisted radical perineal prostatectomy (RPP) technique that facilitates the dissection of the prostate-vesical junction. The technique was employed in four patients with a history of transurethral prostate resection. Before dissecting the prostate from the bladder neck during RPP, we circumscribed the bladder neck perurethrally with a Collins knife. The remaining of the RPP procedure was performed via the traditional approach. The incision of the prostate-vesical junction with the Collins knife protected the bladder-neck integrity and made the dissection of this junction easier. The final pathologic diagnosis was organ-confined prostate cancer with negative surgical margins. All the patients had continence during a 6-month follow-up. The major advantage of this technique is to precisely locate the prostate-vesical junction under direct vision. Our modified technique may prove to be a simple, less invasive, and oncologically safe method to manage the bladder neck perurethrally.
膀胱颈部解剖在因增生而接受过前列腺手术的患者中尤为重要。我们描述了一种内镜辅助根治性经会阴前列腺切除术（RPP）技术，该技术有助于前列腺-膀胱颈交界处的解剖。该技术在 4 例经尿道前列腺切除术病史的患者中应用。在 RPP 期间从膀胱颈部解剖前列腺之前，我们用柯林斯刀环绕尿道进行膀胱颈部切开。RPP 手术的其余部分通过传统方法进行。用柯林斯刀切开前列腺-膀胱颈交界处可保护膀胱颈的完整性，并使该交界处的解剖更容易。最终的病理诊断为局限于器官的前列腺癌，且切缘无肿瘤累及。所有患者在 6 个月的随访期间均保持尿控。该技术的主要优点是可以在直视下精确定位前列腺-膀胱颈交界处。我们改良的技术可能是一种简单、微创且具有肿瘤安全性的经尿道处理膀胱颈部的方法。
