Department of Urology, Division of Pediatric Urology, Children's Medical Center, University of Texas Southwestern Medical Center , Dallas, TX 75235, USA.
J Endourol. 2011 Aug;25(8):1299-305. doi: 10.1089/end.2011.0031. Epub 2011 Jul 20.
To describe robot-assisted complex reconstruction of the lower urinary tract in children with neurogenic bladder and sphincteric incompetence.
Four sequential patients with spinal dysraphism, neurogenic bladder, and sphincteric incompetence based on urodynamic parameters had persistent urinary incontinence on maximal anticholinergic therapy and clean intermittent catheterization (CIC). They underwent robot-assisted Mitrofanoff appendicovesicostomy along with Leadbetter/Mitchell bladder neck reconstruction and bladder neck sling. All patients received cystography 3 weeks postoperatively. Patient demographics, medical history, perioperative parameters, and urinary continence status were collected prospectively.
Mean predicted bladder capacity was 353 mL (range 210-450 mL) while actual preoperative bladder capacity was 216 mL(range 180-275 mL). Preoperatively, one-patient demonstrated uninhibited bladder contractions; none had trabeculated bladders. Mean detrusor leak point pressure was 29 cm H(2)0. Three of four (75%) cases were completed robotically; one necessitated conversion to open and Monti channel creation because of a marginal appendix. Mean operative time (hours:minutes) was 7:45 (range 5:56-12:18). Mean length of stay and blood loss were 85.7 hours and 117.8 mL, respectively. Postoperatively, all patients were completely dry on CIC and anticholinergics. None of the bladders demonstrated trabeculation on follow-up cystography. Unilateral de novo grade II vesicoureteral reflux developed in two patients, and anticholinergics were dose escalated.
Our initial series of robot-assisted appendicovesicostomy with bladder neck reconstruction and sling placement expands the scope of complex robotic reconstruction in children. The preliminary data demonstrate the procedure to be feasible and safe. Comparison with traditional "open" series of the same procedure is necessary.
描述机器人辅助治疗神经源性膀胱和括约肌功能不全儿童下尿路复杂重建。
4 名连续的脊柱裂、神经源性膀胱和基于尿动力学参数的括约肌功能不全患者，在最大抗胆碱能治疗和间歇性清洁导尿（CIC）的情况下持续发生尿失禁。他们接受了机器人辅助米托法诺夫阑尾膀胱造口术，同时进行了利德贝特/米切尔膀胱颈重建和膀胱颈吊带术。所有患者术后 3 周行膀胱造影检查。前瞻性收集患者的人口统计学、病史、围手术期参数和尿控状态。
平均预测膀胱容量为 353ml（范围 210-450ml），而实际术前膀胱容量为 216ml（范围 180-275ml）。术前，1 例患者存在无抑制性膀胱收缩，均无膀胱小梁化。平均逼尿肌漏点压为 29cmH20。4 例中有 3 例（75%）完全通过机器人完成，1 例因阑尾边缘化需要转为开放和蒙蒂通道创建。平均手术时间（小时：分钟）为 7:45（范围 5:56-12:18）。平均住院时间和失血量分别为 85.7 小时和 117.8ml。术后，所有患者在 CIC 和抗胆碱能药物治疗下均完全干燥。随访膀胱造影检查中，所有膀胱均未见小梁化。2 例患者出现单侧新发 II 度膀胱输尿管反流，抗胆碱能药物剂量增加。
我们的机器人辅助阑尾膀胱造口术联合膀胱颈重建和吊带术的初始系列扩大了儿童复杂机器人重建的范围。初步数据表明该手术是可行且安全的。与传统的“开放”系列相同手术的比较是必要的。
