Srinivasan Arun K, Maass Daniel, Shrivastava Dhiren, Long Christopher J, Shukla Aseem R
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
J Pediatr Urol. 2017 Oct;13(5):494.e1-494.e7. doi: 10.1016/j.jpurol.2017.01.021. Epub 2017 Mar 6.
Voiding dysfunction after bilateral extravesical ureteral reimplantation for vesicoureteral reflux has long remained a concern. Robotic approach with improved visualization that enables focused and minimal dissection may help with this concern.
To compare postoperative outcomes after bilateral robot-assisted laparoscopic ureteral reimplantation to unilateral robot-assisted laparoscopic ureteral reimplantation.
This was a retrospective study using data abstracted from an institutional review board-approved registry prospectively maintained at our institution since 2012. Patient demographics, preoperative characteristics, and postoperative outcomes were analyzed. Patients with postoperative febrile urinary tract infection (UTI) underwent voiding cystourethrogram (VCUG). Surgical success is defined as absence of febrile UTI or febrile UTI with negative VCUG.
92 patients with a median follow-up of 14 (25th and 75th IQR 5, 28) months. Median operative time (150 vs. 178 min, p = 0.01) and median hospital stay (33 vs. 37 h, p = 0.01) were longer in the bilateral cohort. Weight-adjusted morphine equivalents requirement was also higher in the bilateral group (0.45 vs. 0.59, p = 0.019).
Early postoperative voiding dysfunction is influenced by anesthesia, postoperative pain, analgesics, age, surgical dissection, and preoperative voiding issues. Effective preoperative management of voiding dysfunction, minimizing surgical dissection and cautery, and minimizing opiate use will aid improving outcomes after surgery and enable bilateral surgeries on uretero-vesical junction. A robotic approach to facilitate such strategies could help outcomes after bilateral ureteral reimplantation. Limitations of this study include its retrospective design, the absence of routine postoperative VCUG after ureteral reimplantation, and unknown confounding variables.
Robot-assisted laparoscopic bilateral extravesical ureteral reimplantation is not associated with an increased risk of postoperative morbidity compared with unilateral surgery.
长期以来，双侧膀胱外输尿管再植术治疗膀胱输尿管反流后的排尿功能障碍一直备受关注。机器人手术方法具有更好的视野，能够进行精准且微创的解剖，可能有助于解决这一问题。
比较双侧机器人辅助腹腔镜输尿管再植术与单侧机器人辅助腹腔镜输尿管再植术的术后结果。
这是一项回顾性研究，使用了自2012年起在我们机构前瞻性维护的、经机构审查委员会批准的登记处提取的数据。分析了患者的人口统计学资料、术前特征和术后结果。术后发生发热性尿路感染（UTI）的患者接受了排尿性膀胱尿道造影（VCUG）检查。手术成功定义为无发热性UTI或发热性UTI且VCUG结果为阴性。
92例患者，中位随访时间为14（第25和第75四分位数间距为5，28）个月。双侧队列的中位手术时间（150分钟对178分钟，p = 0.01）和中位住院时间（33小时对37小时，p = 0.01）更长。双侧组的体重调整吗啡当量需求量也更高（0.45对0.59，p = 0.019）。
术后早期排尿功能障碍受麻醉、术后疼痛、镇痛药、年龄、手术解剖和术前排尿问题的影响。对排尿功能障碍进行有效的术前管理、尽量减少手术解剖和烧灼、尽量减少阿片类药物的使用，将有助于改善手术结果，并使输尿管膀胱连接部的双侧手术成为可能。采用机器人手术方法来促进这些策略可能有助于双侧输尿管再植术后的结果。本研究的局限性包括其回顾性设计、输尿管再植术后缺乏常规的术后VCUG检查以及未知的混杂变量。
与单侧手术相比，机器人辅助腹腔镜双侧膀胱外输尿管再植术术后发病风险并未增加。
