Zhao Lee C, Weinberg Aaron C, Lee Ziho, Ferretti Mark J, Koo Harry P, Metro Michael J, Eun Daniel D, Stifelman Michael D
Department of Urology, New York University, Langone Medical Center, New York, NY, USA.
Department of Urology, New York University, Langone Medical Center, New York, NY, USA.
Eur Urol. 2018 Mar;73(3):419-426. doi: 10.1016/j.eururo.2017.11.015. Epub 2017 Nov 26.
Minimally invasive treatment of long, multifocal ureteral strictures or failed pyeloplasty is challenging. Robot-assisted buccal mucosa graft ureteroplasty (RBU) is a technique for ureteral reconstruction that avoids the morbidity of bowel interposition or autotransplantation.
To evaluate outcomes for RBU in a multi-institutional cohort of patients treated for revision ureteropelvic junction obstruction and long or multifocal ureteral stricture at three tertiary referral centers.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective study involved data for 19 patients treated with RBU at three high-volume centers between October 2013 and July 2016.
RBU was performed using either an onlay graft after incising the stricture or an augmented anastomotic repair in which the ureter was transected and re-anastomosed primarily on one side, and a graft was placed on the other side.
Preoperative, intraoperative, and postoperative variables and outcomes were assessed. A descriptive statistical analysis was performed.
The onlay technique was used for 79%, while repair was carried out using the augmented anastomotic technique for the remaining cases. The reconstruction was reinforced with omentum in 95% of cases. The ureteral stricture location was proximal in 74% and mid in 26% of cases. A prior failed ureteral reconstruction was present in 53% of patients. The median stricture length was 4.0cm (range 2.0-8.0), operative time was 200min (range 136-397), estimated blood loss was 95ml (range 25-420), and length of stay was 2 d (range 1-15). There were no intraoperative complications. At median follow-up of 26 mo, the overall success rate was 90%.
RBU is a feasible and effective technique for managing complex proximal and mid ureteral strictures.
We studied robotic surgery for long ureteral strictures using grafts at three referral centers. Our results demonstrate that robotic buccal mucosa graft ureteroplasty is a feasible and effective technique for ureteral reconstruction.
长段、多灶性输尿管狭窄或肾盂成形术失败后的微创治疗具有挑战性。机器人辅助颊黏膜移植输尿管成形术（RBU）是一种输尿管重建技术，可避免肠道介入或自体移植的并发症。
评估在三个三级转诊中心接受输尿管肾盂连接部梗阻修复术及长段或多灶性输尿管狭窄治疗的多机构队列患者中RBU的疗效。
设计、地点和参与者：这项回顾性研究纳入了2013年10月至2016年7月期间在三个大型中心接受RBU治疗的19例患者的数据。
RBU可采用切开狭窄后行覆盖移植术，或采用增强吻合修复术，即输尿管一侧横断并原位重新吻合，另一侧放置移植物。
评估术前、术中和术后变量及结局。进行描述性统计分析。
79%的病例采用覆盖技术，其余病例采用增强吻合技术修复。95%的病例用网膜加强重建。74%的病例输尿管狭窄位于近端，26%位于中段。53%的患者既往输尿管重建失败。狭窄中位数长度为4.0cm（范围2.0 - 8.0），手术时间为200分钟（范围136 - 397），估计失血量为95ml（范围25 - 420），住院时间为2天（范围1 - 15）。无术中并发症。中位随访26个月时，总体成功率为90%。
RBU是治疗复杂的近端和中段输尿管狭窄的一种可行且有效的技术。
我们在三个转诊中心研究了使用移植物治疗长段输尿管狭窄的机器人手术。我们的结果表明，机器人辅助颊黏膜移植输尿管成形术是一种可行且有效的输尿管重建技术。
