Kirshenbaum Eric J, Zhao Lee C, Myers Jeremy B, Elliott Sean P, Vanni Alex J, Baradaran Nima, Erickson Bradley A, Buckley Jill C, Voelzke Bryan B, Granieri Michael A, Summers Stephen J, Breyer Benjamin N, Dash Atreya, Weinberg Aaron, Alsikafi Nejd F
Department of Urology, Loyola University, Maywood, IL.
Department of Urology, New York University, New York, NY.
Urology. 2018 Aug;118:227-233. doi: 10.1016/j.urology.2018.05.007. Epub 2018 May 16.
To review a robotic approach to recalcitrant bladder neck obstruction and to assess success and incontinence rates.
Patients with a recalcitrant bladder neck contracture or vesicourethral anastomotic stenosis who underwent robotic bladder neck reconstruction (RBNR) were identified. We reviewed patient demographics, medical history, etiology, previous endoscopic management, cystoscopic and symptomatic outcomes, urinary continence, and complications. Stricture success was anatomic and functional based upon atraumatic passage of a 17 Fr flexible cystoscope or uroflowmetry rate >15 ml/s. Incontinence was defined as the use of >1 pad per day or procedures for incontinence.
Between 2015 and 2017, 12 patients were identified who met study criteria and underwent RBNR. Etiology of obstruction was endoscopic prostate procedure in 7 and radical prostatectomy in 5. The mean operative time was 216 minutes (range 120-390 minutes), with a mean estimated blood loss of 85 cc (range 5-200 cc). Median length of stay was 1 day (range 1-5 days). Three of 12 patients had recurrence of obstruction for a 75% success rate. Additionally, 82% of patients without preoperative incontinence were continent with a median follow-up of 13.5 months (range 5-30 months). There was 1 Clavien IIIb complication of osteitis pubis and pubovesical fistula that required vesicopubic fistula repair with pubic bone debridement.
RBNR is a viable surgical option with high patency rates and favorable continence outcomes. This is in contrast to perineal reconstruction, which has high incontinence rates. If future incontinence procedures are needed, outcomes may be improved given lack of previous perineal dissection.
回顾一种治疗顽固性膀胱颈梗阻的机器人手术方法，并评估成功率和尿失禁发生率。
确定接受机器人膀胱颈重建术（RBNR）的顽固性膀胱颈挛缩或膀胱尿道吻合口狭窄患者。我们回顾了患者的人口统计学资料、病史、病因、既往内镜治疗情况、膀胱镜检查及症状性结果、尿失禁情况和并发症。狭窄成功基于17F柔性膀胱镜无创伤通过或尿流率>15ml/s的解剖学和功能标准。尿失禁定义为每天使用超过1片尿垫或进行尿失禁治疗。
2015年至2017年期间，确定12例符合研究标准并接受RBNR的患者。梗阻病因包括7例内镜前列腺手术和5例根治性前列腺切除术。平均手术时间为216分钟（范围120 - 390分钟），平均估计失血量为85cc（范围5 - 200cc）。中位住院时间为1天（范围1 - 5天）。12例患者中有3例梗阻复发，成功率为75%。此外，术前无尿失禁的患者中有82%在中位随访13.5个月（范围5 - 30个月）时保持尿控。有1例耻骨炎和耻骨膀胱瘘的Clavien IIIb级并发症，需要进行耻骨膀胱瘘修补和耻骨清创。
RBNR是一种可行的手术选择，通畅率高且尿失禁结局良好。这与会阴重建术不同，后者尿失禁发生率高。如果未来需要进行尿失禁手术，由于缺乏先前的会阴解剖，结局可能会得到改善。
