Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Affiliated to University of Leeds, Level F Martin Wing, Leeds, LS1 3EX, UK.
Ghent University, Ghent, Belgium.
World J Urol. 2020 Aug;38(8):1869-1874. doi: 10.1007/s00345-019-02777-9. Epub 2019 May 2.
To present the author's experience with detrusorotomy (DM) for refractory detrusor overactivity (RDO) with open and robotic approach.
Children who underwent DM for RDO in a single surgeon series since 2012 were identified from a prospectively maintained database. Those who completed the defined strict bladder cycling regime postoperatively were included in this report excluding those who failed the bladder cycling regime.
Ten children (M7: F3) were included in this report, six open and four robotic. All procedures were completed with no conversion to open in the robotic group. There were no intra or postoperative complications from the procedures. Duration of procedure was lower in robotic group (125 min) vs the open group at (208 min). Hospital stay was also lower in the robotic group (2.7 days) compared to the open group (5.6 days). All children in open group had concomitant Mitrofanoff channel created for bladder drainage. One child in robotic group had concomitant Mitrofanoff channel during DM. Median follow-up is longer at 54 months (31-82) in open group compared to 14 months (5-21). All children are clinically well with safe upper tracts on US scan in both series. Estimated % change in bladder capacity is similar in both groups at 140 (90-200) and 126 (80-200) for open and robotic groups, respectively.
DM as an extension of medical treatment for RDO can be performed safely and is effective in children. Preliminary experience with robotic approach to DM is promising with reduced duration of procedure and hospital stay.
介绍作者在经尿道膀胱切开术（DM）治疗难治性逼尿肌过度活动（RDO）方面的经验，包括开放和机器人两种入路方式。
从一名外科医生的前瞻性数据库中确定了自 2012 年以来接受过 DM 治疗 RDO 的儿童患者。本报告仅包括在术后完成明确的严格膀胱循环方案的患者，而不包括那些未能完成膀胱循环方案的患者。
本报告共纳入 10 例儿童患者（男 7 例，女 3 例），其中 6 例为开放手术，4 例为机器人手术。所有手术均顺利完成，机器人组无中转开放手术。手术过程中没有出现任何并发症。机器人组的手术时间（125 分钟）明显短于开放组（208 分钟）。机器人组的住院时间（2.7 天）也短于开放组（5.6 天）。所有开放组的患者均同时进行了膀胱造口术，以建立Mitrofanoff 通道进行膀胱引流。机器人组有 1 例患者在 DM 期间同时进行了 Mitrofanoff 通道手术。开放组的中位随访时间为 54 个月（31-82 个月），明显长于机器人组的 14 个月（5-21 个月）。两组患者的临床情况均良好，超声检查显示上尿路安全。两组的膀胱容量估计百分比变化相似，分别为 140%（90-200）和 126%（80-200）。
DM 作为 RDO 治疗的一种延伸方法，可以安全有效地应用于儿童。初步的机器人 DM 经验显示，该方法具有手术时间和住院时间缩短的优势。
