Masieri L, Sforza S, Di Maida F, Grosso Antonio Andrea, Mari A, Rosi Emma Maria, Tellini R, Carini M, Minervini A
Department of Pediatric Urology, University of Florence, Meyer Hospital, Florence, Italy.
Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy.
Scand J Urol. 2019 Oct;53(5):356-360. doi: 10.1080/21681805.2019.1651390. Epub 2019 Aug 30.
Iatrogenic stenosis is a relatively common complication and it could happen after urological procedures in the entire course of the ureter. The aim of this study is to report the surgical outcomes of 36 consecutive patients (period April 2013-November 2018) submitted to robot-assisted correction of benign stricture with previous urological surgery in a tertiary referral center. Elective criteria were to have had a benign ureteral stricture development after at least one urological procedure. Patients were classified as failures in the event of post-operative ultrasound demonstrating persistent hydronephrosis with or without symptoms or persistent symptoms with renal scan evidence of obstruction or redo procedures. Eighteen patients (50%) were treated for calculosis, seven (19.4%) patients were submitted to double J ureteral stenting and previous pyeloplasty was performed in 11 (30.5%) patients. Overall median operative time was 160 min (IQR = 120-180). Five (13.8%) complications with three (8.3%) surgical post-operative complications occurred. Length of stay was 6 (IQR = 5-7) days. At last follow-up, ranging between 7-60 months, the overall success rate was 86.1% (31/36): three of them (8.3%) were submitted to retrograde holmium laser endopyelotomy, while two (5.5%) underwent a redo robot-assisted correction. Robot-assisted correction procedures can be done safely with good perioperative outcomes and a high post-operative success rate in a tertiary referral center. Further randomized clinical trials are mandatory to confirm the safety of this procedure.
医源性狭窄是一种相对常见的并发症，可发生于输尿管全程的泌尿外科手术后。本研究旨在报告在一家三级转诊中心对36例连续患者（2013年4月至2018年11月期间）进行机器人辅助纠正既往泌尿外科手术后良性狭窄的手术结果。入选标准为至少接受过一次泌尿外科手术后出现良性输尿管狭窄。如果术后超声显示持续肾积水（无论有无症状）或持续症状且肾扫描有梗阻证据或需再次手术，则患者被归类为治疗失败。18例患者（50%）因结石病接受治疗，7例患者（19.4%）接受了双J输尿管支架置入术，11例患者（30.5%）曾接受肾盂成形术。总体中位手术时间为160分钟（四分位间距 = 120 - 180）。发生了5例（13.8%）并发症，其中3例（8.3%）为术后手术并发症。住院时间为6天（四分位间距 = 5 - 7）。在最后随访时，随访时间为7至60个月，总体成功率为86.1%（31/36）：其中3例（8.3%）接受了逆行钬激光肾盂内切开术，2例（5.5%）接受了再次机器人辅助纠正手术。在三级转诊中心，机器人辅助纠正手术可以安全地进行，围手术期效果良好，术后成功率高。需要进一步的随机临床试验来证实该手术的安全性。
