Section of Urology, University of Chicago Medicine, Comer Children's Hospital, Chicago, IL.
Section of Urology, University of Chicago Medicine, Comer Children's Hospital, Chicago, IL.
Urology. 2020 Mar;137:206-207. doi: 10.1016/j.urology.2019.11.023. Epub 2019 Nov 30.
Robot-assisted laparoscopic (RAL) techniques for the management of neurogenic bladder involves complex procedures using lower urinary tract and bowel. When medical therapy fails, surgery aims to preserve upper tract function and social continence. Traditionally, the procedure was performed in an open approach, but newer minimally-invasive techniques offer improved cosmesis, reduced pain and length of stay. A series of 38 cases showed the feasibility and safety of this approach. Here, we describe a RAL bladder neck reconstruction with appendicovesicostomy in a 7-year-old with neurogenic bladder (Fig. 1).
The patient was placed in a lithotomy position followed by double-J and Foley catheter placement. With an open Hasson technique, a 12-mm, two 8-mm, and a 5-mm port were positioned. The bladder is prefilled with saline (80 mL) and a cystotomy is performed. The tubularization is completed in 2 layers achieving a 3-cm tunnel (Figs. 2-3). The appendix is implanted in the posterior wall of the bladder with a submucosal tunnel. Ultimately, 2 suprapubic tubes are placed and the bladder is closed in a single layer.
No complications reported, operative time was 5 hours and estimated blood loss was 50 mL. At 1-month follow-up, double-J stents were removed and the patient reported catheterizing well with good continence and well-healed incisions.
Robotic continence procedures have demonstrated to be a safe and effective alternative. Here, we presented a satisfactory outcome using RAL bladder neck reconstruction with appendicovesicostomy in a 7 years old with persistent incontinence, despite untethering and maximal anticholinergic therapy.
机器人辅助腹腔镜（RAL）技术用于治疗神经源性膀胱涉及到复杂的下尿路和肠道操作。当药物治疗失败时，手术旨在保留上尿路功能和社交控尿能力。传统上，该手术采用开放入路，但较新的微创技术提供了更好的美容效果、减轻疼痛和缩短住院时间。一系列 38 例病例表明了这种方法的可行性和安全性。在这里，我们描述了一例 7 岁神经源性膀胱患者的 RAL 膀胱颈重建与阑尾膀胱吻合术（图 1）。
患者取截石位，然后放置双 J 管和 Foley 导管。采用开放 Hasson 技术，放置 12mm、2 个 8mm 和 5mm 端口。膀胱用生理盐水（80mL）预充，并进行膀胱造口术。在 2 层完成管状化，形成 3cm 的隧道（图 2-3）。阑尾通过黏膜下隧道植入膀胱后壁。最终，放置 2 根耻骨上引流管，并将膀胱单层关闭。
无并发症报告，手术时间为 5 小时，估计失血量为 50mL。术后 1 个月随访时，拔除双 J 支架，患者报告导管插入良好，具有良好的控尿能力，切口愈合良好。
机器人控尿术已被证明是一种安全有效的替代方法。在这里，我们介绍了一例 7 岁持续性尿失禁患者，尽管进行了松解和最大剂量的抗胆碱能治疗，但通过 RAL 膀胱颈重建与阑尾膀胱吻合术获得了满意的结果。
