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[根治性前列腺切除术后吻合口狭窄及良性前列腺增生治疗后膀胱颈狭窄:重建选择]

[Anastomosis stenosis after radical prostatectomy and bladder neck stenosis after benign prostate hyperplasia treatment: reconstructive options].

作者信息

Rosenbaum C M, Becker B, Gross A, Netsch C

机构信息

Klinik für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22307, Hamburg, Deutschland.

Young academic urologists - working group trauma and reconstructive urology, EAU, Arnheim, Niederlande.

出版信息

Urologe A. 2020 Apr;59(4):398-407. doi: 10.1007/s00120-020-01143-7.

Abstract

Bladder neck stenosis (BNS) after simple prostatectomy and vesicourethral anastomosis stenosis (VUAS) after radical prostatectomy for prostate cancer are common sequelae. However, the two entities differ in their pathology, anatomy and their surgical results. VUAS has an incidence of 0.2-28%. Commonly, VUAS occurs within the first 2 years after surgery. Initial therapy should be performed endourologically: dilatation, (laser) incision or resection. After three unsuccessful treatment attempts, open reconstruction should be considered. Different surgical approaches (abdominal, perineal, abdominoperineal) have been described. All are associated with good success rates. However, they are accompanied by high rates of urinary incontinence. Incontinence can be treated safely by implantation of an artificial urinary sphincter. The incidence of BNS is around 5% for all types of surgery for benign prostate hyperplasia. It occurs within the first 2 years after surgery. Initial treatment should be performed endourologically. In case of recalcitrant BNS, open reconstruction is indicated. The YV-plasty is an established procedure, and the T‑plasty represents a modification. Success rates of both procedures are high. Robot-assisted reconstructive procedures have been described for both VUAS and BNS.

摘要

前列腺癌根治性前列腺切除术后的膀胱颈狭窄(BNS)和膀胱尿道吻合口狭窄(VUAS)是常见的后遗症。然而,这两种情况在病理、解剖结构和手术结果方面存在差异。VUAS的发生率为0.2%至28%。通常,VUAS发生在术后的头2年内。初始治疗应采用腔内泌尿外科手术:扩张、(激光)切开或切除。经过三次治疗尝试失败后,应考虑开放重建。已经描述了不同的手术方法(腹部、会阴、腹会阴联合)。所有这些方法都有较高的成功率。然而,它们都伴随着较高的尿失禁发生率。尿失禁可以通过植入人工尿道括约肌进行安全治疗。所有类型的良性前列腺增生手术中BNS的发生率约为5%。它发生在术后的头2年内。初始治疗应采用腔内泌尿外科手术。对于顽固性BNS,应进行开放重建。Y-V成形术是一种成熟的手术方法,T形成形术是一种改良方法。两种手术的成功率都很高。已经描述了用于VUAS和BNS的机器人辅助重建手术。

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