Tuderti Gabriele, Mastroianni Riccardo, Flammia Simone, Ferriero Mariaconsiglia, Leonardo Costantino, Anceschi Umberto, Brassetti Aldo, Guaglianone Salvatore, Gallucci Michele, Simone Giuseppe
"Regina Elena" National Cancer Institute, Department of Urology, 00100 Rome, Italy.
"Sapienza" University of Rome, Department of Urology, 00100 Rome, Italy.
J Clin Med. 2020 Feb 20;9(2):577. doi: 10.3390/jcm9020577.
Our aim was to illustrate our technique of sex-sparing (SS)-robot-assisted radical cystectomy (RARC) in female patients receiving an intracorporeal neobladder (iN). From January 2013 to June 2018, 11 female patients underwent SS-RARC-iN at a single tertiary referral center. Inclusion criteria were a cT ≤ 2 N0 M0 bladder tumor at baseline imaging (CT or MRI) and an absence of tumors in the bladder neck, trigone and urethra at TURB. Baseline, perioperative, and outcomes at one year were reported. The median operative time was 255 min and the median hospital stay was seven days. Low-grade Clavien complications occurred in four patients (36.3%), while high-grade complications were not observed in any. Seven patients (63.7%) had an organ-confined disease at the pathologic specimen; nodal involvement and positive surgical margins were not detected in any of the cases. At a median follow-up of 28 months (IQR 14-51), no patients developed new onset of chronic kidney disease stage 3b. After one year, daytime and nighttime continence rates were 90.9% and 86.4% respectively. Quality of life as well as physical and emotional functioning improved significantly over time (all ≤ 0.04), while urinary symptoms and sexual function worsened at three months with a significant recovery taking place at one year (all ≤ 0.04). Overall, 8 out of 11 patients (72.7%) were sexually active at the 12-month evaluation. In select female patients, SS-RARC-iN is an oncologically sound procedure associated with favorable perioperative and functional outcomes.
我们的目的是阐述在接受体内新膀胱（iN）的女性患者中采用保留性功能（SS）的机器人辅助根治性膀胱切除术（RARC）的技术。2013年1月至2018年6月，11例女性患者在一家三级转诊中心接受了SS-RARC-iN手术。纳入标准为基线影像学检查（CT或MRI）显示cT≤2 N0 M0膀胱肿瘤，且经尿道膀胱肿瘤电切术（TURB）时膀胱颈、三角区和尿道无肿瘤。报告了基线、围手术期及一年时的结果。中位手术时间为255分钟，中位住院时间为7天。4例患者（36.3%）发生低级别Clavien并发症，未观察到高级别并发症。7例患者（63.7%）病理标本显示为器官局限性疾病；所有病例均未检测到淋巴结受累及手术切缘阳性。中位随访28个月（四分位间距14 - 51），无患者出现新的3b期慢性肾脏病。一年后，白天和夜间控尿率分别为90.9%和86.4%。随着时间推移，生活质量以及身体和情感功能显著改善（均P≤0.04），而泌尿系统症状和性功能在术后3个月恶化，一年时显著恢复（均P≤0.04）。总体而言，11例患者中有8例（72.7%）在12个月评估时仍有性生活。在特定女性患者中，SS-RARC-iN是一种肿瘤学上合理的手术，具有良好的围手术期和功能结局。
