Benamran Daniel, Phé Véronique, Drouin Sarah J, Perrot Ophélie, Grégoris Adrien, Parra Jérôme, Vaessen Christophe, Seisen Thomas, Rouprêt Morgan
Urology Department, Geneva University Hospitals, Geneva, Switzerland.
Urology Department, Sorbonne University, GRC n° 5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
J Robot Surg. 2020 Dec;14(6):813-820. doi: 10.1007/s11701-020-01070-x. Epub 2020 Mar 21.
Robot-assisted radical cystectomy with intracorporeal urinary diversion is one of the most challenging procedures in urological surgery. Over the past 15 years, this procedure has gained in popularity and the number of procedures performed has increased significantly. While ileal conduit remains the most common diversion, orthotopic neobladders are also formed in a few expert centres that have developed their technique for totally intracorporeal neobladder. The objective of this review is to summarise the techniques currently used to perform totally intracorporeal neobladder with a special focus on their functional outcomes, such as continence or sexual function. The techniques described are the Karolinska-modified Studer neobladder, the USC-modified Studer neobladder, the pyramid pouch, the Y-pouch, and the vesica Ileale Padovana, some trying to totally reproduce the steps of open surgery and others trying to simplify them. Functional outcomes vary depending on the technique performed. Standardisation in assessing outcomes is lacking, as well as objective outcome measurements with questionnaires or urodynamic assessments. Current evidence shows acceptable functional outcomes after totally intracorporeal neobladder construction, but larger prospective randomised series with longer follow-up, better defined outcomes, and more objective measurements are needed in the future.
机器人辅助根治性膀胱切除术联合体内尿流改道术是泌尿外科手术中最具挑战性的手术之一。在过去15年里，该手术越来越受欢迎，手术例数显著增加。虽然回肠膀胱术仍然是最常见的尿流改道方式，但在一些已开发出完全体内新膀胱技术的专家中心也开展了原位新膀胱术。本综述的目的是总结目前用于构建完全体内新膀胱的技术，特别关注其功能结果，如控尿或性功能。所描述的技术包括卡罗林斯卡改良的施图德新膀胱术、南加州大学改良的施图德新膀胱术、金字塔形贮尿囊、Y形贮尿囊和帕多瓦伊利亚膀胱术，有些技术试图完全重现开放手术的步骤，而另一些则试图简化这些步骤。功能结果因所采用的技术而异。在评估结果方面缺乏标准化，也缺乏使用问卷或尿动力学评估的客观结果测量。目前的证据表明，完全体内新膀胱构建术后的功能结果是可接受的，但未来需要更大规模的前瞻性随机系列研究，随访时间更长，结果定义更明确，测量更客观。
