Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
Department of Urology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
Urology. 2021 Jan;147:306-310. doi: 10.1016/j.urology.2020.08.003. Epub 2020 Aug 13.
To update our prior multi-institutional experience with robotic ureteroplasty with buccal mucosa graft and analyze our intermediate-term outcomes. Although our previous multi-institutional report provided significant insight into the safety and efficacy associated with robotic ureteroplasty with buccal mucosa graft, it was limited by small patient numbers.
We retrospectively reviewed our multi-institutional database to identify all patients who underwent robotic ureteroplasty with buccal mucosa graft between October 2013 and March 2019 with ≥12 months follow up. Indication for surgery was a complex proximal and/or middle ureteral stricture not amenable to primary excision and anastomosis secondary to stricture length or peri-ureteral fibrosis. Surgical success was defined as the absence of obstructive flank pain and ureteral obstruction on functional imaging.
Of 54 patients, 43 (79.6 %) patients underwent an onlay, and 11 (20.4%) patients underwent an augmented anastomotic robotic ureteroplasty with buccal mucosa graft. Eighteen of 54 (33.3%) patients previously failed a ureteral reconstruction. The median stricture length was 3.0 (IQR 2.0-4.0, range 1-8) centimeters. There were 3 of 54 (5.6%) major postoperative complications. The median length of stay was 1.0 (IQR 1.0-3.0) day. At a median follow-up of 27.5 (IQR 21.3-38.0) months, 47 of 54 (87.0%) cases were surgically successful. Stricture recurrences were diagnosed ≤2 months postoperatively in 3 of 7 (42.9%) patients, and ≥10 months postoperatively in 4 of 7 (57.1%) patients.
Robotic ureteroplasty with buccal mucosa graft is associated with low peri-operative morbidity and excellent intermediate-term outcomes.
更新我们之前多机构应用颊黏膜移植机器人输尿管成形术的经验，并分析我们的中期结果。虽然我们之前的多机构报告提供了与颊黏膜移植机器人输尿管成形术相关的安全性和有效性的重要见解，但它受到患者数量少的限制。
我们回顾性地审查了我们的多机构数据库，以确定 2013 年 10 月至 2019 年 3 月期间接受颊黏膜移植机器人输尿管成形术且随访时间≥12 个月的所有患者。手术适应证为复杂的近段和/或中段输尿管狭窄，由于狭窄长度或输尿管周围纤维化，不适合原发性切除和吻合术。手术成功定义为无梗阻性腰痛和功能影像学上的输尿管梗阻。
54 例患者中，43 例（79.6%）患者行单纯黏膜下移植，11 例（20.4%）患者行颊黏膜移植增强吻合机器人输尿管成形术。54 例患者中有 18 例（33.3%）之前曾行输尿管重建术失败。狭窄长度中位数为 3.0（IQR 2.0-4.0，范围 1-8）cm。54 例中有 3 例（5.6%）发生重大术后并发症。中位住院时间为 1.0（IQR 1.0-3.0）天。中位随访 27.5（IQR 21.3-38.0）个月，54 例中有 47 例（87.0%）手术成功。7 例中有 3 例（42.9%）在术后≤2 个月诊断为狭窄复发，7 例中有 4 例（57.1%）在术后≥10 个月诊断为狭窄复发。
颊黏膜移植机器人输尿管成形术具有较低的围手术期发病率和良好的中期结果。
