Diamant E, de la Taille A, Lavolle A, Chahwan C, M Champy C, Grinholtz D, Hoznek A, Yiou R, Vordos D, Ingels A
Département d'urologie, hôpital Henri-Mondor, Créteil, France.
Département d'urologie, hôpital Henri-Mondor, Créteil, France.
Prog Urol. 2021 Sep;31(10):591-597. doi: 10.1016/j.purol.2020.12.014. Epub 2021 Jan 16.
Urethro-vesical anastomosis stenosis following radical prostatectomy is a rare complication but represents a challenging situation. While the first-line treatment is endoscopic, recurrences after urethrotomies require a radical approach. We present the updated results of our patient's cohort treated by pure robotic anastomosis refection.
This is a retrospective, single-center study focusing on one surgeon's experience. Patients presented an urethro-vesical stricture following a radical prostatectomy. Each patient received at least one endoscopic treatment. The procedure consisted of a circumferential resection of the stenosis, followed by a re-anastomosis with well-vascularized tissue. We reviewed the outcomes in terms of symptomatic recurrences and continence after the reconstructive surgery.
From April 2013 to May 2020, 8 patients underwent this procedure. Half of the patients had previously been treated with salvage radio-hormonotherapy. The median age was 70 years (64-76). The mean operative time was 109minutes (60-180) and blood loss was 120cc (50-250). One patient had an early postoperative complication, with vesico-pubic fistula. The average length of stay was 4.6 days (3-8). Mean follow-up was 24.25 months (1-66). Half of the patients experienced a recurrence at a median time of 8.25 months (6-11) after surgery. Five patients experienced incontinence of which 3 required an artificial urinary sphincter implantation.
Extra-peritoneal robot-assisted urethro-vesical reconstruction is feasible and safe to manage bladder neck stricture after radical prostatectomy. The risk of postoperative incontinence is high, justifying preoperative information.
III.
根治性前列腺切除术后尿道膀胱吻合口狭窄是一种罕见的并发症，但却是一个具有挑战性的情况。虽然一线治疗是内镜治疗，但尿道切开术后复发需要采取根治性方法。我们展示了采用单纯机器人吻合口修复术治疗的患者队列的最新结果。
这是一项回顾性单中心研究，重点关注一位外科医生的经验。患者在根治性前列腺切除术后出现尿道膀胱狭窄。每位患者至少接受了一次内镜治疗。该手术包括对狭窄进行环形切除，然后用血运良好的组织进行重新吻合。我们回顾了重建手术后症状复发和控尿方面的结果。
从2013年4月至2020年5月，8例患者接受了该手术。一半的患者先前接受过挽救性放疗 - 激素治疗。中位年龄为70岁（64 - 76岁）。平均手术时间为109分钟（60 - 180分钟），失血量为120毫升（50 - 250毫升）。1例患者术后早期出现并发症，即膀胱耻骨瘘。平均住院时间为4.6天（3 - 8天）。平均随访时间为24.25个月（1 - 66个月）。一半的患者在术后中位时间8.25个月（6 - 11个月）出现复发。5例患者出现尿失禁，其中3例需要植入人工尿道括约肌。
腹膜外机器人辅助尿道膀胱重建术治疗根治性前列腺切除术后膀胱颈狭窄是可行且安全的。术后尿失禁风险较高，术前告知患者是合理的。
III级
