Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche, Italy; ORSI Academy, Melle, Belgium; Department of Urology, Onze Lieve Vrouw Hospital, Moorselbaan, Aalst.
Division of Urology, United Hospital of Ancona, School of Medicine Marche Polytechnic University, Ancona, Marche.
Arch Ital Urol Androl. 2021 Mar 22;93(1):101-106. doi: 10.4081/aiua.2021.1.101.
According to the Urology guidelines, in selected cases of distal upper tract urothelial carcinoma (UTUC) segmental ureterectomy (SU) can be offered. There is no consensus in the surgical technique of preference. Robot-assisted SU could be an option to overcome all the limitations of open and laparoscopic techniques. We describe our first experience of robot assisted SU with psoas hitch ureteral reimplantation (RAPHUR).
11 patients underwent RAPHUR for distal UTUC between 2013 and 2017 in a single centre. Pre-, intra-, and postoperative outcomes were assessed. Conventional imaging was performed after 1, 3, 6 months and 1 year from surgery as follow up protocol. We retrospectively evaluated the technical feasibility, oncological and functional outcomes.
Median age was 71 years (57-91). The median length of the ureteral defect was 23 mm (10-40). Median preoperative creatinine level was 1.22 mg/dl (0.7-1.85) and median eGFR was 57.5 ml/min/1.73m2 (31-80). Five (45.5%) patients were symptomatic and 7 (63.6%) had hydronephrosis. Median operative time was 185 min (120-240), with a median blood loss of 100 ml (50-300). No case required conversion to open surgery. Overall, only 1 (9%) patient developed Clavien Dindo ≥ 3 postoperative complications. Average hospital stay was 7 (2-9) days. Mean postoperative creatinine was 1.05 mg/dl (0.8-1.85) and mean postoperative eGFR was 72 (36-83). During a median follow up time of 25.5 months (12-53), 4 (36.4%) patients experienced recurrence of urothelial cancer at conventional imaging follow up and 2 (18.2%) died due to its progression.
In our initial experience RAPHUR can be proposed to selected cases of distal ureteral carcinoma with optimal perioperative and functional outcomes. However, cancer control may be undermined compared to nephroureterectomy. Thus, further prospective studies are needed to confirm our findings.
根据泌尿科指南，在选定的情况下，可提供远端上尿路尿路上皮癌（UTUC）的节段性输尿管切除术（SU）。手术技术偏好方面尚无共识。机器人辅助 SU 可能是克服开放和腹腔镜技术所有局限性的一种选择。我们描述了首例机器人辅助辅助 SU 伴腰大肌悬带输尿管再植术（RAPHUR）的经验。
2013 年至 2017 年间，在一家中心对 11 例远端 UTUC 患者行 RAPHUR。评估术前、术中、术后的结果。术后常规影像学检查在术后 1、3、6 个月和 1 年进行，作为随访方案。我们回顾性评估了技术可行性、肿瘤学和功能结果。
中位年龄为 71 岁（57-91 岁）。输尿管缺损的中位长度为 23mm（10-40mm）。术前中位血肌酐水平为 1.22mg/dl（0.7-1.85mg/dl），中位 eGFR 为 57.5ml/min/1.73m2（31-80ml/min/1.73m2）。5 例（45.5%）患者有症状，7 例（63.6%）有肾积水。中位手术时间为 185 分钟（120-240 分钟），中位出血量为 100ml（50-300ml）。无病例需转为开放手术。总体而言，仅 1 例（9%）患者术后发生 Clavien Dindo ≥3 级并发症。平均住院时间为 7（2-9）天。术后平均血肌酐为 1.05mg/dl（0.8-1.85mg/dl），术后平均 eGFR 为 72（36-83）。在中位随访时间为 25.5 个月（12-53 个月）期间，4 例（36.4%）患者在常规影像学随访中出现尿路上皮癌复发，2 例（18.2%）患者因肿瘤进展而死亡。
在我们的初步经验中，RAPHUR 可适用于选定的远端输尿管癌病例，具有最佳的围手术期和功能结果。然而，与肾输尿管切除术相比，癌症控制可能会受到影响。因此，需要进一步的前瞻性研究来证实我们的发现。
