Rutgers Robert Wood Johnson Medical School and Cancer Institute of New Jersey, New Brunswick, NJ.
USC Institute of Urology, Los Angeles, CA.
Urology. 2022 Mar;161:125-130. doi: 10.1016/j.urology.2021.11.020. Epub 2022 Jan 7.
To examine the safety, feasibility and durability of robotic reimplantation of ureteroenteric stricture after radical cystectomy.
A retrospective multi-institutional review was performed for all patients undergoing robotic repair of ureteroenteric stricture from January 2010 to January 2019. Functional outcomes and complications were followed and data were analyzed with SPSS statistical software.
A total of 46 patients and 58 renal units were identified, of which 15 had right sided, 19 left sided and 12 patients had bilateral strictures. Presentation of stricture was asymptomatic in 14 (30.4%) patients. Symptomatic presentations included infection in 22 (47.8%), worsening renal function in 11 (23.9%) and pain in 3 (6.5%) patients. Median time from cystectomy to diagnosis of stricture was 5 months (1-40). Median stricture length was 1.5 cm (range 0.5-10). All strictures were of benign etiology except for 4 (6.9%), which were due to malignancy. Overall, 49 (84.5%) ureters underwent primary re-implantation, while 9 (15.5%) required Boari-like advancement flaps prior to re-implantation. Median operative time was 190 min (range 45-540) with median estimated blood loss of 50 mL (range 25-2000) and median length of stay of 2 days (range 1-33, IQR 2-4). Seven (15.2%) patients experienced complications; 3 (6.5%) were low grade and 4 (8.7%) high grade. With median follow up of 18 months (range 1-51) the stricture recurrence rate was 8.6%.
Robotic reimplantation of ureteroenteric strictures following radical cystectomy is safe and feasible in experienced centers with high success rates.
探讨机器人辅助根治性膀胱切除术后输尿管肠吻合口狭窄再植入的安全性、可行性和耐久性。
对 2010 年 1 月至 2019 年 1 月期间接受机器人修复输尿管肠吻合口狭窄的所有患者进行回顾性多中心研究。采用 SPSS 统计软件对功能结果和并发症进行随访和数据分析。
共确定 46 例患者和 58 个肾脏单位，其中右侧 15 例，左侧 19 例，双侧 12 例。14 例（30.4%）患者的狭窄无症状。有症状的表现包括感染 22 例（47.8%）、肾功能恶化 11 例（23.9%）和疼痛 3 例（6.5%）。从膀胱切除术到诊断狭窄的中位时间为 5 个月（1-40 个月）。狭窄长度中位数为 1.5cm（范围 0.5-10cm）。除 4 例（6.9%）因恶性肿瘤外，所有狭窄均为良性病因。总体而言，49 例（84.5%）输尿管行原发性再植入，9 例（15.5%）在再植入前需要 Boari 样推进皮瓣。中位手术时间为 190min（范围 45-540min），中位估计出血量为 50ml（范围 25-2000ml），中位住院时间为 2 天（范围 1-33 天，IQR 2-4 天）。7 例（15.2%）患者发生并发症；3 例（6.5%）为低级别，4 例（8.7%）为高级别。中位随访 18 个月（范围 1-51 个月），狭窄复发率为 8.6%。
在经验丰富的中心，机器人辅助根治性膀胱切除术后输尿管肠吻合口狭窄再植入是安全可行的，成功率高。
