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单孔经膀胱前列腺切除术更快恢复的转变。

A Transition Toward a Faster Recovery in Single-Port Transvesical Simple Prostatectomy.

机构信息

Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

出版信息

J Endourol. 2022 Aug;36(8):1036-1042. doi: 10.1089/end.2021.0805. Epub 2022 May 20.

Abstract

To present the updated technique and evaluate the perioperative and postoperative outcomes of single-port transvesical simple prostatectomy (SP TVSP) Forty-two consecutive patients with benign prostatic hyperplasia indicated for surgery underwent SP TVSP in a single institution. Through direct suprapubic bladder access, the SP robot was docked. Prostatic enucleation was performed using the prostatic capsule as a landmark. Then a complete vesicourethral mucosal advancement flap was accomplished. Demographics, perioperative, and postoperative data were prospectively collected. Mean follow-up period was 12 months. All procedures were effectively performed with no conversion, additional port placement, or intraoperative complication. The median prostatic volume was 170 cc. Ninety-five percent of the patients did not require opioids analgesia after discharge. Excluding planned admissions, 92% (21/23 patients) were discharged after a median (interquartile range) of 4.6 (4.1-5.7) hours after surgery. The median Foley catheter duration for all cohort was 7 days, and decreased to 3 days after technique adjustment for the last 19 consecutive patients. The median international prostate symptom score decreased from 23 before surgery to 2.5 after surgery. All patients had a significant postoperative improvement in maximum flow rate with a 200% improvement over baseline (19 6.5 mL/sec). In our initial series, SP TVSP allows for favorable perioperative and early postoperative outcomes including low complication same-day discharge, short Foley catheter stay, minimal opioids use, and quick recovery.

摘要

目的

介绍经单孔膀胱径路前列腺剜除术(SP TVSP)的最新技术,并评估其围手术期和术后结果。

方法

在一家单中心,42 例因良性前列腺增生而需要手术的连续患者接受了 SP TVSP。通过直接耻骨上膀胱入路,将 SP 机器人对接。使用前列腺包膜作为标志进行前列腺剜除。然后完成完整的膀胱尿道黏膜推进瓣。前瞻性收集人口统计学、围手术期和术后数据。平均随访时间为 12 个月。

结果

所有手术均有效完成,无中转、附加端口放置或术中并发症。前列腺体积中位数为 170 cc。95%的患者出院后无需阿片类药物镇痛。不包括计划住院的患者,92%(21/23 例)在手术后中位数(四分位间距)4.6(4.1-5.7)小时出院。所有患者的 Foley 导尿管留置时间中位数为 7 天,在最后 19 例连续患者的技术调整后减少至 3 天。国际前列腺症状评分中位数从术前的 23 分降至术后的 2.5 分。所有患者的最大尿流率均有显著改善,与基线相比提高了 200%(19 6.5 mL/sec)。

结论

在我们的初步系列中,SP TVSP 可实现良好的围手术期和早期术后结果,包括低并发症、当天出院、短 Foley 导尿管留置时间、低阿片类药物使用和快速康复。

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