机器人辅助反 YV 成形术治疗复发性膀胱颈狭窄的短期和中期疗效——单中心研究。
Short and Intermediate-Term Outcome of Robot-Assisted Inverted YV-Plasty for Recurrent Bladder Neck Stenosis - a Single Centre Study.
机构信息
Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland..
Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland.
出版信息
Urology. 2023 May;175:196-201. doi: 10.1016/j.urology.2023.02.011. Epub 2023 Feb 23.
OBJECTIVE
To report the technique and preliminary results for extraperitoneal robot-assisted laparoscopic YV-plasty (RAYV) for refractory bladder neck stenosis (BNS) and vesicoureteral anastomosis stenosis (VUAS).
MATERIALS AND METHODS
Included were patients with recurrent BNS and VUAS who underwent RAYV at our institution. Primary outcome was short and intermediate-term functional results measured with urinary peak flow (Qmax), post-void residual urine (PVR) as well as quality of life assessment with the international prostate symptom score (IPSS) and short form health survey (SF-8). Short- and intermediate-term follow-up periods were defined as 1-6 months and 6-24 months, respectively. Secondary, all patients were reviewed for etiology as well as perioperative data. Treatment success was defined by absence of further treatment and/or need for intermittent or permanent catheterization.
RESULTS
Between March 2016 and October 2020 a total of 30 patients with a median age of 70.8 (64-77) years underwent RAYV with a median follow-up of 27 months. Median operative time (skin-skin) was 131 (112-145) minutes. The transurethral indwelling catheter was removed after 10 (5 - 16) days. There were no intraoperative complications but 2 postoperative major complications Clavien-Dindo IIIa and IV, respectively. Short- and intermediate-term results revealed significant improvement of IPS score from 17 (11-24) points to 11 (6-13) points and 6 (3-9) points, respectively. Further PVR decreased from 90 (5-302) mL to 0 (0-30) mL and 0 (0-90) mL, respectively, and Qmax increased from 7.4 mL/s to 13 (8-16) mL/s and 17 (12-4) mL/s, respectively. Improvement of SF-8 did not reach significance. A total of 5/30 (16.7%) patients had a treatment failure after 24 months whereof 2 had a re-stricture.
CONCLUSION
RAVY-Plasty for recurrent bladder neck stenosis is a safe and effective procedure with good functional short- and intermediate-term outcome.
目的
报告经腹腔机器人辅助腹腔镜下 YV 成形术（RAYV）治疗难治性膀胱颈狭窄（BNS）和膀胱输尿管吻合口狭窄（VUAS）的技术和初步结果。
材料和方法
本研究纳入了在我院接受 RAYV 治疗的复发性 BNS 和 VUAS 患者。主要结果是通过尿流率（Qmax）、剩余尿量（PVR）以及国际前列腺症状评分（IPSS）和健康调查简表（SF-8）评估生活质量来测量短期和中期的功能结果。短期和中期随访时间分别定义为 1-6 个月和 6-24 个月。其次，所有患者均回顾了病因和围手术期数据。治疗成功定义为无需进一步治疗和/或无需间歇性或永久性导尿。
结果
2016 年 3 月至 2020 年 10 月，共 30 例患者接受了 RAYV 治疗，中位年龄为 70.8 岁（64-77 岁），中位随访时间为 27 个月。中位手术时间（皮肤-皮肤）为 131 分钟（112-145 分钟）。经尿道留置导尿管于术后 10 天（5-16 天）拔出。无术中并发症，但有 2 例术后严重并发症（Clavien-Dindo IIIa 和 IV 级）。短期和中期结果显示，IPSS 评分从 17 分（11-24 分）分别显著改善至 11 分（6-13 分）和 6 分（3-9 分）。进一步 PVR 从 90ml（5-302ml）降至 0ml（0-30ml）和 0ml（0-90ml），Qmax 从 7.4ml/s 分别增至 13ml/s（8-16ml/s）和 17ml/s（12-4ml/s）。SF-8 改善无统计学意义。24 个月时，共有 5/30（16.7%）例患者治疗失败，其中 2 例出现再狭窄。
结论
对于复发性膀胱颈狭窄，RAYV 成形术是一种安全有效的方法，具有良好的短期和中期功能效果。
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