Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France; Department of Urology, Institut Universitaire du Cancer-Toulouse, Oncopole (IUCT-O), Toulouse, France; Department of Urology, MD Anderson Cancer Center, Houston, USA.
Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France; Department of Urology, Casablanca International Oncology Center, Casablanca, Morocco.
Eur Urol Focus. 2023 Sep;9(5):760-764. doi: 10.1016/j.euf.2023.03.006. Epub 2023 Mar 13.
Prior studies on robot-assisted laparoscopic prostatectomy (RALP) have shown that preservation of the anterior periprostatic structures is associated with good functional outcomes in terms of urinary continence and erectile function. With this in mind, we developed a technique for preservation of the lower part of the detrusor apron (LDA) and anterior periprostatic structures at the time of robot-assisted radical cystectomy (RARC) and intracorporeal neobladder (ICNB) reconstruction.
To describe our LDA-sparing RARC technique and to assess its safety and outcomes.
DESIGN, SETTING, AND PARTICIPANTS: We retrospectively evaluated 11 patients who underwent LDA-sparing RARC and ICNB reconstruction at our centre from January 2017 to May 2021.
In brief, after developing the plane posterior to the bladder and prostate, the dissection proceeds laterally on both sides of the prostate in an effort to identify the prostatic pedicle. At this point, the bladder pedicles are sectioned in an antegrade fashion. Once the prostate is reached, the dissection is continued laterally by developing the plane that was previously identified. The neurovascular bundles and the lateral and anterior periprostatic structures are conserved in toto. Neobladder reconstruction is performed intracorporeally.
Postoperative complications, urinary continence (UC), and erectile function (EF).
The median console time was 290 min. The 30-d complication rate was 36%, with two Clavien-Dindo grade II and two grade III complications that were not attributable to the novel surgical technique. At 12 mo, all patients reported daytime UC or use of a safety pad; at night, seven patients were continent or used a safety pad. Regarding 12-mo EF, four patients were potent without a need for medications, while six were potent with the use of oral phosphodiesterase type 5 inhibitors and one with the use of intracavernosal injections. Limitations include the small number of cases.
LDA-sparing RARC is an applicable and reproducible procedure. Our results suggest that this approach is associated with good functional outcomes in terms of UC and EF.
We describe a novel approach for robot-assisted removal of the bladder that allows greater preservation of nerve bundles and other structures. Our study shows that the technique is safe and associated with good outcomes for urinary function and erectile function for patients eligible for this surgical procedure.
先前关于机器人辅助腹腔镜前列腺切除术（RALP）的研究表明，保留前列腺周围前结构与尿控和勃起功能方面的良好功能结果相关。考虑到这一点，我们在机器人辅助根治性膀胱切除术（RARC）和体内新膀胱（ICNB）重建时开发了一种保留逼尿肌前围裙下部（LDA）和前列腺周围前结构的技术。
描述我们的 LDA 保留 RARC 技术，并评估其安全性和结果。
设计、设置和参与者：我们回顾性评估了 2017 年 1 月至 2021 年 5 月期间在我们中心接受 LDA 保留 RARC 和 ICNB 重建的 11 例患者。
简要地说，在开发膀胱和前列腺后方的平面后，在前列腺的两侧进行横向解剖，以确定前列腺蒂。此时，以逆行方式切割膀胱蒂。一旦到达前列腺，就通过继续开发先前确定的平面进行横向解剖。神经血管束和外侧及前列腺周围前结构被全部保留。新膀胱重建在体内进行。
术后并发症、尿控（UC）和勃起功能（EF）。
控制台的中位时间为 290 分钟。30 天的并发症发生率为 36%，其中 2 例 Clavien-Dindo Ⅱ级和 2 例Ⅲ级并发症与新手术技术无关。在 12 个月时，所有患者均报告白天 UC 或使用安全垫；夜间，7 名患者有尿控或使用安全垫。关于 12 个月的 EF，4 名患者无需药物治疗即可保持勃起，6 名患者通过口服磷酸二酯酶 5 抑制剂和 1 名患者通过阴茎内注射来保持勃起。局限性包括病例数量较少。
LDA 保留 RARC 是一种可行且可重复的手术。我们的结果表明，这种方法在 UC 和 EF 方面具有良好的功能结果。
我们描述了一种新的机器人辅助膀胱切除方法，可以更好地保留神经束和其他结构。我们的研究表明，对于符合该手术条件的患者，该技术是安全的，并且与良好的尿功能和勃起功能结果相关。
