Ji Hao, Wu Qikai, Ji Jianbo, Qian Yuhang, Cai Lingkai, Bai Kexin, Cao Qiang, Yang Xiao, Cao Yongke, Lv Qiang, Li Pengchao
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China.
Department of Urology, Yancheng Third People's Hospital, Yancheng Clinical Medical College, Nanjing Medical University, Yancheng, PR China.
Heliyon. 2024 Apr 4;10(8):e29198. doi: 10.1016/j.heliyon.2024.e29198. eCollection 2024 Apr 30.
To describe a bladder cuff excision method modified with ureteral catheterization to better visualize the ureteral orifice during robot-assisted nephroureterectomy (RANU).
We retrospectively analyzed 66 patients with upper urinary tract urothelial carcinoma of the renal pelvis and/or upper-mid ureter treated between January 2020 and January 2023. Among them, 32 patients (group A) underwent RANU supported by ureteral catheterization, and the remaining patients (group B) received routine transperitoneal RANU. Postoperative cystoscopy was performed routinely to compare the rates of residual ureteral orifice between the two groups.
Surgeries were completed uneventfully in all 66 patients, without blood transfusion or conversion to open procedures. The operative time, estimated blood loss, and postoperative length of hospital stay were similar between both groups. However, the mean time required for BCE in group A was shorter than that in group B (9.5 min vs. 16.0 min, p = 0.006). Cystoscopy at postoperative three months showed no ipsilateral ureteral orifice in group A, but residual ureteral orifice was found in 23.5% of patients in group B. During a short follow-up period of 16 months, no patients in group A experienced bladder tumor recurrence. However, two patients (5.9%) in group B developed bladder tumor recurrence, with one experiencing local tumor recurrence at the level of the ureteral stump.
Our novel technique enables complete ureteral retrieval, accurate and rapid bladder cuff excision, which makes the procedure less invasive and safely reproducible during robot-assisted nephroureterectomy.
描述一种经输尿管插管改良的膀胱袖口切除术，以便在机器人辅助肾输尿管切除术（RANU）期间更好地观察输尿管口。
我们回顾性分析了2020年1月至2023年1月期间接受治疗的66例肾盂和/或输尿管中上段上尿路尿路上皮癌患者。其中，32例患者（A组）在输尿管插管支持下接受了RANU，其余患者（B组）接受了常规经腹RANU。常规进行术后膀胱镜检查，以比较两组之间输尿管口残留率。
所有66例患者手术均顺利完成，无输血或转为开放手术。两组的手术时间、估计失血量和术后住院时间相似。然而，A组膀胱袖口切除的平均所需时间短于B组（9.5分钟对16.0分钟，p = 0.006）。术后三个月的膀胱镜检查显示，A组无同侧输尿管口，但B组23.5%的患者发现有输尿管口残留。在16个月的短期随访期间，A组无患者发生膀胱肿瘤复发。然而，B组有2例患者（5.9%）发生膀胱肿瘤复发，其中1例在输尿管残端水平出现局部肿瘤复发。
我们的新技术能够完整取出输尿管，准确快速地切除膀胱袖口，这使得机器人辅助肾输尿管切除术的创伤更小且安全可重复。
