Department of Urology, University of California San Diego, San Diego, CA.
David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA.
Urology. 2024 Oct;192:136-140. doi: 10.1016/j.urology.2024.07.042. Epub 2024 Jul 26.
To evaluate the viability of robot-assisted appendiceal ureteroplasty as an innovative surgical approach for the reconstruction of ureteral strictures in cases where traditional methods are unsuitable.
We conducted a retrospective review of 14 patients who underwent robot-assisted appendiceal ureteroplasty for right-sided ureteral stricture disease at three academic centers between March 2018 and November 2022. Patients were selected based on stricture characteristics, tissue quality, and the need for tissue transfer techniques. Surgical outcomes, including stricture-free rates, renal function, and complication rates, were analyzed.
The median patient age was 63years, with a balanced gender distribution. The median stricture length was 4.75 cm. The majority of strictures were located in the proximal ureter (50%). Surgical approaches included appendiceal onlay flaps (71.4%) and interposition flaps (28.6%). The median operative time was 268 minutes, with an average estimated blood loss of 75 mL. Postoperatively, ureteral patency was achieved in 92.9% of patients. Two patients (14.3%) experienced urinary tract infections requiring readmission. There was no significant change in serum creatinine levels postoperatively. Hydronephrosis grade significantly improved following surgery (P = .025).
Robot-assisted appendiceal ureteroplasty is a safe and effective technique for managing ureteral strictures. It offers a high success rate with minimal complications, making it a valuable addition to the urologic surgeon's armamentarium for complex ureteral reconstructions.
评估机器人辅助阑尾输尿管成形术作为一种创新的手术方法，用于重建传统方法不适用的输尿管狭窄。
我们对 2018 年 3 月至 2022 年 11 月在三个学术中心接受机器人辅助阑尾输尿管成形术治疗右侧输尿管狭窄疾病的 14 例患者进行了回顾性研究。根据狭窄特征、组织质量和组织转移技术的需要选择患者。分析手术结果，包括无狭窄率、肾功能和并发症发生率。
患者的中位年龄为 63 岁，性别分布均衡。中位狭窄长度为 4.75cm。大多数狭窄位于输尿管近端（50%）。手术方法包括阑尾覆盖瓣（71.4%）和间置瓣（28.6%）。中位手术时间为 268 分钟，平均估计出血量为 75ml。术后，92.9%的患者输尿管通畅。2 名患者（14.3%）发生尿路感染需要再次入院。术后血清肌酐水平无明显变化。手术后肾积水程度显著改善（P=0.025）。
机器人辅助阑尾输尿管成形术是一种安全有效的治疗输尿管狭窄的方法。它具有较高的成功率和最小的并发症，是泌尿科医生处理复杂输尿管重建的宝贵工具。
