Department of Urology, Hospital Clínic de Barcelona, Villarroel 170, Barcelona, 08036, Spain.
World J Urol. 2024 Oct 8;42(1):568. doi: 10.1007/s00345-024-05284-8.
The aim of the present study is to assess the role of indocyanine green (ICG) to evaluate distal ureteral vascularity during robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion and its impact on the incidence of benign ureteroenteric strictures (UES).
The study included patients who underwent RARC for bladder cancer between 2018 and 2023. All patients included underwent intracorporeal urinary diversion with ileal conduit or neobladder. Bricker technique was performed in all ureteroenteric anastomosis. ICG was employed during the study period to evaluate ureteral vascularity. We divided patients into 2 groups depending on the utilization of ICG during surgery and compared demographic, clinicopathological and perioperative outcomes, including benign UES rates.
We identified 221 patients that underwent RARC with intracorporeal urinary diversion. Ileal conduit was performed in 173 (78.3%) patients and neobladder in 48 (21.7%) cases. A total of 142 (64.3%) and 79 (35.7%) patients were in the non-ICG and ICG group, respectively. With a median follow-up of the entire cohort of 21.1 months, there were no differences in the rate of benign UES after RARC between the non-ICG and the ICG group (p = 0.901). In the non-ICG group, 26 (18.3%) patients developed benign UES and in the ICG group 15 (19.0%) patients. Most of the strictures appeared in the left ureter in both groups (80.8% non-ICG vs. 66.7% ICG, p = 0.599). Median time to stricture diagnosis was 4 months (IQR 3-7.25) for the non-ICG and 3 months (IQR 2-5) for the ICG group (p = 0.091). The ICG group had a slightly greater length of ureter resected compared with the non-ICG group (1.5 vs. 1.3 cm, p = 0.007).
In our experience, choosing to use ICG intraoperatively to evaluate distal ureteral vascularity may not reduce the rate of benign UES after robot-assisted radical cystectomy with intracorporeal urinary diversion and Bricker ureteroileal anastomosis.
本研究旨在评估吲哚菁绿（ICG）在机器人辅助根治性膀胱切除术（RARC）中评估远端输尿管血管的作用，以及其对良性输尿管-肠吻合口狭窄（UES）发生率的影响。
本研究纳入了 2018 年至 2023 年间接受 RARC 治疗膀胱癌的患者。所有患者均接受了腔内尿流改道术，包括回肠导管或新膀胱。在所有的输尿管-肠吻合术中均采用 Bricker 技术。在研究期间，使用 ICG 评估输尿管的血供。我们根据手术中是否使用 ICG 将患者分为两组，并比较了两组的人口统计学、临床病理和围手术期结局，包括良性 UES 发生率。
我们共纳入了 221 例行 RARC 加腔内尿流改道术的患者。其中 173 例（78.3%）患者行回肠导管术，48 例（21.7%）患者行新膀胱术。142 例（64.3%）和 79 例（35.7%）患者分别在 ICG 组和非 ICG 组。全队列的中位随访时间为 21.1 个月，两组 RARC 后良性 UES 的发生率无差异（p=0.901）。非 ICG 组 26 例（18.3%）患者发生良性 UES，ICG 组 15 例（19.0%）患者发生良性 UES。两组的大多数狭窄均发生在左侧输尿管（非 ICG 组 80.8%，ICG 组 66.7%，p=0.599）。非 ICG 组和 ICG 组狭窄的中位诊断时间分别为 4 个月（IQR 3-7.25）和 3 个月（IQR 2-5）（p=0.091）。与非 ICG 组相比，ICG 组切除的输尿管长度略长（1.5 vs. 1.3cm，p=0.007）。
根据我们的经验，在机器人辅助根治性膀胱切除术加 Bricker 输尿管-肠吻合术中，选择术中使用 ICG 来评估远端输尿管的血供并不能降低良性 UES 的发生率。
