经会阴再吻合术作为根治性前列腺切除术后复发性膀胱尿道吻合口狭窄挽救性治疗的结果
Outcomes of transperineal reanastomosis as a salvage treatment for recurrent vesicourethral anastomosis stenosis after radical prostatectomy.
作者信息
Gwara Piotr, Białek Łukasz, Rydzińska Marta, Dobruch Jakub, Skrzypczyk Michał Andrzej
机构信息
Department of Urology, Centre of Postgraduate Medical Education, Independent Public Hospital of Prof. W. Orlowski, Warsaw.
出版信息
Arch Ital Urol Androl. 2024 Oct 29;96(4):12829. doi: 10.4081/aiua.2024.12829.
PURPOSE
To evaluate transperineal reanastomosis (TRPA) combined with incontinence surgery as a complex treatment for recurring vesicourethral anastomosis stenosis (VUAS) after radical prostatectomy (RP).
METHODS
Retrospective analysis of 8 patients who underwent TRPA for recurring VUAS. Detailed preoperative and follow up data were assessed.
RESULTS
Mean follow up lasted 47 months (range 17-77) with mean age being 63.4 years (range 61-70). All patients achieved patency and 87.5% (7/8) maintained it to the end of follow up. However, four of them required additional procedures to retain patency. Six underwent incontinence surgery - artificial urinary sphincter (AUS) implantation - after which one cuff erosion occurred. In the end 62.5% (5/8) of patients achieved patent urethra and continence.
CONCLUSIONS
TRPA combined with incontinence surgery is a reasonable treatment for patients with recurrent VUAS. Nonetheless, this is a set of difficult surgeries that may ultimately end in failure, i.e. the inability to restore urethral patency, urinary incontinence or urinary diversion, hence they should be performed by experienced surgeons.
目的
评估经会阴再吻合术（TRPA）联合尿失禁手术作为根治性前列腺切除术（RP）后复发性膀胱尿道吻合口狭窄（VUAS）的综合治疗方法。
方法
回顾性分析8例行TRPA治疗复发性VUAS的患者。评估详细的术前和随访数据。
结果
平均随访47个月（范围17 - 77个月），平均年龄63.4岁（范围61 - 70岁）。所有患者均实现了尿道通畅，87.5%（7/8）在随访结束时仍保持通畅。然而，其中4例需要额外的手术来维持通畅。6例患者接受了尿失禁手术——人工尿道括约肌（AUS）植入术，术后发生1例袖带侵蚀。最终，62.5%（5/8）的患者实现了尿道通畅和控尿。
结论
TRPA联合尿失禁手术是复发性VUAS患者的一种合理治疗方法。尽管如此，这是一组困难的手术，最终可能以失败告终，即无法恢复尿道通畅、尿失禁或尿流改道，因此应由经验丰富的外科医生进行。
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