Sihra Neha, Lecoanet Pierre, Dubois Alexandre, Penafiel Juan, Haudebert Camille, Mazeaud Charles, Mellouki Adil, Hascoet Juliette, Ahallal Younes, Manunta Andrea, Bentellis Imad, Peyronnet Benoit
The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London E1 1FR, UK.
Department of Urology, University of Rennes, Rennes, France.
Ther Adv Urol. 2025 Jul 25;17:17562872251359339. doi: 10.1177/17562872251359339. eCollection 2025 Jan-Dec.
We aim to explore the feasibility of robot-assisted supratrigonal cystectomy and augmentation cystoplasty (RA-SCAC) for the management of adult neurogenic lower urinary tract dysfunction and to compare the functional and surgical outcomes of an intracorporeal and extracorporeal approach. A retrospective review of all patients who underwent robot-assisted supratrigonal cystectomy and augmentation cystoplasty was performed. Data was collected on age, body mass index, American Society of Anaesthesiologists (ASA) score, type and duration of neurological disease, previous abdominal surgery and renal function. Bladder diary, urodynamics and validated symptom score results were recorded at baseline and repeated postoperatively. Intraoperative details included type of diversion, concomitant surgery, duration of surgery, blood loss and conversion to open. Postoperative surgical recovery was also reviewed. The primary endpoint was the rate of major postoperative complications defined as any complication Clavien-Dindo grade ≥3 occurring within the first 90 days postoperatively. There were 26 patients in total; 7 performed extracorporeally and 19 intracorporeally. Mean age was 41.5, mean BMI 24.4 and majority were ASA score 2 (61.5%). Twelve (46.1%) patients had spinal cord injury and 6 (23.1%) spina bifida. Seven (26.9%) had a concomitant procedure including bladder neck artificial urinary sphincter (AUS) insertion, bladder neck fascial sling or creation of a continent catheterisable channel. The surgical outcomes were analysed separately for those that had RA-SCAC only versus RA-SCAC with a concomitant procedure. The operative time was shorter in the intracorporeal group, and the length of stay was similar in both groups. The total number of major postoperative complications was low (n = 3; 11.5%). All urodynamic parameters significantly improved at 6 months in the intracorporeal group. Median number of urinary incontinence episodes per 24 h decreased significantly in both groups at 3 months but the continence status and ICIQ-UI SF demonstrated statistical significance in the intracorporeal group only. In conclusion, robot-assisted supratrigonal cystectomy and augmentation cystoplasty is feasible in adult neurological patients, favouring an intracorporeal approach.
我们旨在探讨机器人辅助三角区上方膀胱切除术及膀胱扩大成形术（RA-SCAC）治疗成人神经源性下尿路功能障碍的可行性，并比较体内和体外手术入路的功能及手术效果。对所有接受机器人辅助三角区上方膀胱切除术及膀胱扩大成形术的患者进行了回顾性研究。收集了患者的年龄、体重指数、美国麻醉医师协会（ASA）评分、神经疾病类型及病程、既往腹部手术史和肾功能等数据。在基线时记录膀胱日记、尿动力学及经过验证的症状评分结果，并在术后重复记录。术中细节包括改道类型、同期手术、手术时长、失血量及转为开放手术的情况。还对术后手术恢复情况进行了评估。主要终点是术后主要并发症发生率，定义为术后90天内发生的任何Clavien-Dindo分级≥3级的并发症。总共有26例患者，其中7例采用体外手术，19例采用体内手术。平均年龄为41.5岁，平均体重指数为24.4，大多数患者ASA评分为2级（61.5%）。12例（46.1%）患者患有脊髓损伤，6例（23.1%）患有脊柱裂。7例（26.9%）患者接受了同期手术，包括膀胱颈人工尿道括约肌（AUS）植入、膀胱颈筋膜悬吊或建立可控性造瘘通道。分别对仅接受RA-SCAC手术的患者和接受RA-SCAC联合同期手术的患者的手术效果进行了分析。体内手术组的手术时间较短，两组的住院时间相似。术后主要并发症总数较低（n = 3；11.5%）。体内手术组在术后6个月时所有尿动力学参数均显著改善。两组在术后3个月时每24小时尿失禁发作的中位数均显著下降，但仅体内手术组的控尿状态和ICIQ-UI SF具有统计学意义。总之，机器人辅助三角区上方膀胱切除术及膀胱扩大成形术在成年神经源性患者中是可行的，更倾向于体内手术入路。
