Kronstedt Shane, Kaldany Alain, Patel Hiren V, Elsamra Sammy E
Division of Urology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States.
Front Urol. 2023 Mar 14;3:1080856. doi: 10.3389/fruro.2023.1080856. eCollection 2023.
The management of urinary tract stricture disease has evolved over the last several decades, with robotic surgery representing a bourgeoning method for urologic reconstruction. Conventionally, proximal and mid-ureteral strictures, as well as lengthy urethral strictures, have presented a challenge for surgeons to create tension-free repairs. Options for repair include endoscopic dilation, endopyelotomy, ureteroplasty or pyeloplasty, and urethroplasty. Small and large bowel can be incorporated into various urinary tract stricture repairs. Their use has proven successful in reconstructing both upper and lower urinary tract strictures and offers flexibility for complex cases such as lengthy or multifocal strictures. While the use of bowel, most notably the appendix, for stricture repair is not a novel concept, a growing body of evidence supports its use with minimally invasive robotic approaches. In addition, there has been a substantial amount of recent data suggesting low rates of postoperative complications and long progression-free survival after robotic stricture repair using small bowel or rectum. We present a comprehensive review of literature outlining the role of the small bowel, appendix, and rectum in the minimally invasive repair of urinary tract stricture disease, as well as a description of the various techniques employed.
在过去几十年中，尿路狭窄疾病的治疗方法不断发展，机器人手术已成为泌尿外科重建领域中一种新兴的方法。传统上，输尿管上段和中段狭窄以及较长的尿道狭窄给外科医生进行无张力修复带来了挑战。修复方法包括内镜扩张、肾盂内切开术、输尿管成形术或肾盂成形术以及尿道成形术。小肠和大肠可用于各种尿路狭窄修复手术。事实证明，它们在重建上尿路和下尿路狭窄方面是成功的，并且为诸如长段或多灶性狭窄等复杂病例提供了灵活性。虽然使用肠道（最显著的是阑尾）进行狭窄修复并非新概念，但越来越多的证据支持在微创机器人手术中使用它。此外，最近有大量数据表明，使用小肠或直肠进行机器人狭窄修复术后并发症发生率低，无进展生存期长。我们对文献进行了全面综述，概述了小肠、阑尾和直肠在尿路狭窄疾病微创修复中的作用，并描述了所采用的各种技术。
