{"title":"机器人辅助 T 形成形术治疗顽固性膀胱颈狭窄:技术描述和初步结果。","authors":"Nicolaas Lumen, Zeyu Wang, Mieke Waterschoot, Thomas Tailly, Beatrice Turchi, Wesley Verla","doi":"10.23736/S2724-6051.24.05872-5","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to describe the technique and initial outcomes of robot-assisted T-plasty for recalcitrant bladder neck stenosis.</p><p><strong>Methods: </strong>Patients who underwent robot-assisted T-plasty for recalcitrant bladder neck stenosis in a single center were included. Presence of bladder neck stenosis was preoperatively confirmed by the combination of retrograde urethrography with voiding cysto-urethrography and flexible urethroscopy. Follow-up visits were performed with history taking, uroflowmetry and echographic residual urine measurement. Complications were graded according to the Clavien-Dindo classification. Patients without urinary symptoms and with a maximum uroflow of no less than 15mL/s were considered as successfully treated. Otherwise, cystoscopy would be performed, and recurrence was defined as the inability to pass a 14 French cystoscope through the bladder neck.</p><p><strong>Results: </strong>Since 2018, seven patients were treated. The etiologies were transurethral resection of the prostate and simple prostatectomy in respectively 6 patients and 1 patient. Cystoscopy was able to diagnose bladder neck stenosis in all cases whereas urethrography was equivocal in 3 out of 7 cases. Median (range) age at surgery was 60 (54-75) years, and median number of prior endoscopic treatment for bladder neck stenosis was 3 (1-16). The median operative time was 123 (110-159) minutes. No intraoperative complications were reported. Three patients suffered a grade 2 complication. After a median follow-up of 27 (4-74) months, the recurrence-free rate was 100% with no evidence of de-novo incontinence or erectile dysfunction.</p><p><strong>Conclusions: </strong>In our series, robot-assisted T-plasty suggests positive and safe outcomes in treating recalcitrant bladder neck stenosis with a good patency rate and low incontinence rate. Additionally, cystoscopy is reliable in the diagnosis of patients with inconclusive urethrography results.</p>","PeriodicalId":53228,"journal":{"name":"Minerva Urology and Nephrology","volume":null,"pages":null},"PeriodicalIF":4.9000,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Robot-assisted T-plasty for recalcitrant bladder neck stenosis: description of technique and initial results.\",\"authors\":\"Nicolaas Lumen, Zeyu Wang, Mieke Waterschoot, Thomas Tailly, Beatrice Turchi, Wesley Verla\",\"doi\":\"10.23736/S2724-6051.24.05872-5\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The aim of this study was to describe the technique and initial outcomes of robot-assisted T-plasty for recalcitrant bladder neck stenosis.</p><p><strong>Methods: </strong>Patients who underwent robot-assisted T-plasty for recalcitrant bladder neck stenosis in a single center were included. Presence of bladder neck stenosis was preoperatively confirmed by the combination of retrograde urethrography with voiding cysto-urethrography and flexible urethroscopy. Follow-up visits were performed with history taking, uroflowmetry and echographic residual urine measurement. Complications were graded according to the Clavien-Dindo classification. Patients without urinary symptoms and with a maximum uroflow of no less than 15mL/s were considered as successfully treated. Otherwise, cystoscopy would be performed, and recurrence was defined as the inability to pass a 14 French cystoscope through the bladder neck.</p><p><strong>Results: </strong>Since 2018, seven patients were treated. The etiologies were transurethral resection of the prostate and simple prostatectomy in respectively 6 patients and 1 patient. Cystoscopy was able to diagnose bladder neck stenosis in all cases whereas urethrography was equivocal in 3 out of 7 cases. Median (range) age at surgery was 60 (54-75) years, and median number of prior endoscopic treatment for bladder neck stenosis was 3 (1-16). The median operative time was 123 (110-159) minutes. No intraoperative complications were reported. Three patients suffered a grade 2 complication. After a median follow-up of 27 (4-74) months, the recurrence-free rate was 100% with no evidence of de-novo incontinence or erectile dysfunction.</p><p><strong>Conclusions: </strong>In our series, robot-assisted T-plasty suggests positive and safe outcomes in treating recalcitrant bladder neck stenosis with a good patency rate and low incontinence rate. Additionally, cystoscopy is reliable in the diagnosis of patients with inconclusive urethrography results.</p>\",\"PeriodicalId\":53228,\"journal\":{\"name\":\"Minerva Urology and Nephrology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.9000,\"publicationDate\":\"2024-10-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Minerva Urology and Nephrology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.23736/S2724-6051.24.05872-5\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Minerva Urology and Nephrology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.23736/S2724-6051.24.05872-5","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景:本研究旨在描述机器人辅助膀胱颈狭窄T成形术的技术和初步结果:本研究旨在描述机器人辅助T成形术治疗顽固性膀胱颈狭窄的技术和初步疗效:方法:纳入在一个中心接受机器人辅助 T 形成形术治疗顽固性膀胱颈狭窄的患者。术前通过逆行尿道造影、排尿膀胱造影和柔性尿道镜检查确认是否存在膀胱颈狭窄。随访包括病史采集、尿流率测定和超声残余尿测定。并发症根据克拉维恩-丁多分类法进行分级。无排尿症状且最大尿流不低于 15 毫升/秒的患者被视为治疗成功。否则将进行膀胱镜检查,复发的定义是无法将14法分膀胱镜通过膀胱颈:自 2018 年以来,共有 7 名患者接受了治疗。病因分别为经尿道前列腺切除术和单纯前列腺切除术的患者分别为 6 人和 1 人。膀胱镜检查能够诊断出所有病例的膀胱颈狭窄,而尿道造影在 7 例病例中有 3 例诊断不明确。手术时的中位年龄(范围)为60(54-75)岁,之前接受过膀胱颈狭窄内镜治疗的中位数为3(1-16)次。手术时间中位数为123(110-159)分钟。无术中并发症报告。三名患者出现了二级并发症。中位随访27(4-74)个月后,无复发率为100%,且无证据显示再次出现尿失禁或勃起功能障碍:在我们的系列研究中,机器人辅助 T 形成形术在治疗顽固性膀胱颈狭窄方面具有积极而安全的效果,通畅率高,尿失禁率低。此外,对于尿道造影结果不确定的患者,膀胱镜检查也是可靠的诊断方法。
Robot-assisted T-plasty for recalcitrant bladder neck stenosis: description of technique and initial results.
Background: The aim of this study was to describe the technique and initial outcomes of robot-assisted T-plasty for recalcitrant bladder neck stenosis.
Methods: Patients who underwent robot-assisted T-plasty for recalcitrant bladder neck stenosis in a single center were included. Presence of bladder neck stenosis was preoperatively confirmed by the combination of retrograde urethrography with voiding cysto-urethrography and flexible urethroscopy. Follow-up visits were performed with history taking, uroflowmetry and echographic residual urine measurement. Complications were graded according to the Clavien-Dindo classification. Patients without urinary symptoms and with a maximum uroflow of no less than 15mL/s were considered as successfully treated. Otherwise, cystoscopy would be performed, and recurrence was defined as the inability to pass a 14 French cystoscope through the bladder neck.
Results: Since 2018, seven patients were treated. The etiologies were transurethral resection of the prostate and simple prostatectomy in respectively 6 patients and 1 patient. Cystoscopy was able to diagnose bladder neck stenosis in all cases whereas urethrography was equivocal in 3 out of 7 cases. Median (range) age at surgery was 60 (54-75) years, and median number of prior endoscopic treatment for bladder neck stenosis was 3 (1-16). The median operative time was 123 (110-159) minutes. No intraoperative complications were reported. Three patients suffered a grade 2 complication. After a median follow-up of 27 (4-74) months, the recurrence-free rate was 100% with no evidence of de-novo incontinence or erectile dysfunction.
Conclusions: In our series, robot-assisted T-plasty suggests positive and safe outcomes in treating recalcitrant bladder neck stenosis with a good patency rate and low incontinence rate. Additionally, cystoscopy is reliable in the diagnosis of patients with inconclusive urethrography results.