Background

Refractory vesicourethral anastomotic stenosis (VUAS) after radical prostatectomy poses challenges distinct from bladder neck contracture, due to close proximity to the sphincter mechanism. Open reconstruction is technically demanding, risking de novo stress urinary incontinence (SUI) or recurrence.

Objective

To demonstrate patency and continence outcomes of robotic-assisted VUAS repair.

Design, setting and participants

Patients with VUAS underwent robotic-assisted reconstruction from 2015 to 2020 in the Trauma and Urologic Reconstructive Network of Surgeons (TURNS) consortium of institutions. The minimum postoperative follow-up was 3 mo.

Surgical procedure

The space of Retzius is dissected and fibrotic tissue at the vesicourethral anastomosis is excised. Reconstruction is performed with either a primary anastomotic or an anterior bladder flap-based technique.

Measurements

Patency was defined as either the passage of a 17 French flexible cystoscope or a peak flow on uroflowmetry of >15 ml/s. De novo SUI was defined as either more than one pad per day or need for operative intervention.

Results and limitations

A total of 32 patients met the criteria, of whom 16 (50%) had a history of pelvic radiation. Intraoperatively, 15 (47%) patients had obliterative VUAS. The median length of hospital stay was 1 d. At a median follow-up of 12 mo, 24 (75%) patients had patent repairs and 26 (81%) were voiding per urethra. Of five men with 30-d complications, four were resolved conservatively (catheter obstruction and ileus). In eight patients, recurrent stenoses were managed with redo robotic reconstruction (in two), endoscopically (in four), or catheterization (in two). Of 13 patients without preexisting SUI, 11 (85%) remained continent at last follow-up. No patients underwent urinary diversion.

Conclusions

Robotic-assisted VUAS reconstruction is a viable and successful management option for refractory anastomotic stenosis following radical prostatectomy. The robotic transabdominal approach demonstrates high patency and continence rates.

Patient Summary

We studied the outcomes of robotic-assisted repair for vesicourethral anastomotic stenosis. Most patients, after the procedure, were able to void per urethra and preserve existing continence.

中文翻译：

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通过机器人辅助重建持久治疗难治性膀胱尿道吻合口狭窄：外科医生研究的创伤和泌尿外科重建网络

背景

由于靠近括约肌机制，根治性前列腺切除术后难治性膀胱尿道吻合口狭窄 (VUAS) 带来了与膀胱颈挛缩不同的挑战。开放式重建技术要求高，有重新出现压力性尿失禁 (SUI) 或复发的风险。

客观的

展示机器人辅助 VUAS 修复的通畅性和节制结果。

设计、设置和参与者

2015 年至 2020 年，VUAS 患者在外科医生创伤和泌尿外科重建网络 (TURNS) 机构联盟中接受了机器人辅助重建。术后最短随访时间为 3 个月。

外科手术

解剖 Retzius 的空间并切除膀胱尿道吻合处的纤维化组织。使用主要吻合或基于膀胱前瓣的技术进行重建。

测量

通畅被定义为通过 17 French 柔性膀胱镜或尿流测定中的峰值流量 > 15 ml/s。De novo SUI 被定义为每天超过一个垫或需要手术干预。

结果和局限性

共有 32 名患者符合标准，其中 16 名（50%）有盆腔放射病史。术中，15 名 (47%) 患者出现闭塞性 VUAS。住院时间中位数为 1 天。在 12 个月的中位随访中，24 名（75%）患者进行了专利修复，26 名（81%）患者通过尿道排尿。在有 30 天并发症的 5 名男性中，有 4 人保守治疗（导管阻塞和肠梗阻）。在 8 名患者中，复发性狭窄通过重做机器人重建（2 名）、内窥镜（4 名）或导管插入（2 名）进行管理。在没有预先存在 SUI 的 13 名患者中，11 名 (85%) 在最后一次随访时仍保持在大陆状态。没有患者接受尿流改道。

结论

机器人辅助 VUAS 重建是根治性前列腺切除术后难治性吻合口狭窄的可行且成功的管理选择。机器人经腹方法显示出高通畅率和节制率。

患者总结

我们研究了机器人辅助修复膀胱尿道吻合口狭窄的结果。大多数患者在手术后能够通过尿道排尿并保持现有的节制。