Extraperitoneal robot-assisted laparoscopic modified Y-V plasty for the treatment of refractory bladder neck contracture
10.13263/j.cnki.nja.2024.09.004
- VernacularTitle:经腹膜外机器人腹腔镜改良YV成形术治疗顽固性膀胱颈挛缩的疗效分析
- Author:
Jin-Dong LI
1
,
2
;
Chong ZHANG
;
Cai LÜ
;
Zhen-Xiang LIU
;
Zhi-Ming BAI
;
Xue-Jun SHANG
Author Information
1. 中南大学湘雅医学院附属海口医院泌尿外科,海南 海口 570100
2. 南方医科大学南京临床医学院/东部战区总医院泌尿外科,江苏南京 210002
- Keywords:
bladder neck contracture;
modified Y-V plasty;
robot-assisted laparoscopy
- From:
National Journal of Andrology
2024;30(9):798-802
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical effect of extraperitoneal robot-assisted laparoscopic modified Y-V plasty(LMYVP)in the treatment of refractory bladder neck contracture(BNC).Methods:We retrospectively analyzed the clinical data on 10 cases of refractory BNC after transurethral resection of the prostate between September 2020 and January 2023,all with a history of recurrent urethral dilatation and at least two failures in transurethral surgical treatment of scarring.After definite diagnosis and re-moval of some of the scar tissues to flatten the elevated bladder neck under the cystoscope,we performed robot-assisted LMYVP using the da Vinci Si robotic system and a four-port extraperitoneal approach.The surgical procedure involved an inverted T-shaped incision in the bladder neck and urethral stricture ring,an inverted V-shaped excision of the scar area at the 3-9 o'clock position on the ventral side of the prostatic urethra,continuous full-layer suturing of the bladder neck and inverted V-shaped urethra with 3-0 barbed thread,and indwelling of an F20 silicone catheter for 2 weeks.At 3 months after surgery,we performed cystoscopic examination,measured the maximum urinary flow rate(Qmax),and obtained the IPSS and quality of life(QOL)scores of the patients.Results:Operations were successfully completed in all the cases.At 3 months after surgery,the patients showed significantly increased Qmax([3.65±1.27]vs[20.3±1.77]ml/s,P＜0.05),IPSS(5.9±2.02 vs 30±1.15,P＜0.05)and QOL score(1.3±0.95 vs 5.2±0.79,P＜0.05)compared with the baseline.Cystoscopy revealed a wide and flat bladder neck with good survival and hemody-namics of the bladder flap.All the patients met the criteria for clinical cure at a median follow-up of 13.2 months.Conclusion:Extraper-itoneal robot-assisted LMYVP provides a new strategy for urinary tract reconstruction in the management of refractory BNC,with the ad-vantages of minimal invasiveness,high efficiency and high success rate.
