Robotic Management of Complex Vesicourethral Anastomosis Stenosis With Transperineal Urethral Advancement: A Step-by-Step Technique.
| العنوان: | Robotic Management of Complex Vesicourethral Anastomosis Stenosis With Transperineal Urethral Advancement: A Step-by-Step Technique. |
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| المؤلفون: | Rodriguez VI; The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA., Celis V; The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA., Sayegh A; The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA., Medina LG; The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA., Sanchez D; The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA., Sotelo R; The Catherine and Joseph Aresty Department of Urology, USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA. Electronic address: rene.sotelo@med.usc.edu. |
| المصدر: | Urology [Urology] 2024 Feb; Vol. 184, pp. e256-e257. Date of Electronic Publication: 2023 Nov 29. |
| نوع المنشور: | Video-Audio Media |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Science Country of Publication: United States NLM ID: 0366151 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-9995 (Electronic) Linking ISSN: 00904295 NLM ISO Abbreviation: Urology Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: New York : Elsevier Science Original Publication: Ridgewood, N.J., Professional Medical Services Co. |
| مواضيع طبية MeSH: | Urethra*/surgery , Robotic Surgical Procedures*, Male ; Humans ; Constriction, Pathologic/etiology ; Constriction, Pathologic/surgery ; Urogenital Surgical Procedures ; Anastomosis, Surgical |
| مستخلص: | Background: Vesicourethral anastomosis stenosis (VUAS) refers to the diameter narrowing of a vesicourethral anastomosis (VUA). It is a known complication after radical prostatectomy that nowadays presents in less than 1% of these cases. When the lumen narrows sufficiently to impede urine flow, obstructive symptoms arise. While the incidence of VUAS used to be notably higher prior to the widespread use of the robotic approach, traditional procedures still fail in up to 42% of cases. Initial management typically involves endoscopic procedures, such as dilation, incision, or resection. If these approaches prove ineffective, VUA reconstruction is warranted. Following the resection of the unhealthy urethra, a potential drawback is the insufficient length of the healthy proximal urethral to reach the bladder without tension. In such cases, urinary diversion with an ileal conduit is an option. However, when the patient prefers to maintain an orthotopic urinary tract configuration, there is limited guidance in the literature regarding surgical techniques. Objective: To outline the indications, describe the step-by-step technique, and evaluate the outcomes of transperineal urethral advancement to facilitate a tension-free VUA. Materials: We first discuss the indications to identify which patients are candidates for this procedure. Then, a step-by-step description of the robotic VUA revision assisted by transperineal urethral mobilization is presented. Detailed steps and helpful hints are included. Finally, we outline the postoperative pathway and expected outcomes. Results: This technique allows patients with VUAS to preserve the orthotopic configuration of the urinary tract when a tension-free anastomosis proves challenging. Although urinary incontinence is expected, an artificial urinary sphincter could be placed in the following months. Conclusion: The robotic management of complex vesicourethral anastomosis stenosis with transperineal urethral advancement is a feasible and safe procedure that requires the interdisciplinary management of robotic and reconstructive urologists. Competing Interests: Declaration of Competing Interest All authors declare no conflict of interest. (Copyright © 2023. Published by Elsevier Inc.) |
| تواريخ الأحداث: | Date Created: 20231130 Date Completed: 20240304 Latest Revision: 20240423 |
| رمز التحديث: | 20240423 |
| DOI: | 10.1016/j.urology.2023.10.035 |
| PMID: | 38036219 |
| قاعدة البيانات: | MEDLINE |
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