经膀胱途径机器人辅助根治性前列腺切除术治疗钬激光前列腺剜除术后顽固性膀胱颈挛缩的疗效

Curative effects of transvesical robot-assisted radical prostatectomy treat for recalcitrant bladder neck contracture after holmium laser enucleation of prostate

本研究采用经膀胱途径机器人辅助根治性前列腺切除术治疗钬激光前列腺剜除术后顽固性膀胱颈挛缩患者8例,年龄(73.3±3.7)岁。前列腺体积(34.2±11.4)ml,最大尿流率(4.1±0.6)ml/s,残余尿量(186.7±46.7)ml,国际前列腺症状评分(IPSS)(31.2±2.2)分,生活质量(QOL)评分(5.3±0.4)分。手术切开膀胱后壁,暴露并环形切割病态膀胱颈口,分离输精管和精囊并暴露前列腺后壁和包膜,向两侧延伸。沿包膜向前列腺尖部分离,显露并切断尿道,使用双针倒刺线重建膀胱颈口。所有手术均顺利完成,手术时间(127.5±18.3)min,出血量(55.0±15.0)ml。术后住院时间(7.5±1.0)d。术后3个月最大尿流率(18.0±1.6)ml/s,残余尿量(24.2±15.8)ml,IPSS(10.7±1.7)分,Q0L评分(1.0±0.3)分。所有患者术后6个月内恢复尿控。

This study used transvesical robot-assisted radical prostatectomy to treat 8 patients with recalcitrant bladder neck contracture after holmium laser enucleation of the prostate.The patients had an average age of(73.3±3.7)years,prostate volume of(34.2±11.4)ml,and Qmax of(4.1±0.6)ml/s,post-void residual urine volume(PVR)of(186.7±46.7)ml,international prostate symptom score(IPSS)of(31.2±2.2),and quality of life(QOL)score of(5.3±0.4).The surgical procedure involved incising the posterior bladder wall,performing a circular resection of the diseased bladder neck,dissecting the vas deferens and seminal vesicles,and transecting the urethra.The bladder neck was then reconstructed using double-needle barbed sutures.All surgeries were successfully completed,with an average operating time of(127.5±18.3)min,blood loss of(55.0±15.0)ml,and a postoperative hospital stay of(7.5±1.0)days.Three months after surgery,the Qmax increased to(18.0±1.6)ml/s,the PVR decreased to(24.2±15.8)ml,the IPSS improved to(10.7±1.7),and the Q0L score improved to(1.0±0.3).All patients had continence within 6 months.