1. Réfection d’anastomose urétro-vésicale par voie extra-péritonéale laparoscopique robot-assistée pour sténose anastomotique post-prostatectomie radicale
- Author
-
A. De La Taille, David Grinholtz, A. Hoznek, C. Champy, Alexandre Ingels, C. Chahwan, A. Lavollé, E. Diamant, Dimitrios Vordos, and R. Yiou
- Subjects
Reconstructive surgery ,medicine.medical_specialty ,business.industry ,Prostatectomy ,Urology ,Fistula ,medicine.medical_treatment ,030232 urology & nephrology ,Postoperative complication ,Anastomosis ,medicine.disease ,Surgery ,Artificial urinary sphincter ,03 medical and health sciences ,Neck of urinary bladder ,Stenosis ,0302 clinical medicine ,Medicine ,business - Abstract
Introduction Urethro-vesical anastomosis stenosis following radical prostatectomy is a rare complication but represents a challenging situation. While the first-line treatment is endoscopic, recurrences after urethrotomies require a radical approach. We present the updated results of our patient's cohort treated by pure robotic anastomosis refection. Material and methods This is a retrospective, single-center study focusing on one surgeon's experience. Patients presented an urethro-vesical stricture following a radical prostatectomy. Each patient received at least one endoscopic treatment. The procedure consisted of a circumferential resection of the stenosis, followed by a re-anastomosis with well-vascularized tissue. We reviewed the outcomes in terms of symptomatic recurrences and continence after the reconstructive surgery. Results From April 2013 to May 2020, 8 patients underwent this procedure. Half of the patients had previously been treated with salvage radio-hormonotherapy. The median age was 70 years (64-76). The mean operative time was 109minutes (60-180) and blood loss was 120cc (50-250). One patient had an early postoperative complication, with vesico-pubic fistula. The average length of stay was 4.6 days (3-8). Mean follow-up was 24.25 months (1-66). Half of the patients experienced a recurrence at a median time of 8.25 months (6-11) after surgery. Five patients experienced incontinence of which 3 required an artificial urinary sphincter implantation. Conclusion Extra-peritoneal robot-assisted urethro-vesical reconstruction is feasible and safe to manage bladder neck stricture after radical prostatectomy. The risk of postoperative incontinence is high, justifying preoperative information. Level of evidence III.
- Published
- 2021