以達文西機器手臂輔助經恥骨後尿道游離手術治療
陰道懸吊手術後膀胱頸阻塞之案例報告
許自翔1、范玉華1,2,3、林冠榮1、黃志賢1,2,3
1臺北榮民總醫院 泌尿部；2國立陽明大學 醫學院 泌尿學科；3書田泌尿科學研究中心
Robotic-assisted Retropubic Urethrolysis for Colposuspension Related Bladder Neck Obstruction– a Case Report
Tzu-Hsiang Hsu1, Yu-Hua Fan1,2,3 , Kuan-Jung Lin1, William J. Huang1,2,3
1Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan;
2Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan;
3Shu-Tien Urological Science Research Center, Taipei, Taiwan
Introduction:
Bladder outlet obstruction (BOO) may occur after any types of anti-incontinence surgeries due to overcorrection of urethra or excessive scar formation. Previous study revealed retropubic urethrolysis was more successful in relieving Burch colposuspension related-urethral obstruction. Robotic-assisted retropubic approach was reported in one small case series and the efficacy seemed promising. We presented our first case who was treated with robotic-assisted retropubic urethrolysis.
Case Presentation:
A 69-year-old woman with hypertension came to our clinic because of voiding difficulty. She received colposuspension for stress urinary incontinence and vaginal hysterectomy for uterine prolapse about 30 years ago. She had been well with improvement of incontinence after surgery until 1 year earlier, when acute urinary retention developed after fleet enema for colonoscopy. An indwelling Foley catheter was placed for 1 week, followed by clean intermittent self-catheterization for another 3 weeks. Afterwards, she suffered from voiding difficulty with prolonged voiding time, especially after holding urine.
On evaluation, a physical examination revealed high position of bladder neck. The video-urodynamic study (VUDS) disclosed detrusor overactivity, bladder diverticulum and closed bladder neck on voiding with high detrusor pressure. The Tamsulosin was prescribed without effect.
We performed robotic-assisted retropubic urethrolysis with the console time of 162 minutes and estimated blood loss less than 30 ml. She had an uneventful surgical convalescence. She reported good voiding without obvious stress or urge urinary incontinence after surgery. Urinary Distress Inventory (UDI-6) score decreased from 14 to 7. The VUDS was repeated 3 months post-operatively. Although her bladder neck still did not relax well on voiding, the maximum flow rate increased from 6.2 to 9.1 ml/s, with the Pdet at a maximum flow decreasing by at least 30 cmH2O. She was satisfied with this operation because of resolution of the obstructive symptoms.
Conclusions:
The robotic-assisted urethrolysis is a safe and feasible procedure for BOO after colposuspension. It offers improved visualization with a high resolution three-dimensional surgical field and reduced blood loss due to pneumoperitoneum and meticulous dissection.