使用心包异体组织(Tutoplast®)对一名正在接受尿道切除术并安装了充气阴茎假体的患者进行腹侧下体加固:病例报告

UroPrecision Pub Date : 2024-06-11 DOI:10.1002/uro2.62
Mohammed Mahdi, Shannon Leung, Curtis Pettaway, Run Wang
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引用次数: 0

摘要

勃起功能障碍是根治性膀胱切除术(RC)后的常见后果,充气阴茎假体(IPP)被认为是治疗难治性病例的金标准。根治性膀胱切除术后尿道复发必须进行尿道切除术,这给已安装 IPP 的患者带来了挑战。在尿道切除术中,腹侧白膜变薄可能会增加体腔破坏和 IPP 柱状动脉瘤的风险,从而影响装置的功能。本病例报告介绍了一种新颖的手术技术,即在存在原位 IPP 的情况下,在尿道切除术中使用 Tutoplast(一种来源于人类的心包同种异体组织)进行体腔加固。一名 74 岁的男性患者曾接受过机器人辅助 RC 和 IPP,出现尿道反复出血。影像学检查发现尿道肿块。患者接受了全尿道切除术,但腹侧白膜明显变薄。为防止出现装置动脉瘤或机械故障,术中使用了 Tutoplast 移植来加固变薄的鳞状上皮。术后 6 个月对患者进行了随访。最终病理结果显示为尿道高级别乳头状尿道上皮癌。患者术后恢复顺利,IPP功能正常,随访6个月。在尿道切除术中使用 Tutoplast 加固已有 IPP 的患者的下体,为降低下体破坏和 IPP 柱状动脉瘤的风险提供了简单而经济的解决方案。本病例报告中展示的积极成果值得对更大的患者群体和更长的随访期进行进一步研究,以评估该技术的长期效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Ventral corporal reinforcement using a pericardium allograft (Tutoplast®) in a patient undergoing urethrectomy procedure with an inflatable penile prosthesis in place: A case report
Erectile dysfunction is a common consequence following radical cystectomy (RC), with inflatable penile prostheses (IPPs) placement considered as the gold standard for refractory cases. Urethral recurrence post‐RC necessitates urethrectomy, which poses challenges for patients with an IPP in place. The thinning of the ventral tunica albuginea during urethrectomy may increase the risk of corporal disruption and IPP cylinder aneurysm, affecting device functionality. This case report introduces a novel surgical technique using Tutoplast, a human‐derived pericardium allograft, for corporal reinforcement during urethrectomy in the presence of an in‐situ IPP.A 74‐year‐old male, with a history of robotic‐assisted RC and IPP presented with recurrent bleeding per urethra. Imaging revealed urethral masses. The patient underwent total urethrectomy which resulted in significant thinning of the ventral tunica albuginea. To prevent device aneurysm or mechanical failure, a Tutoplast graft was used intraoperatively to reinforce the thinned tunica. Patient was followed up six months postoperatively.Final pathology showed urethral high‐grade papillary urothelial carcinoma. Postoperatively, the patient exhibited smooth recovery, with normal IPP functionality up to the 6‐month follow‐up period. While Tutoplast has been used in other settings, its application in preventing IPP malfunction posturethrectomy is a unique contribution.Corporal reinforcement using Tutoplast during urethrectomy in patients with an existing IPP presents a simple and cost‐effective solution to mitigate the risks of corporal disruption and IPP cylinder aneurysms. The positive outcomes demonstrated in this case report warrant further studies on larger patient populations and longer follow‐up periods to assess the long‐term outcomes of this technique.
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