去带盲升结肠可控膀胱术后贮尿囊结石

目的:探讨去带盲升结肠可控膀胱术后贮尿囊结石的发生原因与对应措施.方法:对去带盲升结肠可控膀胱术后患者105例随访14～94个月,平均43.5个月,对相关临床资料进行回顾性分析.结果:贮尿囊结石发生率6.7%(7/105),6例手术治愈,其中2例行经皮穿刺膀胱镜下气压导弹道碎石,4例行贮尿囊切开取石,术后随访未见复发.结论:去带盲升结肠可控膀胱术后贮尿囊结石的发生多与症状性泌尿系感染相关,规律、充分的贮尿囊冲洗及定时清洁导尿对于预防贮尿囊结石有重要作用;选择性地采取经皮穿刺膀胱镜下碎石术或贮尿囊切开取石术,均可取得理想治疗效果.     

可控性回结肠膀胱

可控性回结肠膀胱梅骅用肠管做成可控性膀胱，由患者定期经腹壁输出道导尿，是尿流改道的一种重要改良方法．可控膀胱的基本组成部分包括用肠管重建的贮尿囊，抗返流的输尿管贮尿囊吻合以及可控的腹壁输出道．Ｇｉｌｃｈｒｉｓｔ于１９５０年已报告了用盲升结肠做贮尿囊，...     

原位阑尾作输出道的可控回结肠膀胱术后远期并发症

目的 探讨可控性回结肠膀胱术后远期并发症及其处理方法。方法 膀胱癌患者30例，行回结肠可控膀胱阑尾原位腹壁造口术并进行长期随访观察。随访时间108～126个月，平均118个月。结果 本组远期并发症包括：贮尿囊容量过大5例，贮尿囊内结石形成6例，插管导尿困难4例，输尿管梗阻3例，贮尿囊内出血1例，高氯性酸中毒1例。针对发生的并发症作出相应处理，症状均得到控制。结论 可控性回结肠膀胱阑尾原位腹壁造口术远期疗效可靠，但并发症发生率仍较高，有待进一步完善。     

去带可控盲升结肠膀胱术的尿动力学实验与临床研究

目的　评价去带可控盲升结肠膀胱术的应用价值。　方法　对１５ 头猪去带盲升结肠膀胱术动物实验模型及２３ 例膀胱癌患者去带可控盲升结肠膀胱术进行尿动力学测定，观察贮尿囊容量、内压及输出道压参数。　结果　动物实验结果显示切断结肠带后贮尿囊内压降低，容量、长度及周径均增加。２３ 例患者术后均获得了良好的可控，３ 个月贮尿囊容量可达４００ｍｌ。１３ 例术后（１９．２±８．９）个月尿动力学显示贮尿囊最大容量为（６９７ ±２０４）ｍｌ，最大充盈压为（５８ ．７ ±２４．５）ｃｍＨ２Ｏ，输出道最大闭合压为（１０４ ．３±３３ ．８）ｃｍＨ２Ｏ。　结论　该术式可以获得大容量、低内压的贮尿囊，具有操作简单、可控效果好、节省肠袢等优点。     

去带可控盲结肠膀胱术的疗效观察（附30例报告）

目的 评价去带可控盲结肠膀胱术的疗效。方法 采用膀胱全切去带可控盲结肠膀胱术治疗膀胱癌30例。结果 30例随访8－40个月。1年后贮尿囊容量360－580ml,贮尿囊内最大压力19．5－78．5cmH2O。白天完全可控28例,可控率93％;夜间完全可控27例,可控率90％。贮尿囊造影及IVU显示单侧输尿管狭窄并肾脏轻度积水1例,无输尿管返流。血清电解质及肾功能正常。结论 去带可控盲结肠膀胱术操作简单,并发症少,疗效可靠,是一种较理想的尿流改道方法。     

正位可控性去带盲结肠膀胱术的疗效观察

目的:探讨正位可控性去带盲结肠膀胱术的临床疗效.方法:对17例膀胱肿瘤患者行膀胱全切除术后,应用末段回肠及盲升结肠作贮尿囊行正位膀胱重建术.结果:17例中15例获随访6～24个月,平均14.5个月.全组无严重并发症,均无瘤生存;术后3周自主可控性排尿,日间排尿可控率为93.3%,1年夜间尿失禁22.2%.术后6个月尿动力学检查,膀胱容量336 ml、最大尿流率13.7 ml/s、剩余尿量42 ml,而充盈期膀胱压力明显低于尿道闭合压.输尿管反流1例,但无尿道、输尿管狭窄,肾功能正常.结论:正位可控性去带盲结肠膀胱术具有膀胱容量大、内压低,正位排尿,可控性好,且手术操作简单、并发症少等优点,患者易于接受,是一种较理想的尿流改道方式.     

去带盲结肠可控膀胱术3例报告

目的：探讨一种全膀胱切除或全盆腔脏器切除术后尿流改道方法,方法：对２例全盆顺切除和１例全膀胱切除患行去带盲结肠可控膀胱术。结果：随访４～１６个月,贮尿囊平均容量４５０ｍｌ,平均内压为（１．９６±０．４９）ｋＰａ,无输尿管反流,血电解质和肾功能正常,排尿控制良好,结论：去带盲结脾性可控膀胱术具有手术操作简单,贮尿囊容量大、内压低,自控排尿良好,并发症少优点,是目前较为理想的尿流改道方法。     

可控性回结肠膀胱术远期疗效的临床研究

目的 对可控性回结肠膀胱术的远期疗效进行评价。方法 对23例回结肠膀胱术术后患者的可控性尿动力学、血清电解质、肾功能等进行随访观察。结果 23例随访4～126个月，平均59个月。白天可控率为100％，夜问可控率96％。贮尿囊容量350～640ml，平均560ml，贮尿囊内压力9．30～32，08cmH2O（1cmH2O=0．098kPa），平均19．20cmH2O。B超、静脉肾盂造影（IVP）及贮尿囊造影显示：单侧输尿管狭窄并肾积水1例。贮尿囊结石2例。血清电解质及肾功能正常。结论 可控性回结肠膀胱术远期疗效可靠、并发症少，是一种较理想的尿路分流术式。     

改良去带盲结肠可控膀胱术

目的：评价改良去带盲结肠可控膀胱术的临床价值。方法：对8例膀胱癌患者施行全膀胱切除和改良去带盲结肠可控膀胱术。结果：随访3－41个月，均获得良好的疗效。贮尿囊容量为260－700ml，贮尿囊内最大压力为0.981-2.940kPa，每3－6h导尿1次，血清电解质和肾功能正常。结论：本术式可以获得大容量、低内压的贮尿囊，具有可控效果好、操作简单和并发症少等优点。     

去带盲结肠可控膀胱术

目的　改进膀胱癌患者膀胱全切后贮尿和排尿问题。　方法　对 2 3例全膀胱切除患者行去带盲结肠可控膀胱术。　结果　 2 2例术后随访 3～ 30个月 ,3个月后贮尿囊容量 45 0～ 6 0 0ml,平均 5 5 0ml,平均内压 (14± 8)cmH2 O(1cmH2 O =0 .0 98kPa) ,贮尿囊造影未见输尿管返流 ,IVU示上尿路无积水和输尿管狭窄 ,排尿控制良好 ,插管容易。　结论　去带盲结肠可控膀胱术是一种较为理想的尿流改道方法 ,具有较好的应用价值。     

输尿管回肠吻合术在可控性尿流改道中的应用

目的 评价输尿管回肠吻合术在可控性尿流改道术后抗返流及防止上尿路感染中的效果。方法 根治性膀胱切除术后行去带盲升结肠可控膀胱术和新膀胱术的患者10例，采用带回盲瓣的回肠段作为可控性膀胱的输入襻，双侧输尿管黏膜下隧道法与回肠吻合，随访观察患者术后输尿管返流及上尿路感染情况等。结果 10例手术顺利，术后随访6～36个月，均未发生输尿管返流或上尿路感染，1例发生单侧肾积水，为吻合口狭窄所致。结论 黏膜下隧道法输尿管回肠吻合术预防去带盲升结肠可控性尿流改道术后输尿管返流及上尿路感染效果良好。     

盲升结肠可控膀胱术后上尿路感染危险因素多元逐步回？…

目的 建立多元回归方程,了解根治性膀胱全切、去带盲升结肠储尿囊、阑尾或回肠输出道可控膀胱术后上尿路感染的发病危险因素。方法 对１９９５～１９９８年３１例根治性膀胱全切去带盲升结肠储尿囊可控膀胱术虱进行问卷式随访,多因素逐步回归分析尿流改道后上悄路感染的发病危险因素。结果 门坎值Ｆ＝３．８４引入变量。回归方程Ｙ＝０．６３２＋０．４０５ｘ１－０．０９４ｘ２－０．５２０ｘ３＋０．２４４ｘ４－０．１５４ｘ     

Evaluation and management of mechanical dysfunction in continent colonic urinary reservoirs

PURPOSE: We analyze a group of patients who presented with mechanical dysfunction of the reservoir and/or efferent limb of a continent colonic urinary diversion, and establish an evaluation and management algorithm. MATERIALS AND METHODS: A total of 16 patients with a mean age of 58 years and 1 or more symptoms related to continent colonic urinary diversion were evaluated. Presenting symptomatology included difficult catheterization in 8 cases (50%), disabling incontinence in 8 (50%) and recurrent urinary tract infections in 6 (37.5%). All patients had normal, nonobstructed, nonrefluxing upper tracts and none presented with stone disease. Urological evaluation consisted of catheterization, fluoroscopy and urography of the pouch, retrograde urography of the external limb and urodynamics (enterocystometrogram and outlet pressure profilometry). RESULTS: Of the 8 patients with difficulty with catheterization 4 had stomal stenosis, 2 had an elongated and redundant external limb, and 2 had a false passage. Diagnosis was established by the inability to catheterize, fluoroscopy of the pouch and retrograde urography. Disabling incontinence occurred in 8 patients, including 7 who presented with an incompetent outlet and 2 with high pressure intestinal contractions of the reservoir. The aforementioned abnormalities were diagnosed by a combination of retrograde urography, urography of the pouch and urodynamics. Recurrent symptomatic urinary infections were observed in 5 patients of the previous groups and in another with an hourglass reservoir, which was primarily diagnosed by urography of the pouch. Surgical correction in 15 patients included outlet reinforcement, reservoir revision, stomal or external limb revision and conversion to a urinary conduit. Surgical treatment was successful in 14 of 15 patients (93%). CONCLUSIONS: Catheterization difficulty requires retrograde urography to define possible anatomical abnormalities (false passage, conduit elongation) if catheterization and fluoroscopy of the pouch do not demonstrate stomal stenosis. Urinary incontinence benefits from enterocystometry and outlet pressure measurement to determine reservoir and external limb function. Recurrent urinary tract infections not related to ureteral obstruction or reflux requires fluoroscopy of the pouch and external limb to determine abnormalities in patients with detubularization and localization of areas of urine pooling.     

Continent urinary diversion. A 5 1/2 year experience.

From August 1982 through March 1988, 531 patients have undergone continent urinary diversion using an ileal reservoir constructed according to the method of Kock. For the past year, the Division of Urology at the USC School of Medicine in Los Angeles has used the principle of Kock reservoir construction for primary lower urinary tract reconstruction after cystectomy in 39 highly selected male patients by means of a ureteroileal urethrostomy. Early complications occurred in 86 of 531 patients (16.2%), resulting in an operative mortality rate of 1.9% (ten of 531). The early complication rate was 16.5% in patients undergoing single stage cystectomy and Kock pouch construction and 15.2% among patients undergoing Kock pouch conversion. Late complications have been analyzed in a group of 489 patients who have undergone Kock cutaneous diversion. The complications unique to continent urinary diversion, their incidence, and the effect of technical modifications in reducing the number of late complications are discussed. Since the time of the last modification, in July 1985, the overall incidence of late complication has dropped to 22%. Based on this ongoing experience, the authors conclude that: 1) the continent ileal reservoir as conceived by Kock remains the best internal reservoir for bladder replacement in terms of volume, accommodation with the lowest internal pressures compared with other alternative reservoir construction, 2) the intussuscepted ileal nipple valve mechanism is a reproducible, highly effective mechanism that prevents reflux in 95% of patients and produces excellent continence, 3) our enthusiasm remains tempered by the need for reoperation in approximately 10-15% of patients, usually due to a pinhole fistula or false passage at the base of the efferent nipple valve mechanism, 4) electrolyte abnormalities rarely occur and gastrointestinal dysfunction is unusual in the absence of radiation, and 5) continent urinary diversion is a viable long-term concept that provides a real alternative in terms of quality of life and self-image for the patient undergoing urinary diversion.     

Urinary diversion with Kock pouch: clinical results in 75 cases focusing on late complications

Internal urinary reservoir type urinary diversions have been getting popularity since Kock reported a continent ileal reservoir in 1982. From November 1984 through October 1987, we performed Kock pouch operation in 75 patients (male 64, female 11; from 24 to 82 years old, mean age 56 years old). The underlined diseases were mostly bladder cancer patients; bladder cancer 70, rectal cancer 2, prostatic sarcoma 1, vesical exstrophy 1 and neurogenic bladder 1 case. The end results for 71 evaluable cases, followed up more than 3 months, were excellent in 49 (69%), good 14 (20%), fair 6 (8.5%) and poor 2 (2.8%), with success rate 89%. The most common complication was the nipple malfunction; prolapse, including intermittent prolapse, in 7 patients, slippage or sliding in 1, and eversion in one patient. Stone formation occurred in 6 patients, mild acidosis in 2 and a entero-pouch fistula in a patient who was re-diverted from a ileal conduit. There were 2 deaths postoperatively. Late complications were prominently decreased due to several important modifications of the operative technique, such as usage of Cavitron Ultrasonic Surgical Aspirator (CUSA) for defatting the mesentery, and fixing the nipple to the pouch. In conclusion, Kock pouch can be a safe and sound operative modality for patients who need urinary bladder replacement.     

Clinical studies on Kock continent urinary reservoir and Indiana continent urinary reservoir]

Recently, the continent urinary reservoir which provides the patient with a better quality of life has become popular. Many types of reservoirs have been reported, but the optimal procedure remains to be established. From July 1987 through November 1988, we performed Kock pouch construction on 11 patients (ages 39 to 76 years). Between July 1989 and March 1991, 9 patients (ages 44 to 66 years) underwent Indiana pouch operation. The first 4 patients underwent ileal patch type, and the subsequent 5 underwent Heineke-Mikulicz type procedure. A one-stage radical cystectomy and continent urinary reservoir construction was performed on 19 patients, and bilateral cutaneous ureterostomy was converted to Kock pouch in one patient. There were no perioperative deaths, but reoperation was required for urinary leakage from the reservoir on one patient in each group. As the late complications in the Kock pouch group, one patient required revisional operation of the continent valve mechanism, 2 patients experienced intermittent prolapse of the nipple valve of the efferent limb, and 2 had malfunction of the afferent nipple valve. In the Indiana pouch group unilateral hydronephrosis was noticed in one patient, and 4 had mild difficulty of catheterization. Although 3 patients in both groups had mild urinary leakage, all patients had good quality of life with capacity of reservoir over 500 ml and with good renal function. We changed the type of operative procedure from Kock pouch to Indiana pouch because of the high complication ratio in the former.(ABSTRACT TRUNCATED AT 250 WORDS)     

EVOLVING EXPERIENCE WITH CONTINENT URINARY DIVERSION USING THE INDIANA POUCH

The Indiana continent urinary reservoir procedure for urinary diversion was performed in 46 patients. After the first 8 cases several modifications were made to the Indiana pouch. These modifications include complete detubularization of the colonic segment, construction of the pouch augmented with a U-shaped patch of ileum and, more recently, the use of stapled plication. The mean postoperative follow-up period was 46 mo (range 4.5-74.1 mo). There was 1 perioperative death and this case was excluded from the follow-up study. Late complications related to the urinary reservoir occurred in 12 (26.7%) of the 45 patients. Stone formation was observed in 5 patients. Out of 45 patients, 42 achieved complete urinary continence while 2 suffered mild nocturnal incontinence and 1 had significant leakage. Three had unilateral hydronephrosis due to ureteroanastomotic stricture. Reservoirgraphy demonstrated no reflux into the upper urinary tract in all of the follow-up cases. Loopography of the efferent limb showed that a staple-plicated ileum functions better than a suture-plicated one in terms of reliability of the continence mechanism and ease of catheterization. The Indiana pouch should be considered for any patient requiring cutaneous urinary diversion because it is technically easy to perform and it has a low revision and high continence rate.