膀胱次全切除回肠扩大膀胱术治疗神经源性膀胱尿道功能障碍

目的：探讨肠道扩大膀胱成形术治疗神经源性膀胱尿道功能障碍的价值。方法：采用膀胱次全切除、回肠扩大膀胱成形术治疗7例神经源性膀胱尿道功能障碍患者。结果：2例术后排尿通畅,剩余尿消失;3例术后曾有排尿困难,经尿道膀胱颈电切后排尿通畅,无尿失禁,最大尿流率分别为27、16和18ml/s;1例术前曾采用经尿道膀胱颈电切术无效,行本手术后剩余尿消失,但仍有尿失禁,后在超声引导下于尿道周围注射硅酮后,尿失禁症状明显改善;余1例术后仍有排尿困难。结论：该手术方法对神经源性膀胱尿道功能障碍是一种可行的治疗方法。

Observation on subtotal cystectomy and augmentation ileocystoplasty in the management of neurogenic bladder and urethra dysfunction

Purpose:To explore the possibility of subtotal cystectomy and augmentation ileocystoplasty for the treatment of neurogenic bladder dysfunction.Method:7 patients with neurogenic bladder dysfunction underwent a procedure of subtotal cystectomy and augmentation ileocystoplasty. Results:2 patients voided well and was no residue urine. Postoperative difficulty in voiding occurred in 3 patients and was corrected by subsequent transurethral bladder neck revision resulting in free passage of urine and continence, the maximun flow rate being 27,16 and 18ml/sec. Transurethral resection of bladder neck was first carried out in 1 patient with failure and therefore augmentation ileocystoplasty was performed. Although the patient was still incontinent but there was no residue urine. The urinary incontinence has been remarkably improved after injection of silicone around the urethra. 1 patient with high pressure of urethra was difficulty in voiding.Conclusion:Subtotal cystectomy and augmentation ileocystoplasty were considered to be a practicable method for the management of neurogenic bladder dysfunction.