女性原位尿流改道的临床研究

目的　总结女性膀胱全切患者行原位尿流改道的临床疗效。　方法　回顾性分析1995年9月至2003年12月34例女性膀胱全切、原位尿流改道患者的临床资料。34例患者,年龄53~64岁,平均58岁。其中移行细胞癌30例,腺癌3例,鳞状上皮癌1例。原发肿瘤30例,复发肿瘤4例。34例患者均行膀胱全切,其中24例保留自主神经。所有患者均截取末段回肠,行回肠代膀胱。术后随访观察临床效果。　结果　34例手术时间平均360min(280~420min),输血量平均600ml(300~1000ml)。术后30例获随访,随访6~108个月,平均61个月。术后6个月昼夜控尿率分别为90% (27 /30)和86% (26 /30)。一次性排空膀胱23例, 2例排尿可控过度,需定时导尿,另5例需采用手压下腹部排空新膀胱。23例行尿动力检查结果显示:贮尿囊容量300~520ml,充盈期囊内压<23cmH2O(6~23cmH2O, 1cmH2O=0. 098kPa),最大尿道压35 ~70cmH2O,功能性尿道长2. 6~3. 5cm,剩余尿量0~38ml。IVU检查贮尿囊球形,无输尿管狭窄,轻度输尿管返流1例,肾盂输尿管轻度扩张1例。血电解质和肾功能正常.无肠膀胱或尿道残端复发者。　结论　女性膀胱癌患者行原位尿流改道可获得满意的临床效果,可作为该类患者的首选治疗方法。     

Comparison of orthotopic sigmoid and ileal neobladders: continence and urodynamic parameters

OBJECTIVES: The objective this of the study was to compare continence rates and urodynamic parameters among patients who had undergone orthotopic bladder substitution with sigmoid or ileal segments. METHODS: Continent urinary reservoirs were constructed in 112 patients. Fifty patients received a sigmoid neobladder (SN) and 62 patients an ileal neobladder (IN). Thirty-four patients with an SN (mean age 64.4 years), and 20 with an IN (mean age 57.8 years) agreed to postoperative urodynamic evaluation at a median time after surgery of 18 and 37 months, respectively. Continence and urodynamic parameters were compared in both groups. RESULTS: The average reservoir capacity of the SN (296 ml) was lower than the IN (546 ml). The majority of patients voided by the Valsalva maneuver and achieved good peak flow rates [SN group 16.6 (range 7-32) ml/s, IN group 25.5 (range 5-35) ml/s]. Of the patients with an SN 26 (76%) and with an IN 15 (75%) emptied to near completion with a post-void residual (PVR) of less than 100 ml. Daytime continence was achieved in 90% of IN patients and 85% of SN patients. Only 9% of patients with an SN and 60% of patients with an IN were continent at night. CONCLUSION: A neobladder constructed from detubularized ileum or sigmoid achieves adequate capacity with a satisfactory daytime continence rate. Nighttime incontinence in patients with IN can be at least partly explained by periods of high pressure due to neobladder contractions in combination with a relaxed sphincter during sleep. The low nighttime continence rate of the SN is probably related to its small functional capacity.     

Ileal neobladder for urinary bladder replacement following total pelvic exenteration for rectal carcinoma

OBJECTIVE: The aim of this study was to determine the feasibility of using the ileal neobladder as a substitute for the urinary bladder following total pelvic exenteration for rectal carcinoma. PATIENTS AND METHODS: Between 1992 and 1998, we performed total pelvic exenteration with ileal neobladder in 5 men with rectal carcinoma. Four patients had primary tumors, and one had recurrent disease after low anterior resection for rectal carcinoma. Histological types were adenocarcinoma in 4 and squamous cell carcinoma in 1. Invaded organs were: the urinary bladder in 1, the urinary bladder and prostate in 2, the prostate and seminal vesicle in 1, and the prostate in 1. RESULTS: There was no operative death. In 1 patient, an ileal conduit was needed because of partial necrosis of the neobladder. Minor leakage on the dorsal wall of the neobladder occurred in 2 patients, which was successfully stopped with simple closure and a gluteus maximus fasciocutaneous flap, respectively. All except one patient with the ileal conduit could void via the urethra. Complete daytime urinary continence was achieved, but nocturnal continence was maintained with voiding once or twice per night. As the urodynamic state, the mean maximum flow rate was 20.9 ml/s (range 9.0-34.1), the mean average flow rate was 7.7 ml/s (range 3.0-11.0), and the mean voided volume was 285.5 ml (range 160-432). The mean length of follow-up was 47.8 months. One patient died of local recurrence 38 months postoperatively, and 1 died of pneumonia 10 months postoperatively. Both patients could void via the urethra until death. The other three patients are currently alive without any evidence of recurrence. CONCLUSIONS: Although total pelvic exenteration is a laborious surgical procedure, an ileal neobladder could be a good alternative to the urinary bladder enabling the patients to void via the urethra with urinary continence.     

球形可控回肠膀胱术的尿动力学研究

目的 探讨球形可控回肠原位膀胱术的尿动力学特点和临床效果.方法 1999年1月至2008年6月行球形可控回肠原位新膀胱术48例,对其中26例男性患者(膀胱移行细胞癌20例,移行细胞癌部分鳞化4例,移行细胞癌伴腺癌及鳞癌1例,移行细胞癌伴隐匿前列腺腺癌1例)进行尿动力学随访.统计学比较患者术后3～12个月新膀胱压力、容积、尿道压和尿流率等指标.结果 术后6个月26例患者新膀胱容量400 ml时基本压力＜15 cm H2O(1 cm H2O=0.098 kPa),膀胱完全充盈时平均压力为18.2 cm H2O.新膀胱平均收缩压＜40 cm H2O.术后膀胱充盈期压力比较:3个月与6个月t=3.03,P＜0.05;6个月与9个月t=0.54,P＞0.05;9个月与12个月t=1.27,P＞0.05;平均残余尿42 ml.Valsalva动作排尿,排尿峰值平均19.6 ml/s.术后平均4.5个月患者昼夜控尿率分别为92%(24/26)和65%(17/26).结果 球形可控回肠膀胱术所需肠管短、容量大、压力低、可控性好,是原位膀胱重建的良好术式.     

Experience and functional outcome of modified ileal neobladder in 95 patients

AIMS: We took advantage of the Goodwin method to develop a modified ileal neobladder. We present the operation procedure and assessed the functional results. METHODS: From April 1997 and May 2005, 95 patients (75 men and 20 women), mean age 64.6 years (range: 36-80 years) underwent orthotopic ileal neobladder replacement with application of the Goodwin method. The Le Duc technique was used for antireflux procedure. However, for the last 35 patients, antireflux procedure was not carried out. The median follow-up period was 37 months (range: 3-98 months). We reviewed the surgical outcome and complications. Continent status and urodynamic profile were also measured. RESULTS: The mean operation time for the neobladder formation was 130 mins (range: 65-285 mins). There were no perioperative deaths. Leakage from the ileourethral anastomosis leak was found in four patients (4.2%), wound infection in nine patients (9.5%), ileal anastomosis leak in two patients (2.1%) and paralytic ileus in two patients. No hydronephrosis, neobladder-ureteral reflux or deterioration of renal function was seen. The maximum neobladder pressure was 21 +/- 13 cm (mean +/- SD) at 6 months and 12 +/- 11 cm at 12 months after surgery. The neobladder capacity was 293 +/- 118 mL at 6 months and 312 +/- 85 mL at 12 months after surgery. Of the 95 patients, 87 (91.6%) maintained complete dryness day and night. CONCLUSIONS: These results suggest that the present orthotopic ileal neobladder is simple to be carried out and achieves acceptable voiding function. Longer observation for neobladder and upper urinary tract function is necessary.     

Sigmoid neobladder in women after radical cystectomy

PURPOSE: Neobladder reconstruction using an intestinal segment is the common procedure of choice in men after cystectomy. Recently this procedure has been extended to women. We present our surgical and functional experience with the sigmoid neobladder in women. MATERIALS AND METHODS: A total of 11 women 49 to 74 years old (mean age plus or minus standard deviation 60 +/- 8.5) with transitional cell carcinoma of the bladder underwent lower urinary tract reconstruction with a modified sigmoid neobladder after nerve and urethral support sparing cystectomy. After at least 3 months voiding pattern and continence status were evaluated. Pressure flow studies and uroflowmetry were performed, the urethral pressure profile and neocystourethral angle were measured, and blood chemistry was analyzed. RESULTS: After at least 3 months complete daytime continence was achieved in 2 patients, while 8 had mild stress incontinence. At night 8 of the 11 women (72.7%) were continent with or without voiding at regular intervals. All except 1 patient voided to completion. Of the 2 patients with complete continence 1 needed clean intermittent catheterization 4 months postoperatively. Mean maximal urinary flow was 19.9 +/- 10.5 ml. per second. Excluding the woman who required catheterization mean residual urine volume was 15 +/- 13.7 ml. Postoperatively maximal urethral pressure was slightly lower and functional urethral length was about 10 mm. shorter than preoperatively. The mean neocystourethral angle was 131.9 +/- 21.7 degrees. Mean pH, bicarbonate and base excess were 7.38 +/- 0.03, 23. 48 +/- 2.34 mmol./l. and -0.92 +/- 2.50, respectively. CONCLUSIONS: After nerve and urethral support sparing cystectomy a modified sigmoid neobladder may be constructed in women to obtain satisfactory continence and voiding results.     

机器人辅助全腹腔镜下"紫砂壶型"原位回肠新膀胱的临床疗效分析

目的探讨机器人辅助全腹腔镜下"紫砂壶型"原位回肠新膀胱患者的尿控和肿瘤学预后。 方法以2017年5月至2019年6月连续进行的10例机器人辅助根治性膀胱切除+回肠原位新膀胱术患者为研究对象，男9例，女1例，年龄（63±11）岁，极高危非肌层浸润膀胱癌5例，肌层浸润性膀胱癌5例；术后随访时间为12～37个月。记录手术视频、术后90 d内并发症、随访期间患者的尿控恢复、分肾功能、上尿路影像学结构改变以及肿瘤学预后。 结果10例患者均顺利完成全腹腔镜下机器人辅助根治性膀胱切除回肠原位新膀胱手术，手术时间（584±56）min，出血量（655±275）ml，术后进食时间1～3 d；1例患者术后6个月行切口疝修复术，其余无Ⅲ级以上并发症。5例（50%）患者术后6～12个月尿流动力学检查提示最大尿流率及平均尿流率分别为（6.3±4.5）ml/s、1.80（0.30）ml/s，术后新膀胱充盈尿量及残余尿量分别为（525±273）ml、161（227）ml，患者日间完全控尿9例（90%），夜间完全控尿8例（80%）。随访期间，发现4侧肾盂轻度扩张，监测分肾功能正常。1例患者术后18个月出现肺转移，其余患者未发现局部复发及转移。 结论"紫砂壶型"回肠原位新膀胱是在Studer型、VIP型回肠新膀胱基础上的储尿囊成型技术改进，术后新膀胱功能良好，能有效保护上尿路形态，恢复排尿功能。     

正位可控去带盲结肠膀胱加回肠抗反流术

目的：探讨正位可控去带盲结肠膀胱加回肠抗反流术的临床效果。方法：采用膀胱全切正位可控去带盲结肠膀胱加末段回肠抗反流术治疗膀胱癌20例。结果：随访9～42个月，白天均可控制排尿，14例夜间能白控排尿，6例夜间有尿失禁。尿动力学检查：12个月贮尿囊平均最大容量350ml，平均最大囊内压3．16kPa，剩余尿量为16ml，平均最大尿流率19．2ml／s。贮尿囊造影及IVU显示2例有双侧输尿管反流，无输尿管狭窄和肾积水。血电解质及肾功能正常。结论：正位可控去带盲结肠膀胱加末段回肠抗反流术操作简单，并发症少，疗效好，是一种较理想的膀胱替代术。     

生活质量评分表在肠代膀胱功能评估中的应用研究

目的 探讨生活质量(QOL)评分表评估全膀胱切除肠代膀胱术后功能的可行性.方法 对22例肠代膀胱术后患者进行问卷调查,重点了解日间及夜间排尿间隔、排尿时间、尿失禁发生程度,填写QOL评分表;患者均行常规尿动力学检测.分析QOL评分与排尿间隔、尿失禁程度及常见尿动力学参数间的相关性.结果 22例患者QOL评分0～5分,平均2分;日间完全控尿19例,轻度尿失禁2例、中度尿失禁1例;夜间尿失禁12例,轻度4例、中度3例、重度5例;日间排尿间隔45～210 rain,平均136 rain.最大尿流率2.7～22.1ml/s,平均12.9 ml/s;最大尿道闭合压33～114 cm Ha0(1 em H20-0.098 kPa),平均69.3 cm H2O,剩余尿量5～300 ml,平均91.8 ml.QOL评分与尿失禁程度呈正相关(日间:r=0.510,P=0.015;夜间:r=0.911,P<0.001),与日间排尿间隔呈负相关(r=0.749,P<0.001);QOL评分的影响因素包括最大尿道闭合压、剩余尿量及最大尿流率.结论 QOL评分可以作为评估肠代膀胱功能的量化指标,能较准确地反映患者实际控尿能力及生活质量的主观感受,且与常见尿动力学参数具有显著相关性.     

Orthotopic ileal neobladder reconstruction using a modified Goodwin method: functional outcome in 37 patients

Since 1996, we have been using a modified Goodwin technique for orthotopic ileal neobladder replacement. We report on the surgical technique and the voiding function of ileal neobladder in 37 patients. A small bowel segment, 50 cm in length, was resected 20 cm proximal to the ileocecal valve. The small bowel loops were then arranged in a U shape. Vodiing function was evaluated in terms of voiding pattern, continence and urodynamic study. The mean follow-up period was 18 months (range 3 to 64). The mean maximum neobladder pressure in the storage phase was 15 cm water at 6 months, 12 at 12 months, and 7 at 24 months. The mean maximal urethral closed pressure was 52 cm water at 6 months, 51.7 at 12 months, and 66 at 24 months. The mean maximal urinary flow rate was 16.2 ml per second at 6 months, 17.6 at 12 months, and 20.8 at 24 months. The mean maximal neobladder capacity was 300 ml at 6 months, 302 ml at 12 months, 382 ml at 24 months. Among the 37 patients, 30 remained completely dry day and night. Three patients were incontinent only during the nighttime, and required only one pad. Four patients were wet day and night, and required 2 pads daily. Our results indicate that the modified Goodwin method appears to be an excellent technique for ileal neobladder replacement following cystectomy and seems successful in producing balanced voiding dynamics.     

保留部分前列腺外科包膜对原位新膀胱功能的影响

目的　探讨全膀胱切除术中保留远端部分前列腺外科包膜及其周围横纹括约肌对原位新膀胱功能的影响。　方法　对 2 3例男性膀胱癌患者行全膀胱切除并肠道原位新膀胱术。分两组 :①改良手术组 :13例 ,在膀胱切除时保留远端部分前列腺外科包膜及其周围横纹括约肌 ,新膀胱与残留前列腺包膜连续缝合 ;②常规手术组 :10例 ,行常规全膀胱切除 ,新膀胱与后尿道间断缝合。对两组新膀胱术后的控尿和排尿功能进行随访和比较。　结果　术后病理分期 :T2aN0 M0 13例 ,T2bN0 M0 6例 ,T1N0 M0 1例 ,T3aN0 M0 1例 ,T3bN1M0 1例和T4aN0 M0 1例。术后随访 3～ 4 0个月。改良手术组无瘤生存 11例 ;带瘤生存 2例 ,其中 1例为低分化移行细胞癌 ;另 1例为低分化腺癌。 13例新膀胱排尿良好 ,剩余尿 0～ 70ml;完全控尿 12例 ,夜间尿失禁 1例。常规手术组 10例均无瘤生存 ,7例排尿好 ,剩余尿 10～ 10 0ml,3例剩余尿 10 0～ 2 5 0ml,需要不定期间歇导尿 ;完全控尿 7例 ,昼夜尿失禁 1例 ,夜间尿失禁 2例。　结论　保留部分前列腺外科包膜及其周围横纹括约肌可改善原位新膀胱术后患者的排尿和控尿功能。     

回肠新膀胱术的临床疗效观察

为客观地评价回肠新膀胱术的远期疗效，对５２例术后病人的可控性、尿动力学、肾功能、贮尿囊组织学变化及尿ｓＩｇＡ等进行随访研究。４９例获随访３～６６个月，平均随访３５个月。日间可控率为９４％，夜间为８１％。平均最大膀胱容积为４２４．５ｍｌ，最大内压为２．７０ｋＰａ（１ｋＰａ＝１０．２０ｃｍＨ２Ｏ），平均剩余尿２４．８ｍｌ，最大尿流率为１８．０ｍｌ／ｓ。ＩＶＵ示８例１１条输尿管轻中度扩张，膀胱造影２例轻度返流，血肌酐、尿素氮保持正常，尿ＮＡＧ２例升高。术后病人尿ｓＩｇＡ较高。随术后时间延长，贮尿囊绒毛及微绒毛逐渐萎缩，酸中毒发生率下降，尿内粘液减少。肿瘤尿道复发１例。认为回肠新膀胱术是一种可选择的手术。     

Ileal neobladder. Principles of function and continence

Since April 1986, total bladder substitution, by the ileal neobladder in cases of radical cystoprostatectomy or bladder augmentation, proved to be a reliable alternative method of urinary diversion in 81 patients. The operative technique is standardized, comparably simple and safe to prevent upper urinary tract deterioration, reflux, as well as incontinence. The neurovascular bundle can be preserved, so potency might not be compromised. As preservation of the external urethral sphincter is possible, total day and night time continence is a result of residual sphincter function and abolishment of high pressure waves of the intestinal reservoir. Follow-up of the patients is between 1 and 28 months (mean 12.2 months). 64 patients had a follow-up of more than 3 months postoperatively and the evaluation included private micturition behavior and urodynamic investigation. Stress incontinence, which has to be corrected by an artificial sphincter, was found in 3 and night time incontinence needing some external device in 2 patients. There was no perioperative mortality. The special technique of creating the ileal neobladder by folding the ileal segment 4 times with complete detubularization, besides preserving urethral sphincter function, seems to be the most important reason why total continence during the day and night is achieved in more than 90% of the patients.     

Clinical, urodynamic and endoscopic characteristics of the Stanford pouch ileal neobladder constructed with absorbable staples

PURPOSE: The clinical, urodynamic and endoscopic aspects of the Stanford pouch ileal neobladder formed with absorbable staples were investigated. METHODS: A Stanford pouch ileal neobladder was formed using absorbable staples after radical cystoprostatectomy in 30 male patients with the diagnosis of muscle invasive carcinoma of the bladder between 1995 and 1998. The mean age of the patients was 62 (range 41-70) years. Patients were followed with arterial blood gas, serum biochemistry, pouch cystography, urodynamic tests and endoscopy. RESULTS: Five (16.7%) patients had early postoperative complications and three were related to the neobladder. One year postoperatively, low grade (I, II) vesicoureteral reflux was present in five (16.7%) cases. The mean preoperative and 6 months postoperative serum creatinine levels were 1.07+/-0.3 mg/dL and 1.2+/-0.4 mg/dL, respectively, but the difference was not statistically significant (P=0.1). Six months postoperatively the mean serum chloride level was 109+/-4.5 (range 100-113) mmol/L and the mean arterial blood pH was 7.37+/-0.2 (range 7.3-7.4). Two (6.7%) patients required oral alkaline supplementation because of high chloride levels. All the patients except one were continent throughout the day after 1 year. However, nocturnal enuresis was present in 25 (83.3%) cases. The pouch capacity was increased gradually up to 12 months postoperatively and the mean pouch capacity 12 months postoperatively was 460+/-95.8mL. Micturition occurred spontaneously in most patients while some needed abdominal straining. None of the patients had a residual urine of more than 60 mL. The mean maximum flow rate 6 months postoperatively was 9.8 (range 5.4-15.0) mL/s. After 6 months the stapled edge was noticed as a nodular line. One year postoperatively only a white scar could be observed at the suture line. CONCLUSION: The Stanford pouch ileal neobladder constructed using absorbable staples was able to provide a good capacity low pressure reservoir with a low rate of complications.     

Infrequent voiders syndrome (nurses bladder). Prevalence among nurses and assistant nurses in a surgical ward

We evaluated the prevalence of infrequent voiders syndrome (defined as women with a mean voided volume above 400 ml) and predisposing factors among the female nursing staff in a busy 100 beds department of surgery. One hundred and five nurses and assistant nurses were invited to fill in a questionnaire and a frequency/volume chart for a 24-hour period. The infrequent voiders were further studied using uroflowmetry and medium-fill CO2 cystometry. Seventy-two women completed the study. Six (95% c.l. 3%-17%) were infrequent voiders, although fifty women (57%-80%) suppressed the desire to void during working hours. Main reasons for suppression of desire to void were busy work, poor toilet facilities and indolence. The frequency of micturition was higher during evening and night shifts than in the day shift. In the infrequent voiders the functional bladder capacity ranged from 550-1,100 ml, but none had residual urine exceeding 120 ml.     

Nocturnal enuresis in men with an orthotopic ileal reservoir: urodynamic evaluation

PURPOSE: We evaluated the urodynamic features of enuretic and continent patients with an orthotopic neobladder. MATERIALS AND METHODS: Included in our study were 100 men with an orthotopic hemi-Kock or W neobladder and a minimum followup of 1 year. Of the patients 50 were completely continent day and night, and 50 had enuresis without evidence of an underlying organic etiology, such as stones, reflux or urethral stricture. RESULTS: Univariate analysis showed significantly higher pressure and a larger volume of post-void residual urine in the men with enuresis. In addition, maximum urethral pressure, maximum flow and compliance were decreased in the enuretic group compared to the continent group. Multivariate analysis revealed that post-void residual urine volume, frequency and maximum amplitude of uninhibited contractions are the most critical parameters affecting nocturnal continence. CONCLUSIONS: The cystometric parameters significantly associated with nocturnal enuresis in patients with an orthotopic reservoir are post-void residual urine volume, frequency and maximum amplitude of uninhibited contractions. Urethral pressure and flow parameters did not sustain significance on multivariate analysis.     

Early and late urodynamic assessment of ileal orthotopic bladder substitutes combined with an afferent tubular segment

PURPOSE: Limited information is available concerning changes in the urodynamic characteristics of orthotopic bladder substitutes with time. Therefore, we compared early and late urodynamic results in patients with an ileal orthotopic bladder substitute combined with an afferent tubular segment. MATERIALS AND METHODS: Of 139 patients surviving at least 5 years after cystoprostatectomy and ileal orthotopic bladder substitution with an afferent tubular segment 119 underwent urodynamic assessment, including 66 at a median of 9 months (early) and 77 at a median of 62 months (late). Of these patients 24 were assessed at each time point. Simultaneously all patients were asked to complete a bladder diary and questionnaire regarding continence for at least 3 days in the week preceding the urodynamic study. RESULTS: Urodynamic parameters were comparable in patients who were evaluated early and late postoperatively. In addition, median values at early and late urodynamic evaluation in the 24 patients with the 2 examinations showed no statistically significant differences for volume at first desire to void (300 vs 333 ml, p = 0.85), pressure at first desire to void (12 vs 13 cm H2O, p = 0.57), maximum cystometric capacity (450 vs 453 ml, p = 0.84), end filling pressure (19 vs 20 cm H2O, p = 0.17), reservoir compliance (25 vs 28 ml/cm H2O, p = 0.58) or post-void residual urine volume (5 vs 15 ml, p = 0.27). CONCLUSIONS: Urodynamic results after 5 years of living with an ileal orthotopic bladder substitute with an afferent tubular segment show grossly unchanged urodynamic characteristics. Patients maintain a reservoir capacity and micturition pattern consistent with a normal life-style. Reservoir pressure remained low, thereby protecting and preserving upper tract function. To achieve these results patients must be regularly followed, and the causes of bacteriuria, increased post-void residual urine and bladder outlet obstruction must be recognized and dealt with accordingly.     

Orthotopic sigmoid neobladder after radical cystectomy: assessment of complications,functional outcomes and quality of life in 82 Japanese patients

Study Type – Therapy (outcomes study)
Level of Evidence 2c

OBJECTIVES

To retrospectively review our clinical experience with sigmoid neobladder reconstruction.

PATIENTS AND METHODS

The study included 82 consecutive Japanese patients (64 men and 18 women) with bladder cancer who had a radical cystectomy and orthotopic sigmoid neobladder created using the modified technique described previously. Complications, functional outcomes and health‐related quality of life (HRQL, using the Short‐Form 36 instrument) were evaluated in 80 patients with a mean follow‐up of 55 months, after excluding two who died perioperatively.

RESULTS

There were 45 early complications in 28 patients, including wound infection in 16, ileus in nine and pyelonephritis in eight, with 19 late complications in 15, including neobladder stone in five, uretero‐intestinal stricture in four and entero‐urethral stricture in four. Of the 80 patients, 73 could void spontaneously, and daytime and night‐time continence were achieved in 69 and 46, respectively. The mean maximum flow rate, voided volume and postvoid residual were 18.6 mL/s, 345.3 mL and 24.5 mL, respectively. Severe hyperchloraemic metabolic acidosis occurred in three patients, but none of them developed hypovitaminosis of B₁₂. The HRQL survey after surgery showed no significant differences in five of the eight scale scores between the 80 patients with a sigmoid neobladder and an age‐matched control population in Japan. Furthermore, there were no significant differences in any variables assessed in this study between men and women patients.

CONCLUSIONS

The modified sigmoid neobladder provides satisfactory clinical outcomes after radical cystectomy.     

女性功能性膀胱出口梗阻的诊断与治疗

目的探讨女性功能性膀胱出口梗阻的诊断与治疗方法。方法28例因排尿困难就诊的女性患者,经尿流动力学检查,排尿期膀胱造影及膀胱镜检查等确诊为功能性膀胱出口梗阻。平均最大尿流率11.3ml/s,平均剩余尿量180ml。所有患者接受经尿道内括约肌切开术和α鄄受体阻滞剂治疗。结果平均手术时间15min;术后平均住院4d,所有患者排尿顺畅,症状明显改善。术后10月随访,平均最大尿流率25.7ml/s,平均剩余尿量30ml,与治疗前相比差异显著(P<0.05)。结论联合应用尿流动力学检查,排尿期膀胱尿道造影及膀胱镜检查可准确诊断功能性膀胱出口梗阻。经尿道内括约肌切开术及α鄄受体阻滞剂治疗是较理想的治疗方法之一。     

女性可控性回肠膀胱术的远期疗效分析

目的 探讨女性可控性回肠膀胱术的远期随访疗效.方法 女性膀胱肿瘤患者19例,年龄45～66岁,平均52岁.病程16 d～1.9年,平均4.4个月.临床表现均有间歇性无痛性全程血尿.肿瘤单发14例,多发5例.活检病理均为移行细胞癌.分级:G1 10例、G2 7例、G3 2例,UICC分期:pT1 5例、pT2 12例、pT3a 2例.肿瘤距膀胱颈部>2cm.尿道无肿瘤,无尿失禁.19例均采用改良根治性膀胱全切除术,不切除子宫及阴道前壁,保护支配尿道的神经,清除盆腔脂肪淋巴组织,切除近端尿道0.8～1.2cm.应用末端回肠30 cm制作新膀胱.原位尿道吻合.结果 19例手术及术后恢复顺利.术后失访3例.16例随访6～102个月,平均71个月.无瘤存活15例,术后17个月死于心肌梗死1例.术后9个月昼、夜控尿率分别为100%(16/16)和93%(14/15).术后9个月,15例行尿动力学测定,新膀胱容量(519.0±53.0)ml,残余尿量(29.2±4.9)ml,最大尿流率(18.6±2.8)ml/s;平均充盈压力和排尿压力分别为(16.7±3.5)和(53.0±5.0)cm H2O(1 cm H2O=0.098 kPa).术后9个月IVU检查单侧上尿路轻度积水1例,血BUN、Cr、电解质及二氧化碳结合力均正常.肿瘤无复发.结论 女性可控性回肠膀胱术后控尿功能良好,新膀胱容量大、压力低、顺应性好,并发症少,是女性膀胱原位重建的良好术式.