膀胱腹直肌间置术治疗逼尿肌无反射性神经源性膀胱

目的：评价膀胱腹直肌间置术治疗神经源性膀胱的临床效果。方法：通过尿动力学检查选择逼尿肌无反射性膀胱患者8例,通过手术将膀胱置于腹直肌及其前后鞘之间,观察手术后患者症状、排尿情况及残余尿量的改变。结果：手术后62．5％的患者可自行排尿,症状好转或消失;手术后残余尿量较手术前有显著性减少。结论：膀胱腹直肌间置术是治疗神经源性膀胱的有效方法之一,有利于患者的康复。     

膀胱腹直肌间置术治疗神经原性膀胱的疗效观察

采用本院设计的膀胱腹直肌间置术治疗神经原性膀胱39例,效果良好。认为,手术成功的关键是适应证的选择,主要治疗逼尿肌无反射而尿道压正常的患者。术后定期随访十分重要,随诊中应注意残余尿量,有无尿路感染及结石,必要时行尿流动力学检查,发现问题及时处理,以免影响疗效及损害肾功能。     

腹直肌转位术治疗神经原性膀胱

报告采用腹直肌转位术治疗神经原性膀胱12例。随访1～2年,尿失禁症状均消失,能自行排尿,肾功能恢复正常。提示该术式操作简单,疗效可靠。     

腹直肌转位术治疗小儿逼尿肌无反射性神经源性膀胱(附22例报告)

目的 :探讨小儿神经源性膀胱的手术治疗指征及疗效。方法 :对 2 2例小儿神经源性膀胱的患儿 ,经膀胱测压、尿道测压、冰水实验、膀胱造影等检查 ,确定是逼尿肌无反射 ,且不并发输尿管反流 ,尿道压力在正常范围内者行腹直肌转位术。结果 :本组 2 2例患者 ,2 0例尿失禁症状明显好转 ,能自行排尿 ,剩余尿量明显减少 ,2例尿失禁症状无改善。术后 10例测最大尿流率 >15ml/s。 4例术前肾功能中度受损患儿 ,3例术后肾功能明显改善 ,5例术前肾功能轻度受损患儿 ,4例肾功能恢复正常。结论 :此手术对于保护患儿的肾功能及提高生活质量有较好的作用。是治疗小儿逼尿肌无反射性神经源性膀胱的可行手术方法     

应用带蒂腹直肌瓣修补膀胱阴道瘘

报告对15例复杂性膀胱阴道瘘,应用带蒂腹直肌瓣修补痿孔,以加固厚度,促进粘连及血液循环的建立。瘘孔易闭合,成功率高。并对此术的机理、手术时机的选择、手术的入路及术后处理等进行了讨论。     

腹直肌后鞘神经阻滞联合TAP在腹膜透析置管中的应用价值

目的 探讨腹直肌后鞘神经阻滞联合TAP在腹膜透析置管中的应用价值.方法 选择2018年6月—2020年7月在本院住院部需要进行腹膜透析置管的患者146例,将其分为对照组(C组)及实验组(T组),每组73例患者,C组患者采用腹直肌后鞘神经阻滞方式,T组患者采用腹直肌后鞘神经阻滞联合TAP方式.比较两组患者术中疼痛度、抢救...     

带蒂腹直肌瓣修补膀胱阴道瘘39例疗效分析

目的:探讨带蒂腹直肌瓣修补膀胱阴道瘘的临床疗效。方法:回顾性分析2006年1月～2011年1月对39例较大瘘口的膀胱阴道瘘患者行带蒂腹直肌瓣修补,其中初次修补34例,2次以上修补5例;单纯瘘口修补30例,瘘口修补并输尿管膀胱再植9例。结果:39例患者中有38例获得随访,1例失访。一次手术成功率97.4%(37例);1例(2.6%)行二次修补治愈。术后随访6～36个月,均未出现阴道漏尿。结论:利用带蒂腹直肌瓣覆盖修补瘘口是治疗膀胱阴道瘘的有效方法。     

可控膀胱造瘘术治疗逼尿肌无反射性神经源性膀胱

2004年6月至2006年4月我科对3例逼尿肌无反射性神经源性膀胱患者行可控膀胱造瘘术,效果满意,报告如下。1临床资料1.1一般资料本组3例,均为男性,平均年龄54(46~59)岁,平均病程6.7(2~10)年。均以进行性排尿困难为主要临床表现,1例10年前因外伤致T12~L2压缩性骨折导致截瘫,1例有糖尿病史11年、脑梗塞4年,1例10年前患格林巴利。1例查体可触及胀大膀胱,1例查体下腹部饱满,膀胱顶脐下3指,1例留置导尿中。3例均行超声检查,其中1例膀胱尿潴留,1例膀胱内小结石,前列腺钙化,残余尿132m l。1例行CT检查示膀胱多发憩室,前列腺钙化。1例血糖为20.4 mmol…     

经腹直肌外侧缘直切口在输尿管取石术中的应用

为评估经腹直肌外侧缘直切口在输尿管中、中段取石术中的应用价值，报告经腹直肌外侧缘直切口取石５６例，结果除２例分离过程中出现腹膜损伤外，其余手术顺利，与同期经腰或腹部斜切口取石术进行比较，其平均手术时间、术后平均住院天数、术后切口痛，两者均有显著性差异（Ｐ〈０．０５）。认为经腹直肌外侧缘直切口具有组织损伤小，术后恢复快、无后遗切口痛等优点，是一种新的治疗输尿管上、中段结石的手术径路。     

Prospective evaluation of the management of bowel dysfunction in children with neuropathic lower urinary tract dysfunction and its effect on bladder dynamics

Introduction and Aim

Children with neuropathic lower urinary tract dysfunction usually suffer from associated bowel dysfunction, urinary tract infection and vesicoureteral reflux. This work aimed to highlight the impact of bowel management on bladder dynamics.

Hyperammonaemia due to Klebsiella infection in a neuropathic bladder

A boy with a neuropathic bladder and a single hydronephrotic kidney developed hyperammonaemic encephalopathy during a urinary tract infection with Klebsiella oxytoca. Although particularly associated with Proteus infections and prune belly syndrome, hyperammonaemia can complicate infection with any urease-producing bacteria if there is urinary stasis. Received February 9, 1998; received in revised form April 13, 1998; accepted April 14, 1998     

Vesicoureteral reflux and bladder dysfunction

The relationship between vesicoureteral reflux and bladder dysfunction is inseparable and has long been emphasized. However, the primary concern of all physicians treating patients with vesicoureteral reflux is the prevention of renal scarring and eventual deterioration of renal function.Bladder dysfunction, urinary tract infection and vesicoureteral reflux are the three important factors which are closely related to each other and contribute to the formation of renal scar. Especially, there is ongoing discussion regarding the role of bladder dysfunction in the prognosis of both medically and surgically treated vesicoureteral reflux. The effect of bladder dysfunction on VUR is mostly via inadequate sphincter relaxation during infancy which is closer to immature bladder dyscoordination rather than true dysfunction. But after toilet training, functional obstruction caused by voluntary sphincter constriction during voiding is responsible through elevation in bladder pressure, thus distorting the architecture of bladder and ureterovesical junction. Reports suggest that voiding phase abnormalities in lower urinary tract dysfunction contributes to lower spontaneous resolution rate of VUR. However, filling phase abnormalities such as involuntary detrusor contraction can also cause VUR even in the absence of dysfunctional voiding. With regards to the effect of bladder dysfunction on treatment, meta-analysis reveals that the cure rate of VUR following endoscopic treatment is less in children with bladder bowel dysfunction but there is no difference for open surgery.The pathophysiology of bladder dysfunction associated with UTI can be explained by the ‘milk-back’ of contaminated urine back into the bladder and significant residual urine resulting from functional outlet obstruction. In addition, involuntary detrusor contraction can decrease perfusion of the bladder mucosa thus decreasing mucosal immunity and creating a condition prone to UTI. In terms of renal scarring, dysfunctional voiding seems to be more closely related to renal damage in association with VUR than overactive bladder. However, studies show that UTI can induce renal scarring even without VUR present and urodynamic abnormalities are quite often detected in these cases. Whether reflux of sterile urine in bladder dysfunction can cause significant renal scarring, especially when intrarenal reflux is present remains controversial. Another issue that warrants further research is the direct relationship between bladder dysfunction and renal scarring, since some reports suggest that these two conditions share a common genotype.Recently some studies have suggest VUR as a causal factor of bladder dysfunction, supported by the fact that bladder dysfunction resolves after injection therapy of VUR. Further study with more objective evaluation of bladder dysfunction may be needed.     

Surgical management of the congenital neuropathic bladder

We have previously described 3 types of lower urinary tract dysfunction in the congenital neuropathic bladder--contractile, intermediate and acontractile--accounting for 35, 40 and 25% of patients respectively. Subsequent urodynamic and surgical experience has shown that the intermediate type is commoner and the acontractile type less common than was thought. The contractile group accounts for 31% of patients and rarely requires surgery (a "clam" ileocystoplasty). The acontractile group accounts for only 9% but more commonly requires surgical treatment, usually the implantation of an artificial urinary sphincter (AUS). The intermediate group accounts for 60% of patients and usually requires surgery. If there is no significant sphincter weakness incontinence, a "clam" ileocystoplasty alone is performed; if there is sphincter weakness, a "clam and a cuff" procedure is performed with implantation of the remainder of the AUS at a later date, if required.     

The empty bladder

The empty (near-empty) bladder can have a volume ranging from 0 to 30 ml. Its diagnosis is effectively and least invasively made by ultrasound (transvaginal superior). It is a key marker of normal bladder function. It is necessary for the accurate assessment of uterovaginal prolapse, as increasing bladder volume has been shown to reduce the extent of the prolapse. Any negative effect of prolapse on voiding is reduced at high bladder volumes compared to voiding from low bladder volumes (due to the same reduction in the extent of the prolapse). An empty bladder is optimal for bimanual pelvic examination and most transvaginal ultrasound examinations including that for uterine version. The retroverted uterus is proving to be of increasing relevance to prolapse. The woman whose bladder is empty post-voiding is at a significantly lower risk of recurrent urinary tract infections. The bladder that can’t be emptied is a marker of bladder dysfunction, requiring a fuller investigation. From a surgical point of view, the empty bladder improves access and reduces surgical risks with laparotomy, as well as both laparoscopic and vaginal surgery.     

Unsuspected meningocele presenting as neurogenic bladder dysfunction in an adult

Two adult patients with neurogenic bladder dysfunction secondary to unsuspected meningoceles are described. The implications of such problems and the need for complete neurourologic evaluation are important.     

Neurogenic bladder dysfunction in sacral agenesis and dysgenesis

In seven adult patients suffering from congenital caudal spinal malformations including total agenesis, dysgenesis, and dysraphism of the sacral bones, the neurological and the neurogenic bladder disorders are described. Based upon clinical, radiological, and urodynamic investigations, previous observations were confirmed of the wide spectrum of micturition disorders in this type of patient. In three females and four males (median age 30 years, range 19–51 years) a wide spectrum of neurogenic bladder disorders ranging from complete suprasacral to complete infrasacral lesions was found. In one patient, no evidence of sensory-motor bladder nerve deficiency was found. The finding of neurologic damage not corresponding to the levels of bone lesions and the high proportion of patients suffering from concurrent genitourinary developmental defects should emphasize the need for thorough and frequent investigations including urodynamics and monitoring of renal function.