Functional characteristics of the Camey ileal bladder

We studied postoperatively 14 men who underwent urinary diversion with a Camey ileal bladder in association with radical cystoprostatectomy. Clinical and urodynamic evaluations revealed that the ileal bladder provides a moderate pressure reservoir (mean pressure at capacity 37 cm. water) and offers the patient reliable daytime continence. The mean capacity of 362 ml. allows for a voiding interval of 2.2 hours but it is not adequate for storage of urine produced through the night, so that nocturnal enuresis results universally. Even after 2 years of followup the tubular-shaped ileal reservoir maintained physiological contraction waves of segmentation and peristalsis typical of human ileum. Voiding is accomplished by abdominal straining and an intraluminal pressure of more than 50 cm. water is required to maintain the urine flow. Mean peak flow rate was 19 ml. per second. Reflux was prevented successfully in 86 per cent of the renal units. Metabolic acidosis was seen in 43 per cent of the patients. While the ileal bladder falls short of being the ideal form of continent urinary diversion, it offers a psychologically attractive technique to selected and highly motivated male patients faced with the need for urinary diversion.     

Functional characteristics of the continent ileocecal urinary reservoir: mechanisms of urinary continence

We evaluated urodynamically 14 patients with a continent ileocecal urinary reservoir. Reservoirs were constructed of detubularized right colon alone (4 patients), or augmented with ileum (2) or with a U-shaped ileal patch (8). All reservoirs were placed in the abdomen and used plicated terminal ileum as the efferent continence mechanism. Twelve patients are completely continent with intermittent catheterization at 4 to 8-hour intervals. Two patients suffer mild nighttime incontinence. Mean reservoir volume was 675 ml. Intermittent intestinal contractions were noted in the plicated ileal segment and reservoir but they occurred more frequently in the former and were either synchronous with or preceded those in the reservoir. Mean and maximal contraction pressures were 24 and 47 cm. water, respectively, in the reservoir and 40 and 151 cm. water, respectively, in the plicated ileal segment (p equals 0.043 and less than 0.001, respectively). The highest reservoir contractions occurred in the 2 patients with nocturnal incontinence. The method of construction bore no consistent correlation with mean or maximal contraction pressures, contraction frequency or continence. Careful urodynamic assessment suggests that the ileocecal urinary reservoir is a relatively low pressure, nonrefluxing and continent bladder substitute. The plicated terminal ileal segment acts as an effective sphincter that responds to pressure elevations in the reservoir. Its simple construction and easy catheterization make it an attractive alternative to intussuscepted ileal segments.     

Continent replacement enterocystoplasty using a low-pressure detubularized ileal pouch after radical prostatocystectomy

Tubular ileal-ileo-caecal or colonic replacement enterocystoplasties induce nocturnal incontinence in more than 70% of cases, partly due to the presence of peristaltic waves responsible for pressures greater than 40 cm of water for low filling volumes. The use of debutularised intestinal grafts considerably attenuates these pressure waves, ensuring excellent diurnal continence and a dramatic reduction in nocturnal incontinence together with protection of the upper urinary tract. The detubularised ileal bladder combines the reliability of all low pressure reservoirs with a simple technique: a 30 cm ileal segment is isolated then opened 2 cm from its anti-mesenteric border. The two limbs of the loop are sutured to each other. The ureters are reimplanted at the summit of each limb according to the mucosal groove procedure and the summit of the pouch is anastomosed to the urethra. This procedure has been used in 10 patients following radical cystectomy for cancer. Seven of these patients underwent clinical, radiological and urodynamic examination 5 months after the operation: all 7 patients were continent during the day. Nocturnal continence was obtained at the cost of getting up one or twice during the night, but incontinence persisted in the other 3 patients. Cystometry did not reveal any pressure waves greater than 25 cm of water for a volume of 500 ml. The detubularised ileal bladder is simple to perform and constitutes a reasonable alternative to traditional tubular enterocystoplasties.(ABSTRACT TRUNCATED AT 250 WORDS)     

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。     

Continence after total bladder replacement: urodynamic analysis of the ileal neobladder

Since April 1986 we have carried out 103 bladder substitutions with the ileal neobladder; 91 of these were performed after radical cystectomy in males (group 1) and 12 after subtotal bladder resection (group 2); 55 patients in group 1 and 8 in group 2 were followed up by long-term urodynamic investigations and by a questionnaire concerning micturition patterns and continence at home 3 months post-operatively. The maximum bladder capacity was approximately 770 ml with an absolute intravesical pressure of 23 to 30 cm H2O. Intravesical pressure waves with a mean amplitude of 20 cm H2O were found in 38% of patients in group 1 and 25% in group 2; 61% of these patients were asymptomatic. The results showed that 85% of patients were continent by day and by night. We attribute this to our operative technique: the ileal loop is folded 4 times in a "W" or "M" shape to achieve complete detubularisation of the bowel and the external urethral sphincter is carefully preserved. Altogether, these data show the ileal neobladder technique to be a reliable and safe method of bladder substitution.     

Ileocecocystoplasty for the management of refractory neurogenic bladder: surgical technique and urodynamic findings

A total of 21 incontinent adults with a neurogenic bladder who were refractory to conservative management underwent a modified technique of ileocecocystoplasty. Followup ranged from 1 to 6 years (mean 3.1 years). To ensure a wide anastomosis the augmentation was accomplished by suturing a detubularized ileocecal patch to a large posterior based bladder flap anchored to the psoas muscles. Postoperatively 20 of 21 patients were continent. The remaining woman was cured after surgical correction of sphincteric incontinence. Mean bladder capacity increased from 185 +/- 17 to 595 +/- 43 ml. (standard error). Mean maximum detrusor pressure decreased from 53 +/- 6.3 to 16 +/- 2.3 cm. water (p less than 0.0001). Followup revealed a persistently large capacity, low pressure reservoir in all patients. No patient required anticholinergic medication. None experienced acid-base imbalance, tumors in the augmented bladder or upper tract deterioration. We conclude that this technique of ileocecocystoplasty is suitable for the management of patients with a refractory neurogenic bladder.     

机器人辅助腹腔镜体内原位U形回肠新膀胱术的临床疗效观察及尿动力分析

目的探讨采用da Vinci Xi机器人系统完成机器人辅助腹腔镜下根治性膀胱切除（RARC）加体内构建原位U形回肠新膀胱术的临床疗效,并结合术后尿动力分析评价该术式对排尿的影响及可能机制。 方法以2020年6月至2021年3月连续进行的8例机器人辅助腹腔镜下根治性膀胱切除+体内原位U形回肠新膀胱术患者为研究对象,其中男7例,女1例,年龄63（18）岁,极高危非肌层浸润膀胱癌1例,肌层浸润性膀胱癌7例,术后随访时间为3~12个月。记录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8例手术均成功完成,并发症发生率37.5%,术后3个月日间完全尿控率87.5%,夜间功能性尿控率75.0%,术后6个月尿动力分析示：最大尿流率和平均尿流率分别为19.8（3.97）ml/s、5.05（0.94）ml/s,最大尿道压81.5（28.75）cm H₂O,新膀胱顺应性26.5（12.75）ml/cm H₂O。 结论RARC术后实施体内原位U形回肠新膀胱术是可行的,具有可重复性,是一种疗效确切、尿控恢复理想的膀胱根治性切除术后新膀胱替代方案。     

腹腔镜下膀胱全切除、原位回肠新膀胱的尿流动力学分析

目的 探讨腹腔镜膀胱全切除、原位回肠新膀胱的临床效果。方法 对8例行腹腔镜膀胱全切除、原位回肠新膀胱患者进行排尿情况的记录和尿动力学检查。结果 8例患者均可自主控制排尿（1例夜间轻微尿失禁）,在新膀胱充盈过程中均可出现胀痛感觉,膀胱平均容量377．5ml,压力17．9cmH2O,最大尿流率18．1ml／s,最大尿道闭合压68．5cnH2O,功能性尿道长度3．7cm。结论 腹腔镜根治性全膀胱切除、原位回肠新膀胱术较传统的开放手术创伤更小,但贮尿囊一样具有容积较大、内压较低和可控性较好的优点,排尿良好,值得临床推广。     

改良原位螺旋构型回肠新膀胱术32例报告

目的 评价原位螺旋构型回肠新膀胱术的疗效.方法 1998-2008年对32例男性膀胱癌患者行原位螺旋构型回肠新膀胱术.采用40～45 cm回肠新建储尿囊,去管后用无水乙醇擦拭以清除、破坏黏液细胞,螺旋状构型缝合成低压储尿囊.两侧输尿管末端袖口状整形后分别行原位"插入式"置入新膀胱(Split-Cuff术式).新建储尿囊采用"四针法"低位与尿道缝合.结果 本组平均手术时间(281.2±48.7)min;平均失血量(545.4±181.9)ml,术中输血20例,平均输血(430.8±235.9)ml;平均住院时间(26.8±9.7)d.白天控尿良好30例(93.7%),夜间控尿良好26例(81.3%).23例于术后6个月复查尿动力学提示新膀胱初始尿意容量为270～420(315.0±33.4)ml,最大膀胱容量350～600(490.3±39.7)ml,充盈压(22.5±11.8)cm H2O,最大排尿压(78.3±14.7)cm H2O,最大尿流率(16.5±5.9)ml/s.术后随访22～132个月,平均58.4个月,术后2年内死于肿瘤转移4例.结论 原位螺旋形回肠新膀胱具有容量大、相对低压、顺应性好、肠管利用率高、消化道干扰小和术后排尿、控尿功能更接近正常生理等特点.新膀胱经无水乙醇处理后减少了分泌吸收功能,降低了尿路梗阻和代谢紊乱发生率.输尿管新膀胱Split-Cuff乳头"插入式"吻合可有效防止尿液反流,且方法简单,不易引起管口狭窄,有效地保护了肾功能.尿道以"四针法"吻合简单、实用,可减少吻合口狭窄的发生率.改良螺旋构型回肠新膀胱术是一种较为合理的原位膀胱替代方法.

Abstract：

Objective To assess the outcomes of modified spiral ileal orthotopic neobladder.Methods From January 1998 to January 2008, 32 patients (all male) underwent radical cystectomy and spiral ileal orthotopic substitution for muscle invasive bladder cancer. A segment of 40 to 45 cm ileal loop was isolated, detubularized, and reconfigured in spiral shape to form a pouch. Bilateral ureters were reimplanted by inserting the 1 cm distal segment into the pouch to form a Split-Cuff nipple.The bottom of the pouch was opened and anastomosed with the urethra (4 stitches). Results There were no perioperative deaths. The mean operative time was 281.2±48.7 min. Blood loss was 545.4±181.9 ml. Twenty cases required a blood transfusion, the mean volume of intraoprative blood transfusion was 430.8±235.9 ml. The average hospital stays were 26.8±9. 7 days. Rate of daytime continence was 93. 7% (30/32) while nighttime continence was 81.3% (26/32). Urodynamic studies were carried out in 23 cases 6 months after surgery. Neobladder capacity at first desire to urinate was 315.0± 33.4 ml(270-420 ml). The maximum neobladder capacity was 490. 3±39.7 ml(350-600 ml).The maximum flow rate (Qmax) was 16.5 ± 5.9 ml/s. Full resting pressure was 22. 5 ± 11.8 cm H2O. Peak voiding pressure was 78.3 ± 14.7 cm H2O. After mean 58. 4 months' follow up (range 22 to 132), 4 cases died of metastasis of bladder cancer. Conclusion Modified spiral ileal orthotopic neobladder is a reasonable option for treating invasive bladder cancer.     

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.     

经阴道联合腹腔镜下根治性女性全膀胱切除原位回肠新膀胱术

目的 探讨经阴道联合腹腔镜下根治性女性全膀胱切除及原位回肠新膀胱的手术方法.方法浸润性膀胱癌患者6例,平均年龄61(55～73)岁.5孔法先行腹腔镜下手术:游离输尿管后分侧清扫盆腔淋巴结;举宫器配合下,用血管闭合器LigaSure切断子宫相关韧带及膀胱两侧血管蒂;电凝钩分离子宫直肠陷窝及膀胱前间隙;LigaSure切断阴蒂背血管复合体;超声刀切开膀胱颈尿道后游离膀胱颈后壁至阴道前穹窿部.阴道手术:直视下剪开阴道前后穹窿,于阴道取出标本,缝合阴道.回肠新膀胱术:下腹正中4～5 cnl切口,将回肠拉出切口外,游离30～40 cm回肠,剖开后w形折叠缝合形成贮尿囊;插入法植入输尿管后将贮尿囊还纳腹腔.缝合切口后重新开启气腹,腔镜下行新膀胱尿道吻合. 结果 手术时间平均6.2(4～8)h;出血量平均665(400～1200)ml.术后1～3个月患者均恢复较满意的控尿功能,IVU显示双肾功能良好,无膀胱输尿管反流及梗阻.新膀胱最大容量平均427(300～600)ml.无新膀胱阴道瘘等需要手术处理的严重并发症.术后平均随访16(9～30)个月,6例均存活.1例术后8个月发现肝转移. 结论 经阴道联合腹腔镜下根治性女性全膀胱切除回肠新膀胱术治疗女性浸润性膀胱癌可行、有效,应用举宫器及经阴道直视下手术可一定程度上降低腹腔镜下全膀胱切除术的手术难度、缩短手术时间.由于阴道切口整齐、缝合确切,新膀胱阴道瘘等并发症的发生机会减少.     

Urorectodynamic evaluation of healthy volunteers

Twelve female and 8 male healthy volunteers underwent urorectodynamic evaluation. Mean bladder capacity was 594 ml. and mean maximal vesical pressure 12.5 cm. water (H2O). Maximal bladder pressure correlated significantly with maximal mural tension (r = 0.96) but did not correlate well with bladder capacity (r = 0.20). Mean bladder volume at first desire to void was 32 per cent of mean bladder capacity. The bladder volume at the first desire did not correlate significantly with the capacity. Mean bladder pressure at 100 ml. volume was 2.9 +/- 0.4 cm. H2O (X +/- SEM). After bethanechol injection, the bladder pressure at 100 ml. volume increased by 8.8 +/- 1.2 cm. H2O (X +/- SEM) at twenty minutes. In only 1 subject did bladder pressure rise higher than 15 cm. H2O (5 per cent). Rectal pressure increased from 1.4 +/- 0.3 to 14.1 +/- 2 cm. H2O (X +/- SEM) at sixteen minutes. Electromyogram (EMG) of the external and sphincter did not follow regular pattern with vesical filling or attempt of voiding. The data obtained in these normal subjects may serve as a basis for comparison in the interpretation of data obtained in patients.     

改良W形回肠代膀胱术的疗效观察(附36例报告)

目的 :探讨改良W形回肠代膀胱术的疗效。方法 :对 36例膀胱肿瘤患者行根治性膀胱切除、W形回肠代膀胱术 ,并对术式进行改进。结果 :36例手术时间平均 4 .2h。术后 31例随访 4～ 19个月 ,平均 10 .6个月 ,无严重并发症 ,均无瘤生存。患者一般于术后 3周自主可控性排尿 ,日间尿控率为 10 0 % ,术后 3、6、12个月夜间尿失禁发生率分别为 2 2 .5 %、11.1%及 6 .2 %。术后 6个月尿动力学检查膀胱容量 (36 0± 30 )ml,最大尿流率 (13.6± 2 .6 )ml/s,剩余尿量 (11.5± 5 .8)ml,充盈期膀胱压力明显低于尿道闭合压。新膀胱造影发现新膀胱呈球形 ,完全位于盆腔 ,未见输尿管反流。B超及IVU检查发现原上尿路积水 4例均明显减轻 ,其余未发现输尿管狭窄和上尿路积水征象。无高氯性酸中毒 ,肾功能正常。结论 :改良W形回肠代膀胱术手术时间短 ,操作简单 ,创伤轻 ,并发症少 ;新膀胱容量大 ,内压低 ,顺应性好 ,功能接近于正常膀胱 ,保持原位排尿 ,明显提高了患者术后生活质量 ,值得临床推广应用。     

Neobladder construction using completely detubularized sigmoid colon after radical cystoprostatectomy

To improve the quality of life of the patient we used completely detubularized sigmoid colon for bladder reconstruction along with radical cystoprostatectomy in 6 men with invasive bladder cancer. Followup was 8 to 20 months. Postoperatively, all of the patients were continent during the day but only 4 (66.7%) were continent at night, although they had to awaken twice to remain dry. Neocystourethroscopy in 4 of the 6 patients revealed no tumor and no stricture at the urethrocolonic anastomosis. However, a stone in the neobladder was found in 1 patients. Urodynamic study of the neobladder showed a low pressure (mean 16.7 cm. water) at the filling phase of water cystometry and an adequate maximal urethral closure pressure (mean 52.0 cm. water) and functional profile length (mean 3.8 cm.). The uroflow rate in all patients was good (1 patient even had a maximal uroflow rate of 31 ml. per second). There was no reflux in any patient. One patient had intestinal obstruction 5 months postoperatively and died 5 months later of widespread metastasis. The remaining 5 patients are alive with a satisfactory quality of life. In conclusion, use of completely detubularized sigmoid colon may be an ideal operation for neobladder construction after radical cystoprostatectomy.     

Estimating detrusor pressure at home in pediatric patients with myelomeningocele.

PURPOSE: We evaluated a method of estimating detrusor pressure at home in patients with myelomeningocele who perform clean intermittent catheterization to empty the bladder. MATERIALS AND METHODS: Patients with myelomeningocele who perform clean intermittent catheterization underwent cystometry. At home they determined bladder pressure before draining a full bladder and after partial draining with the bladder almost empty. Home estimate of detrusor pressure was calculated using the formula, full bladder pressure - almost empty bladder pressure. RESULTS: A total of 4 boys and 5 girls with a mean age plus or minus standard deviation of 9.6+/-7.9 years who were enrolled in our study made 16.9+/-15.2 home bladder pressure and volume recordings weekly each during a mean of 5.8+/-4.3 months. Mean bladder capacity determined at home was significantly greater than cystometric capacity (354+/-185 versus 250+/-146 ml.). At a mean home and cystometric volume of 190+/-110 ml. full bladder pressure at home was not significantly different from cystometric vesical pressure (31.0+/-8.8 versus 27.5+/-7.5 cm. water). At a mean volume of 23+/-15 ml. mean home almost empty bladder pressure was not significantly different from cystometric abdominal pressure at full and almost empty volumes (14.1+/-5.5 versus 17.0+/-7.4 and 15.5+/-5.8 cm. water). Mean home estimate of detrusor pressure was not significantly different from cystometric detrusor pressure (17.0+/-6.3 versus 10.2+/-9.2 cm. water). CONCLUSIONS: Estimation of detrusor pressure at home is reliable and accurate in patients who perform clean intermittent catheterization. These pressure determinations may be used as a baseline for rapid identification of changes in bladder function.     

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.     

经尿道输尿管镜下第三代碎石清石系统治疗婴儿膀胱结石及尿道结石合并急性尿潴留

目的 评价经尿道输尿管镜下第三代碎石清石系统(EMS)治疗婴儿膀胱结石及尿道结石合并急性尿潴留的疗效. 方法应用输尿管镜下EMS治疗三聚氰胺所致膀胱结石及尿道结石合并急性尿潴留患儿10例.男9例,女1例.平均年龄9个月.膀胱结石2例,尿道结石8例,结石直径0.5～1.1 cm,平均0.8 cm.全麻下行经尿道输尿管镜下碎石清石术,采用Wolf 8.0～9.8 F输尿管镜,在电视监视下,从输尿管镜操作通道伸入EMS超声碎石探针将膀胱结石及尿道结石完全粉碎吸出,术中膀胱内保持50～100 ml液体,灌注泵压力为160～210 kPa(1 kPa=10.20 cm H2O),平均180 kPa,超声碎石能量40%～60%,占空比30 0A～70%,平均60%.术后留置8 F双腔气囊导尿管. 结果 10例平均手术时间25 min,均将尿道结石冲入膀胱,在输尿管镜下一次性清除结石,麻醉清醒后拔除导尿管,均能立即顺利排尿.3 d后复查B超.膀胱、尿道内均无残留结石. 结论 对婴儿膀胱结石及尿道结石合并急性尿潴留患儿,应用输尿管镜下EMS清除结石,可以立即解除下尿路梗阻,恢复正常排尿,具有安全、高效、损伤小的优点,可作为膀胱结石及尿道结石合并急性尿潴留患儿手术解除下尿路梗阻的首选方法.     

部分胃体-窦部代膀胱术的临床应用及长期随访

目的探讨部分胃体-窦部代膀胱术的临床应用价值。方法回顾性分析30例胃代膀胱术患者的临床资料、实验室检查、影像学检查、膀胱镜及尿动力学检查结果。男17例，女13例。年龄21—69岁，平均55岁。原发病为膀胱癌24例，结核性膀胱挛缩6例。结果术后新膀胱贮尿功能良好，患者经尿道排尿，膀胱容量280—580ml，平均385ml；最大尿道压20—60cm H2O，平均49cm H2O；充盈期膀胱压5—15cm H2O，平均12cmH2O；最大膀胱压35—65cm H2O，平均55cmH2O；排尿期最大膀胱压28—60cm H2O，平均46cm H2O；最大尿流率10～28ml／s，平均18ml／s；剩余尿量5～85ml，平均20ml。随访9个月一24年，平均8．2年，无水、电解质代谢紊乱，无输尿管返流，无尿失禁及肾功能损害。4例出现会阴部、膀胱区疼痛；5例出现遗尿，术后3—6个月逐渐缓解；1例因膀胱结石再次手术。术后3．5年膀胱肿瘤复发1例，行经尿道膀胱肿瘤电切术。结论部分胃体一窦部代膀胱术后并发症少，相关生理指标接近正常。     

Total replacement of the urinary bladder using an ileal pouch bladder

We have used the continent ileal bladder as a bladder replacement after radical cystectomy. The ileal bladder is an ileal pouch which is anastomosed to the urethral stumps. The ureters are implanted by a free end ureteroileostomy. The long term results with 26 patients who underwent this procedure are reported. In the early postoperative period, urodynamic and radiographic studies revealed small capacity and high intravesical pressure of the ileal bladder. However, it became a low pressure reservoir with increased capacity gradually. The average bladder capacity was about 250 ml and average residual urine was 30 ml. Most of the patients were continent in the daytime if the voiding intervals were less than 3 hours at night, some patients were incontinent. Urinary leakage was the most frequent complication. VUR and hydronephrosis were still the problems to be solved. The ileal pouch bladder is a valuable procedure in properly selected cases.     

Long-term urodynamics followup of bladder augmentation for neurogenic bladder

PURPOSE: Augmentation enterocystoplasty is well tolerated by patients with neurogenic bladder in whom conservative therapy has failed. However, few studies exist on long-term urodynamic evaluation of these patients. We assessed the clinical and urodynamic outcomes of patients with neurogenic bladder treated with augmentation enterocystoplasty with at least 4 years of followup. MATERIALS AND METHODS: A total of 26 patients with neurogenic voiding dysfunction underwent augmentation enterocystoplasty alone or in conjunction with various continence or antireflux techniques. Clinical outcomes regarding incontinence, medications, catheterization schedule, subsequent interventions, bowel function and patient satisfaction were addressed. Urodynamic evaluation was performed to assess the long-term durability of bladder augmentation. RESULTS: Mean followup was 8.0 years (range 4 to 13). All but 1 patient (96%) in our series had near or complete resolution of urinary incontinence. Mean total bladder capacity +/- SD increased from 201 +/- 106 to 615 +/- 204 ml. (p <0.001) and mean maximum detrusor pressure decreased from 81 +/- 43 to 20 +/- 12 cm. H O (p <0.01). Mean interval between catheterizations was 5 hours, with volumes ranging from 314 to 743 ml. Only 2 patients (8%) needed a low dose of oxybutynin postoperatively to maintain continence consistently. Of the 26 patients 23 (88%) reported no significant change in bowel function and nearly all patients expressed extreme satisfaction with urological management. A subsequent urological procedure was required in 12 patients (46%) at a mean of 4.4 years after initial surgery.(2)CONCLUSIONS: Bladder augmentation provides durable clinical and urodynamic improvement for patients with neurogenic bladder dysfunction refractory to conservative therapy. Furthermore, there is a high level of patient satisfaction with bladder augmentation.