保留勃起和射精功能的单纯膀胱切除术

目的 :探讨保留勃起和射精功能的单纯膀胱切除术的临床应用价值。　方法 :7例病人平均年龄 2 7岁。其中 ,结核性挛缩膀胱 2例 ,腺性膀胱炎 1例 ,晚期神经源性膀胱 4例 ,均需行全膀胱切除。为保留勃起和射精功能 ,病人做了改良的单纯性膀胱切除 ,保留输精管、精囊、前列腺和双侧神经血管束。　结果 :平均手术时间 5h 4 5min ,术中出血少 ,未发生围手术期并发症。随访 9～ 6 0个月 ,勃起功能良好 ,均有遗精或顺行射精。新膀胱术者无排尿困难 ,可控性膀胱者插管顺利。尿路造影示上尿路功能良好。病人自我评价生活质量满意。　结论 :对希望保留生育和勃起功能的病人 ,保留输精管、精囊、前列腺和双侧神经血管束的单纯膀胱切除术是一种简单、有效、实用的手术方法

Modified Cystectomy with Preservation of Erectile and Ejaculatory Functions in Men with Nonmalignant Bladder Disease

Objectives: To evaluate modified cystectomy with preservation of erectile and ejaculatory functions in men with nonmalignant bladder disease. Methods: Seven cases with average age of 27 years presented with bladder disease necessitating cystectomy, including 2 cases of tuberculous contractile bladder,1 case of extensive polypoid cystitis glandularis, 4 cases of late stage of neurogenic bladder. All patients wished to maintain erectile and ejaculatory functions after the operation. We performed a modified simple cystectomy with preservation of the vasa deferens, seminal vesicles, prostate and neurovascular bundles, as well as construction of an Indiana pouch or ileal neobladder. Results: Average operative time was 5 h 45 min without perioperative complications in this group. Follow up ranged from 9 to 60 months. Erectile and ejaculatory functions were normal in all cases. All patients remained completely continent and no dysuria in neobladder, and there was no difficulty in inserting catheter to empty pouch. Upper urinary tract was in good condition 3 and 24 months after operation. Conclusions: Modified cystectomy with preservation of the vasa deferens, seminal vesicles, prostate and neurovascular bundles is an effective and reliable option for the patients who wish to maintain their fertility and erectile function after surgery.