经尿道内括约肌切除术在神经源性膀胱患者中的应用及长期随访研究

目的:治疗神经源性膀胱的首要两大目的即保护上尿路功能,获得或保持最恰当的尿控能力,但目前缺乏完美的治疗方法.为评价经尿道内括约肌切除术在神经源性膀胱患者中的应用及长期效果,行本研究.方法:回顾性分析2010年6月-2019年6月在我院接受经尿道内括约肌切除术治疗的17例神经源性膀胱患者的临床资料,其中男9例,女8例,年...

Application and long-term follow-up of transurethral internal sphincter resection in patients with neurogenic bladder

Objective:The two primary goals in the urologic management of neurogenic bladder dysfunction include protecting the patient’s upper urinary tract and allowing the patient to maintain optimal urinary control.There’s no perfect therapy treatment.We conducted the study to evaluate the long-term efficacy of transurethral internal sphincter resection in patients with neurogenic bladder.Methods:Between June 2010 and June 2019,a total of 17(male 9,female 8)neurogenic bladder patients with mean age 57(14-88)years and the duration of the condition for median 24 months(range:2 months to 47 years)were treated using transurethral internal sphincter resection in our center.The neurogenic causes were spinal bifida occulta in 4 cases,Tarlov cyst in 1 case,hysterectomy in 1 case,cerebrovascular accidents in 3 cases,meningomyeloceles in 2 cases,spinal cord injury in 3 cases,lumbar disc herniation in 2 cases,unknown cause in 1 case.There were 11 cases of dysuria and 9 cases of incontinence.Among the 17 patients,4 had indwelling catheterization,other 13 cases were found postvoid residual volume 374(5-1000)mL.Imaging showed 9 cases with hydronephrosis.Cystography was performed in 10 patients,4 of whom had definite vesicoureteral reflux.The changes of hydronephrosis in patients after surgery were observed.Postvoid residual volume and serum creatinine(Scr)level before and after treatment were compared.Results:The average operation time of male patients was 61(30-140)min,female patients 35(29-45)min.The average blood loss was 23(2-50)mL in male patients and 9(5-25)mL in female patients.The follow-up time ranged from 6 months to 7 years,and 1 case was lost.Of the 4 patients who had indwelling catheterization before surgery,3 patients were able to urinate after surgery,and the residual urine volume was 14-221 mL.One patient continued to be indwelt the catheter after being extubated due to the large residual urine volume.Of 9 patients who had bilateral hydronephrosis before operation,5 patients had no hydronephrosis.Three patients relieved compared with preoperative symptom.One was lost to follow-up.Nine patients with incontinence before operation still had varying degrees of urinary incontinence after operation,one of which exacerbated.The postoperative Scr did not increase significantly[preoperative(91±41)μmol/L vs.postoperative(103±54)μmol/L,P>0.05],and the PVR was significantly lower than that before surgery[preoperative(372±253)mL vs.postoperative(134±127)mL,P<0.05].Conclusion:Transurethral internal sphincter resection is an effective treatment for neurogenic bladder.This procedure reduces postvoid residual volume,improves or reduces hydronephrosis,avoids deterioration of renal function and maintains optimal urinary control.The operation is simple,safe and worthy of further clinical observation and research.