Shekarriz B, Upadhyay J, Demirbilek S, Barthold J S, González R
Department of Urology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, USA.
Urology. 2000 Jan;55(1):123-8. doi: 10.1016/s0090-4295(99)00443-4.
Ileal and sigmoid augmentation are equally effective at increasing bladder capacity and compliance. Therefore, knowledge of the incidence of major complications, including perforation, small bowel obstruction (SBO), anastomotic complications, calculus formation, and indications for revision may be useful in choosing the ideal segment. We compared the complications of ileocystoplasty and two types of sigmoidocystoplasty that required reoperative surgery.
Between 1981 and 1997, 158 patients with a mean age of 11 years (range 2 to 25) underwent augmentation cystoplasty. Ileum or sigmoid colon was used in 133 patients, who were the subjects of this study. The mean follow-up was 64 months (range 6 to 185). Indications included neurogenic bladder (n = 100), bladder exstrophy (n = 12), cloacal exstrophy (n = 6), posterior urethral valves (n = 3), and miscellaneous (n = 12). Ileum was used in 65 patients and sigmoid colon in 68. Of these, 48 underwent conventional colocystoplasty and 20 seromuscular colocystoplasty lined with urothelium (SCLU). Seventy-nine percent required additional procedures to achieve continence or facilitate catheterization, which included bladder neck procedures in 56% or continent stomas alone in 23%.
There were no deaths or complications of bowel anastomosis. Overall, continence was achieved in 95%. Spontaneous bladder perforation was highest in patients with neurogenic bladder. Calculi developed more frequently in patients with continent stomas (P = 0.04) and in patients with bladder/cloacal exstrophy (32%) than in patients with neurogenic bladder (P = 0.01). Additional procedures and route of catheterization did not increase the risk of perforation. One patient with SCLU with known hypercalciuria developed bladder calculi.
Sigmoid colon showed a trend of a lower rate of SBO with no difference in perforation or stone formation compared with ileum. Primary diagnoses of bladder or cloacal exstrophy and continent stomas are risk factors for the development of calculi. SCLU has a low rate of surgical complications and no incidence of perforation or SBO thus far; therefore, we advocate the use of SCLU when feasible, and sigmoid as the preferred bowel segment for augmentation cystoplasty.
回肠和乙状结肠扩大术在增加膀胱容量和顺应性方面同样有效。因此，了解包括穿孔、小肠梗阻（SBO）、吻合口并发症、结石形成等主要并发症的发生率以及翻修指征，可能有助于选择理想的肠段。我们比较了需要再次手术的回肠膀胱扩大术和两种类型乙状结肠膀胱扩大术的并发症。
1981年至1997年间，158例平均年龄11岁（范围2至25岁）的患者接受了膀胱扩大术。本研究的对象为133例使用回肠或乙状结肠的患者。平均随访时间为64个月（范围6至185个月）。适应证包括神经源性膀胱（n = 100）、膀胱外翻（n = 12）、泄殖腔外翻（n = 6）、后尿道瓣膜（n = 3）及其他（n = 12）。65例患者使用回肠，68例使用乙状结肠。其中，48例行传统结肠膀胱扩大术，20例行带尿路上皮的浆肌层结肠膀胱扩大术（SCLU）。79%的患者需要额外的手术来实现控尿或便于导尿，其中56%的患者需要膀胱颈手术，23%的患者仅需可控造口。
无死亡病例或肠吻合口并发症。总体而言，95%的患者实现了控尿。神经源性膀胱患者的自发性膀胱穿孔发生率最高。可控造口患者（P = 0.04）以及膀胱/泄殖腔外翻患者（32%）结石形成的频率高于神经源性膀胱患者（P = 0.01）。额外的手术和导尿途径并未增加穿孔风险。1例已知高钙尿症的SCLU患者发生了膀胱结石。
与回肠相比，乙状结肠的SBO发生率有降低趋势，穿孔或结石形成方面无差异。膀胱或泄殖腔外翻的初始诊断以及可控造口是结石形成的危险因素。SCLU手术并发症发生率低，目前尚无穿孔或SBO的发生；因此，我们主张在可行时使用SCLU，并将乙状结肠作为膀胱扩大术首选的肠段。
