Soulié M, Thoulouzan M, Seguin P, Mouly P, Vazzoler N, Pontonnier F, Plante P
Service de Chirurgie Urologique et d'Andrologie, CHU de Rangueil, Toulouse, France.
Prog Urol. 2000 Sep;10(4):548-52.
The Hautmann neobladder is a bladder replacement technique frequently proposed after total cystectomy for bladder cancer. The objective of this prospective study was to evaluate the patients' urinary continence after this operation, based on clinical and urodynamic data.
The functional assessment was based on 26 patients from a series of 45 consecutive Hautmann bladder replacements performed between February 1994 and May 1999. These 26 nonselected patients (21 men and 5 women) with a mean age of 56 years (range: 38-68) accepted the principle of functional assessment of continence at visits held 1, 3, 6 and 12 months postoperatively including clinical interview, urodynamic studies and fibroscopy. Only one patient presented with preoperative stress incontinence. The mean follow-up of these 26 patients was 22 months (range: 10-60). Three patients, including two women, died from progression of their bladder tumour at the 12th, 20th and 32nd postoperative months.
Urodynamic studies showed a mean maximum capacity of the ileal reservoir of 420 ml (range: 316-571), a maximum filling pressure of 15 cmH2O (range: 2-24) and a maximum urethral closure pressure of 49 cmH2O (range: 31-74). According to the evaluation criteria used, the satisfactory continence rates, as assessed by the patients were 62%, 77%, 84.6% during the day and 42%, 615%, 77% at night, at 3, 6 and 12 months, respectively.
The Hautmann neobladder ensures satisfactory diurnal and nocturnal urinary continence in more than 75% of cases after the 6th postoperative month. Continence is an evolving parameter especially during the first postoperative year. The selection of patients in good general condition and motivated for management of their new urinary situation remains an essential prerequisite to obtain a good functional result.
豪特曼回肠新膀胱术是膀胱癌全膀胱切除术后常用的膀胱替代技术。这项前瞻性研究的目的是基于临床和尿动力学数据评估该手术后患者的尿失禁情况。
功能评估基于1994年2月至1999年5月间连续进行的45例豪特曼膀胱替代手术中的26例患者。这26例未经挑选的患者（21例男性和5例女性），平均年龄56岁（范围：38 - 68岁），在术后1、3、6和12个月的随访中接受了尿失禁功能评估原则，包括临床访谈、尿动力学研究和纤维内镜检查。只有1例患者术前存在压力性尿失禁。这26例患者的平均随访时间为22个月（范围：10 - 60个月）。3例患者，包括2例女性，在术后第12、20和32个月因膀胱肿瘤进展死亡。
尿动力学研究显示回肠储尿囊平均最大容量为420毫升（范围：316 - 571毫升），最大充盈压为15厘米水柱（范围：2 - 24厘米水柱），最大尿道闭合压为49厘米水柱（范围：31 - 74厘米水柱）。根据所使用的评估标准，患者评估的日间满意尿失禁率在术后3、6和12个月分别为62%、77%、84.6%，夜间分别为42%、61.5%、77%。
豪特曼回肠新膀胱术在术后第6个月后能确保超过75%的病例日间和夜间尿失禁情况令人满意。尿失禁是一个不断变化的参数，尤其是在术后第一年。选择全身状况良好且有动力管理新尿路情况的患者仍然是获得良好功能结果的重要前提。
