Nomura S, Ishido T, Teranishi J, Makiyama K
Department of Urology, Kanagawa Rehabilitation Hospital, Atsugi-city, Japan.
Urol Int. 2000;65(4):185-9. doi: 10.1159/000064873.
We assessed the roles of suprapubic cystostomy in patients with neurogenic bladder and analyzed the complications and their courses.
We reviewed 118 patients with neurogenic bladder managed with suprapubic cystostomy. The original diseases were spinal cord injury in 90, degenerative disease of the central nervous system in 15, spina bifida in 6, cerebral palsy in 3, pontine bleeding in 1, Parkinson's disease in 1, brain tumor in 1, and dysgenesis of the external sphincter in 1. Fifty-six (62.2%) of spinal cord-injured patients demonstrated cervical damage. Renal function, urinary pH and white blood cell values were measured and evaluated after insertion. The stone-free rate after insertion was estimated by the Kaplan-Meier method.
Indications for cystostomy were failure of clean intermittent catheterization in 62 (52.5%) and Credé's maneuver in 2, severe urethral damage in 30 (25.4%), replacement of urethral catheter in 3, worsening of the original disease in 15 (12.7%), deterioration of the general condition in 2, mental retardation in 2, and traumatic vesical rupture in 1. Frequent complications were formation of the bladder calculi in 30 (25%) and urinary leakage through the urethra in 11 (10%). No fatal complications occurred. The stone-free rates 5 and 10 years after insertion were 77 and 64%, respectively. The urinary pH of the stone-forming group was significantly higher than that of the stone-free group. The high urinary pH group (>7.24) had a higher risk of stone formation.
Although continuous cystostomy drainage is not considered to be ideal management for bladder emptying, some patients with neurogenic bladder may benefit from this procedure.
我们评估了耻骨上膀胱造瘘术在神经源性膀胱患者中的作用，并分析了并发症及其病程。
我们回顾了118例接受耻骨上膀胱造瘘术治疗的神经源性膀胱患者。原发病包括脊髓损伤90例、中枢神经系统退行性疾病15例、脊柱裂6例、脑瘫3例、脑桥出血1例、帕金森病1例、脑肿瘤1例、外括约肌发育不全1例。脊髓损伤患者中有56例（62.2%）表现为颈部损伤。插入造瘘管后测量并评估肾功能、尿液pH值和白细胞值。采用Kaplan-Meier法估计插入造瘘管后的无结石率。
膀胱造瘘术的适应证包括清洁间歇性导尿失败62例（52.5%）、克里德手法失败2例、严重尿道损伤30例（25.4%）、更换尿道导管3例、原发病恶化15例（12.7%）、全身状况恶化2例、智力发育迟缓2例、创伤性膀胱破裂1例。常见并发症为膀胱结石形成30例（25%）和尿道漏尿11例（10%）。未发生致命并发症。插入造瘘管后5年和10年的无结石率分别为77%和64%。结石形成组的尿液pH值显著高于无结石组。高尿液pH值组（>7.24）结石形成风险更高。
尽管持续膀胱造瘘引流不被认为是膀胱排空的理想治疗方法，但一些神经源性膀胱患者可能从该手术中获益。
