Uygur M C, Altug U, Ozgür M, Erol D
Urology Clinic of Ministry of Health Ankara Hospital, Ankara, TURKEY.
Can J Urol. 2001 Feb;8(1):1193-8.
The present paper reports the functional aspects of a novel continent cutaneous reservoir.
A continent cutaneous reservoir was constructed by the application of appendiceal Mitrofanoff principle to Stanford pouch in four male and three female patients between 1995-1998 in our clinic. The mean age of the patients was 45.6 years (7-67 years) and the etiological factor was carcinoma of the bladder in four, interstitial cystitis in one and extrophy-epispadias complex in two cases. Patients were followed with arterial blood gas determination, serum biochemistry, urinalysis and urine culture at postoperative 3 weeks and by 3-month intervals thereafter. Additionally, pouch graphy, abdominal ultrasonography and urodynamic tests were performed every 6 months.
After the operation all the patients were continent. Stoma was transferred from the umbilicus to the right lower quadrant in one case (14.3%) because of difficulty in catheterisation. Pouch graphy at postoperative 6 months revealed low-grade vesicoureteral reflux in two (28.6%) patients and one (14.3%) of them required suppressive antibiotic therapy because of pyelonephritis episodes. Another patient developed hyperchloremic metabolic acidosis and needed oral alkaline supplementation. The mean pouch capacity measured at postoperative 6 months was 423 (350-550) ml and the mean end-filling pressure was found as 21 (18-25) cmH2O. After a mean follow-up period of 37 (18-45) months all the patients remained continent and stable.
The continent cutaneous reservoir presented herein is our alternative to orthotopic neobladder in female patients undergoing radical cystectomy. It also provided continence as well as good quality of life in patients with extrophy-epispadias complex and male patients after radical cystectomy and urethrectomy.
本文报告一种新型可控性皮肤贮尿囊的功能情况。
1995年至1998年期间，在我们诊所，对4例男性和3例女性患者应用阑尾Mitrofanoff原理于斯坦福贮袋构建可控性皮肤贮尿囊。患者的平均年龄为45.6岁（7至67岁），病因方面，4例为膀胱癌，1例为间质性膀胱炎，2例为膀胱外翻-尿道上裂综合征。术后3周对患者进行动脉血气测定、血清生化检查、尿液分析及尿培养，此后每隔3个月进行一次。此外，每6个月进行一次贮袋造影、腹部超声检查及尿动力学检查。
术后所有患者均能自主控尿。1例患者（14.3%）因导尿困难，造口从脐部转移至右下腹。术后6个月的贮袋造影显示，2例患者（28.6%）存在轻度膀胱输尿管反流，其中1例（14.3%）因肾盂肾炎发作需要预防性抗生素治疗。另1例患者出现高氯性代谢性酸中毒，需要口服碱性药物补充。术后6个月测得的平均贮袋容量为423（350至550）毫升，平均充盈末压力为21（18至25）厘米水柱。平均随访37（18至45）个月后，所有患者均保持控尿且情况稳定。
本文介绍的可控性皮肤贮尿囊是我们为接受根治性膀胱切除术的女性患者提供的原位新膀胱替代方案。它也为膀胱外翻-尿道上裂综合征患者以及根治性膀胱切除术和尿道切除术后的男性患者提供了控尿功能及良好的生活质量。
