Zhou Fang-Jian, Qin Zi-Ke, Xiong Yong-Hong, Han Hui, Liu Zhuo-Wei, Mei Hua
Department of Urology, Cancer Center, Sun Yat-sen University, Guangzhou, Guangdong, 510060, P. R. China.
Ai Zheng. 2003 Jan;22(1):55-7.
BACKGROUND & OBJECTIVE: Quality of life (QOL) in the patients who are performed radical cystectomy is affected by the methods of urinary diversion. The patients with continent or non-continent urinary diversion could not void by themselves and their QOL was poor. However, the intestinal neobladder in situ could provide the patients with good voiding and improve QOL. Unfortunately, some degree of poor empty and incontinence would occur in these patients. The aim of this paper was to report the authors' experience of modified intestinal in situ neobladder in reconstructing the lower urinary tract after radical cystectomy.
Reconstruction of the lower urinary tract using modified sigmoid neobladder (in 12 patients) and modified ileal neobladder (in 3 patients) was carried out in 15 patients (male 14, female 1; age 33-68 years, mean 53 years) who underwent radical cystectomy for invasive bladder cancer. The patients were followed up for 3-30 months. Nine of them were followed up for more than 16 months. Clinical outcome of these patients including the function of the neobladder, urinary function, sexual status, renal function, serum electrolytes, and QOL was evaluated.
All patients voided well by themselves and did not need self-catheterization. Thirteen patients were continent in daytime and night-time. One patient was continent in daytime, but had mild incontinence at night. A female patient had moderate stress incontinence. The capacity of the neobladder was 240-640 ml and the residual volume was 0-250 ml. Renal function was normal in all patients. Serum electrolytes were normal in 14 patients. Metabolic acidosis and unilateral ureteral dilation was encountered in one patient respectively. Nine male patients restored sexual function and 13 patients came back to work. All patients felt satisfied with the function of the neobladder.
Satisfactory urinary continence and voiding function was achieved with modified intestinal neobladder, which was believed an ideal procedure for lower urinary tract reconstruction after radical cystectomy.
根治性膀胱切除术后患者的生活质量受尿液改道方式的影响。行可控性或不可控性尿液改道的患者无法自主排尿，生活质量较差。然而，原位回肠新膀胱可为患者提供良好的排尿功能并改善生活质量。遗憾的是，这些患者会出现一定程度的排空障碍和尿失禁。本文旨在报告作者采用改良原位回肠新膀胱重建根治性膀胱切除术后下尿路的经验。
对15例因浸润性膀胱癌行根治性膀胱切除术的患者（男14例，女1例；年龄33 - 68岁，平均53岁）采用改良乙状结肠新膀胱（12例）和改良回肠新膀胱（3例）重建下尿路。对患者进行3 - 30个月的随访，其中9例随访时间超过16个月。评估这些患者的临床结局，包括新膀胱功能、排尿功能、性功能、肾功能、血清电解质及生活质量。
所有患者均能自主良好排尿，无需自我导尿。13例患者白天和夜间均能自控排尿。1例患者白天能自控排尿，但夜间有轻度尿失禁。1例女性患者有中度压力性尿失禁。新膀胱容量为240 - 640 ml，残余尿量为0 - 250 ml。所有患者肾功能正常。14例患者血清电解质正常。1例患者分别出现代谢性酸中毒和单侧输尿管扩张。9例男性患者恢复性功能，13例患者重返工作岗位。所有患者对新膀胱功能均感到满意。
改良回肠新膀胱可实现令人满意的尿控和排尿功能，被认为是根治性膀胱切除术后下尿路重建的理想术式。
