Bennett Stephen G, Bennett Suzanne, Bell Thomas E
Division of Urology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
J Urol. 2003 Sep;170(3):832-4. doi: 10.1097/01.ju.0000081185.62789.97.
We assessed the impact of the gastrostomy button used as a catheterizable urinary stoma on the infection, encrustation and erosion rates, and quality of life in a series of 19 patients.
Patients were selected as candidates for the button based on multichannel urodynamic studies that confirmed an areflexic neurogenic bladder. At study enrollment each patient completed a quality of life questionnaire based on a visual analog scale. If the patient had a preexisting indwelling suprapubic tube, it was replaced with a button. If no preexisting suprapubic tube was present, one was inserted. The button was then inserted approximately 1 month later after an adequate tract was established. For 1 year the patient underwent cystoscopy with urine culture every 2 months for a total of 6 times. Symptomatic infections were treated but asymptomatic colonization was not. A quality of life questionnaire was completed at each visit.
Of the 19 patients 10 had failure, necessitating button removal. These failures were due to an excessive suprapubic distance from skin to bladder, which prevented adequate button fit. All patients in whom the button remained showed significant improvements in quality of life. The colonization rate was 100% but the rate of symptomatic infections was low. The incidence of bladder stones was zero and the rate of encrustation was low.
When used as a catheterizable stoma to treat areflexic neurogenic bladder, a gastrostomy button is a safe, effective option for these patients. The rate of symptomatic infections is low, the risk of bladder stone formation is minimal and erosion was not observed in properly sized button insertions. The current limiting factor is the length of the button compared with the patient suprapubic measurement (length from skin to bladder). Each patient reported that quality of life with the button was significantly better than prior to button placement.
我们评估了作为可导尿尿路造口的胃造口纽扣对19例患者的感染、结痂和糜烂发生率以及生活质量的影响。
根据多通道尿动力学研究确定为无反射性神经源性膀胱的患者被选为使用纽扣的候选对象。在研究入组时，每位患者完成一份基于视觉模拟量表的生活质量问卷。如果患者已有耻骨上留置导管，则用纽扣替换。如果没有预先存在的耻骨上导管，则插入一根。大约1个月后，在建立了足够的通道后插入纽扣。在1年的时间里，患者每2个月接受一次膀胱镜检查并进行尿培养，共6次。有症状的感染进行治疗，但无症状的定植不进行治疗。每次就诊时都要完成一份生活质量问卷。
19例患者中有10例失败，需要移除纽扣。这些失败是由于从皮肤到膀胱的耻骨上距离过大，导致纽扣无法合适安装。所有纽扣保留的患者生活质量均有显著改善。定植率为100%，但有症状感染的发生率较低。膀胱结石的发生率为零，结痂率较低。
当用作治疗无反射性神经源性膀胱的可导尿造口时，胃造口纽扣对这些患者来说是一种安全、有效的选择。有症状感染的发生率较低，膀胱结石形成的风险极小，在尺寸合适的纽扣插入中未观察到糜烂。目前的限制因素是纽扣的长度与患者耻骨上测量值（从皮肤到膀胱的长度）相比。每位患者报告使用纽扣后的生活质量明显优于放置纽扣之前。
