Villanueva Benedicto A, Rioja Sanz C, Sanz Vélez J I, Rioja Sanz L A
Servicio de Urología, Hospital Miguel Servet, Zaragoza, España.
Arch Esp Urol. 1992 Nov;45(9):937-48.
Construction of a neobladder utilizing intestine is currently considered to be the ideal option for the cystectomized patient. We reviewed the history as well as the physical and urodynamic principles of the substitution neobladders and continent reservoirs. In our series of patients who underwent cystectomy from January 1988 to December 1991, we have performed bladder substitution using detubularized ileum in 37 patients (18 Camey II and 16 Hautmann) and 13 patients had a continent reservoir (Mainz pouch). Patient ages ranged from 33 to 72 years (mean 60.4). The functional behaviour of the intestinal neobladders was analyzed clinically, radiologically and urodynamically. Eleven of the 18 patients with a Camey II (61.8%) and 3 of the 16 with a Hautmann (18.7%) neobladder were incontinent during the night, the difference being statistically significant (p < 0.05). Incontinence correlated manometrically with high pressure peaks in the Camey II neobladders and waves with a lower intensity were recorded in the Hautmann neobladders. Flowmetry revealed a normal peak flow in all but one Camey II that required internal urethrotomy due to urethroileal stenosis. The maximum capacity was 215-500 cc for the Camey II (mean 340 cc), 310-850 cc for the Hautmann (mean 590 cc) and 350-925 cc (mean 675) for the Mainz pouch. Intermittent catheterization was required in 3 of the Camey II and 1 of the Hautmann neobladder with important postmicturition residual urine. The patients who received the Mainz pouch had good continence, with pressure recordings less than 55 cm H2O), which is lower than the continent closing pressure. Only one case was incontinent due to failure of the intussusception mechanism. The good functional results achieved with the Hautmann procedure are underscored. The pressure recordings and the incidence of night incontinence for the foregoing procedure were lower than the Camey II. For the unviable urethra, the Mainz pouch achieves moderate pressures and is socially acceptable.
利用肠道构建新膀胱目前被认为是膀胱切除术后患者的理想选择。我们回顾了替代新膀胱和可控性贮尿囊的历史以及其物理和尿动力学原理。在我们1988年1月至1991年12月接受膀胱切除术的一系列患者中，我们用去管化回肠为37例患者进行了膀胱替代（18例Camey II式和16例Hautmann式），13例患者有可控性贮尿囊（Mainz袋）。患者年龄在33至72岁之间（平均60.4岁）。对肠道新膀胱的功能行为进行了临床、放射学和尿动力学分析。18例Camey II式新膀胱患者中有11例（61.8%）、16例Hautmann式新膀胱患者中有3例（18.7%）夜间尿失禁，差异具有统计学意义（p<0.05）。尿失禁在测压上与Camey II式新膀胱中的高压峰值相关，而在Hautmann式新膀胱中记录到强度较低的波。尿流率测定显示，除1例因尿道回肠狭窄需要行内尿道切开术的Camey II式新膀胱外，其他所有新膀胱的峰值尿流均正常。Camey II式新膀胱的最大容量为215 - 500 cc（平均340 cc），Hautmann式为310 - 850 cc（平均590 cc），Mainz袋为350 - 925 cc（平均675 cc）。3例Camey II式新膀胱和1例Hautmann式新膀胱因排尿后残余尿量较多需要间歇性导尿。接受Mainz袋的患者控尿良好，压力记录低于55 cm H2O，低于可控性闭合压力。仅1例因套叠机制失败而尿失禁。强调了Hautmann手术取得的良好功能结果。上述手术的压力记录和夜间尿失禁发生率低于Camey II式。对于无法使用的尿道，Mainz袋可达到适度压力且在社会上是可接受的。
