Stein R, Beetz R, Thüroff J W
Urologische Klinik und Poliklinik im Klinikum der Johannes-Gutenberg-Universität Mainz.
Urologe A. 2004 Apr;43(4):414-20. doi: 10.1007/s00120-004-0558-x.
After the failure of conservative treatment in patients with neurogenic bladders, urinary diversion is a viable compromise between the urologist's concerns and the patient's desire, as the upper urinary tract can be protected in the long-term and high continence rates can be provided. This can be achieved with an acceptable complication rate. Our indications for orthotopic bladder augmentation or substitution involve patients with a good orthopedic condition and mobility, who find it easy to perform CISC through the urethra. A continent umbilical stoma offers a good alternative in obese, immobile or wheelchair bound patients. The serous lined extramural tunnel technique has proven to be superior to submucosal implantation in patients with fibrotic and dilated ureters.
在神经源性膀胱患者保守治疗失败后,尿流改道是泌尿外科医生的关注点与患者需求之间可行的折衷方案,因为从长远来看上尿路可得到保护,且能实现高控尿率。这可以在可接受的并发症发生率情况下达成。我们进行原位膀胱扩大或替代的指征包括骨科状况良好且活动能力强、经尿道自行间歇导尿操作容易的患者。对于肥胖、行动不便或需轮椅代步的患者,可控性脐部造口是一个不错的选择。在输尿管纤维化和扩张的患者中,带浆膜的壁外隧道技术已被证明优于黏膜下植入技术。