Wilson Shandra, Quek Marcus L, Ginsberg David A
Department of Urology, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine at University of Southern California, Los Angeles, California 90089, USA.
J Urol. 2004 Jul;172(1):244-6. doi: 10.1097/01.ju.0000132153.30662.60.
The clinical efficacy of transurethral bulking agents for the treatment of new onset urinary incontinence following radical cystectomy and orthotopic lower urinary tract reconstruction in women was evaluated.
Between 1990 and 2002, 101 female patients with primary transitional cell carcinoma of the bladder were treated with radical cystectomy and orthotopic ileal neobladder reconstruction. Of the 101 patients 12 (12%) underwent treatment for new onset urinary incontinence following exenterative surgery with transurethral injection of bulking agents, including collagen in 11 and nonabsorbable pyrolytic carbon coated beads in 1.
A total of 25 injections were administered to 12 female patients with a mean age of 75.4 years following orthotopic neobladder reconstruction. Mean followup was 22.5 months (range 2 to 51). Two of the 12 patients (16.7%) reported complete continence and were considered cured, although subjective complaints of urinary frequency persisted. Four patients (33%) had decreased objective average daily pad use (6.75 to 2.25) and 6 (50%) showed no subjective or objective improvement in symptomatology.
Although injection of urethral bulking agents is a minimally invasive treatment for stress urinary incontinence following orthotopic neobladder reconstruction, long-term results in patients with severe disease show a less than optimal durable response.
评估经尿道填充剂治疗女性根治性膀胱切除术后原位下尿路重建新发性尿失禁的临床疗效。
1990年至2002年间，101例原发性膀胱移行细胞癌女性患者接受了根治性膀胱切除术和原位回肠新膀胱重建术。101例患者中有12例（12%）在扩大性手术后因新发性尿失禁接受经尿道注射填充剂治疗，其中11例注射胶原蛋白，1例注射不可吸收的热解碳包被微球。
12例平均年龄75.4岁的女性患者在原位新膀胱重建术后共接受了25次注射。平均随访时间为22.5个月（范围2至51个月）。12例患者中有2例（16.7%）报告完全控尿，虽仍有尿频的主观症状，但被认为已治愈。4例患者（33%）客观上平均每日使用尿垫量减少（从6.75片降至2.25片），6例患者（50%）症状在主观和客观上均无改善。
尽管注射尿道填充剂是原位新膀胱重建术后压力性尿失禁的微创治疗方法，但重症患者的长期治疗效果显示持久反应欠佳。
