Shpall Andrew I, Ginsberg David A
Department of Urology, Rancho Los Amigos National Rehabilitation Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
J Urol. 2004 Dec;172(6 Pt 1):2296-9. doi: 10.1097/01.ju.0000144072.15735.32.
Bladder neck closure (BNC) is an important component of reconstructive urological surgery, especially in the management of neurogenic bladder. To our knowledge we present the largest series of patients who have undergone this procedure.
A total of 39 patients with lower urinary tract (LUT) dysfunction secondary to neurogenic bladder underwent transabdominal BNC and simultaneous LUT reconstruction between 1988 and 2002. Charts were reviewed and patients were retrospectively interviewed to ascertain demographics, previous urological surgeries, perioperative data, postoperative results and complications.
Mean postoperative followup was 36.9 months (range 7 to 173). Concomitant procedures included ileovesicostomy in 19 patients (49%), augmentation enterocystoplasty with continent cutaneous stoma in 19 (49%) and revision of a previous Mitrofanoff appendicovesicostomy in 1. The overall complication rate was 31% with a vesicourethral fistula in 6 patients (15%), of whom 4 required eventual transabdominal or transvaginal surgical correction. No other problems directly related to BNC were identified. Patients were followed by serial renal ultrasound and abdominal x-ray with upper tract maintenance seen in all patients.
Bladder neck closure with simultaneous urinary diversion is a highly effective, well tolerated treatment for many pathological processes of the LUT. Risks for prolonged urethral leakage include high pressure systems, prior bladder neck surgery and noncompliance with catheter/drain management. These data support our belief that a high degree of success with an acceptable complication rate is attainable with careful adherence to surgical technique, proper patient selection, appropriate early postoperative management and rigid surveillance.
膀胱颈闭合术（BNC）是泌尿外科重建手术的重要组成部分，尤其是在神经源性膀胱的治疗中。据我们所知，我们呈现了接受该手术的最大系列患者。
1988年至2002年间，共有39例因神经源性膀胱导致下尿路（LUT）功能障碍的患者接受了经腹膀胱颈闭合术及同期LUT重建术。回顾病历并对患者进行回顾性访谈，以确定人口统计学资料、既往泌尿外科手术史、围手术期数据、术后结果及并发症。
术后平均随访36.9个月（范围7至173个月）。同期手术包括19例（49%）回肠膀胱造口术、19例（49%）带可控性皮肤造口的扩大肠膀胱成形术以及1例既往米氏阑尾膀胱造口术的修复术。总体并发症发生率为31%，6例患者（15%）出现膀胱尿道瘘，其中4例最终需要经腹或经阴道手术矫正。未发现其他与膀胱颈闭合术直接相关的问题。所有患者均通过系列肾脏超声和腹部X线检查进行随访，以维持上尿路状态。
膀胱颈闭合术同期尿路改道是治疗许多LUT病理过程的一种高效且耐受性良好的方法。长期尿道漏的风险包括高压系统、既往膀胱颈手术以及不遵守导尿管/引流管管理。这些数据支持我们的观点，即通过严格遵循手术技术、正确选择患者、适当的术后早期管理和严格的监测，可实现高成功率且并发症发生率可接受。
