Seski J C, Diokno A C
Am J Obstet Gynecol. 1977 Jul 15;128(6):643-51. doi: 10.1016/0002-9378(77)90211-3.
Bladder dysfunction is a common occurrence following radical hysterectomy. We studied bladder function prospectively in 10 patients before and after radical hysterectomy. Results suggest that the hypertonic phase observed immediately postoperatively is the result of an increase in myogenic tonicity of the detrusor muscle secondary to the trauma of operation and prolonged catheter drainage. The inability of patients to urinate effectively is due to partial detrusor denervation. Combined cystometry and electromyography confirmed the presence of normal sphincter function and the absence of detrusor sphincter dyssynergia. Prevention of postoperative bladder atony includes a careful preoperative urologic evaluation, including cystometry. Postoperative bladder care should emphasize the prevention of overdistention. Inability to empty the bladder after operation may be managed effectively by intermittent self-catheterization, Urecholine, or prolonged catheter drainage. Patients should be evaluated periodically to uncover delayed bladder decompensation.
膀胱功能障碍是根治性子宫切除术后的常见情况。我们对10例患者在根治性子宫切除术前和术后进行了膀胱功能的前瞻性研究。结果表明，术后立即观察到的高张期是由于手术创伤和长期导尿管引流继发逼尿肌肌源性张力增加所致。患者无法有效排尿是由于部分逼尿肌去神经支配。联合膀胱测压和肌电图证实括约肌功能正常且不存在逼尿肌括约肌协同失调。预防术后膀胱无张力包括术前仔细的泌尿外科评估，包括膀胱测压。术后膀胱护理应强调预防过度膨胀。术后无法排空膀胱可通过间歇性自我导尿、乌拉胆碱或延长导尿管引流有效处理。应定期对患者进行评估以发现延迟性膀胱失代偿。
