Chabchoub K, Ketata H, Fakhfakh H, Bahloul A, Mhiri M N
Service d'urologie, CHU de Lens, 99, route de la Bassée, sac postal 8, 62307 Lens, France.
Prog Urol. 2008 Feb;18(2):120-4. doi: 10.1016/j.purol.2007.12.006. Epub 2008 Mar 11.
To analyze the urodynamic parameters and the mechanisms of continence of Mitrofanoff urinary diversion.
Urodynamic assessment was performed via the stoma in 11 patients with continent urinary diversion according to the Mitrofanoff principle. The mean age of the patients at the time of the operation was 29 years. The appendix, used as conduit in all cases, was anastomosed to the skin of the right iliac fossa. Ileocystoplasty was performed in 10 patients. The urodynamic assessment was performed after a mean follow-up of seven years (range: five to 12 years).
Reservoir pressures after filling did not exceed 20 cm H2O in nine cases. Uninhibited contractions were recorded in two patients with an enlarged bladder with pressures not exceeding 30 cm H2O. Appendix pressures during filling were always higher than bladder pressures. The mean pressure measured at the end of filling was 75 cm H2O (range: 45 to 90 cm H2O). After the Valsalva maneuver, these pressures were between 80 and 150 cm H2O with good transmission. The mean conduit closing pressure was 70 cm H2O (range: 40 to 90 cm H2O). The mean functional length of the conduit was 5 cm (range: 2.6 to 7.2 cm).
The Mitrofanoff diversion is mainly characterized by the high intraluminal pressure in the continent conduit. A low bladder pressure is essential to maintain a perfectly continent diversion.
分析米氏可控性尿流改道术的尿动力学参数及控尿机制。
根据米氏原理，对11例可控性尿流改道患者经造口进行尿动力学评估。手术时患者的平均年龄为29岁。所有病例均采用阑尾作为管道，将其与右髂窝皮肤吻合。10例患者行回肠膀胱扩大术。平均随访7年（范围：5至12年）后进行尿动力学评估。
9例患者充盈后储尿囊压力不超过20 cm H₂O。2例膀胱扩大患者记录到无抑制性收缩，压力不超过30 cm H₂O。充盈期间阑尾压力始终高于膀胱压力。充盈末期测得的平均压力为75 cm H₂O（范围：45至90 cm H₂O）。瓦尔萨尔瓦动作后，这些压力在80至150 cm H₂O之间，传导良好。管道平均关闭压力为70 cm H₂O（范围：40至90 cm H₂O）。管道平均功能长度为5 cm（范围：2.6至7.2 cm）。
米氏尿流改道术的主要特点是可控管道内腔内压力高。低膀胱压力对于维持完美的可控性尿流改道至关重要。
