Baron J C, Claude R, Hermieu J F, Villers A, Delmas V, Boccon-Gibod L
Clinique Urologique, Hôpital Bichat, Paris, France.
Prog Urol. 1991 Jun;1(3):449-56.
The treatment of urinary incontinence due to unstable bladder remains difficult. In the case of failure of medical or physiotherapeutic treatments, clam enterocystoplasty represents a major and important therapeutic possibility. The operation consists of frontal section of the bladder to form a bivalve followed by interposition, between the two valves, of a detubed ileal graft in order to increase the functional vesical capacity and to interrupt the transmission of detrusor contraction waves from one valve to the other. 10 patients (7 men and 3 women) suffering from urinary incontinence due to neurogenic unstable bladder (4 cases: 3 meningoceles, 1 operated cauda equina neuroma) or to another cause (6 cases, including one sequela of radiotherapy for prostatic cancer and 5 cases of apparently primary urinary incontinence) underwent enterocystoplasty combined, in the case of neurogenic incontinence (2 cases simultaneously and 2 cases previously), with the insertion of an AMS 800 sphincter. No major complication was observed. 9 patients are continent and 1 had to be reoperated to undergo an augmentation enterocystoplasty (failure of the initial operation due to radiation changes of the bladder), 3 retain a post-voiding residual of about 200 ml but not requiring self catheterisation due to the absence of any repercussions on the upper urinary tract. Lastly, urodynamic studies demonstrated a spectacular increase in compliance and functional capacity of the bladder together with a reduction of the amplitude of intravesical pressure peaks.
不稳定膀胱所致尿失禁的治疗仍然困难。在药物或物理治疗失败的情况下，膀胱扩大术是一种主要且重要的治疗选择。该手术包括将膀胱前部切开形成双瓣，然后在两瓣之间置入一段去管化的回肠移植物，以增加膀胱功能容量并中断逼尿肌收缩波从一个瓣向另一个瓣的传导。10例因神经源性不稳定膀胱（4例：3例脑脊膜膨出、1例马尾神经瘤术后）或其他原因（6例，包括1例前列腺癌放疗后遗症和5例明显原发性尿失禁）导致尿失禁的患者接受了膀胱扩大术，其中神经源性尿失禁患者（2例同时进行，2例先前进行）在手术时同时植入了AMS 800括约肌。未观察到重大并发症。9例患者实现控尿，1例因膀胱放射性改变导致初次手术失败而需再次手术进行膀胱扩大术；3例患者排尿后残余尿量约200 ml，但由于对上尿路无任何影响，无需自行导尿。最后，尿动力学研究表明膀胱顺应性和功能容量显著增加，膀胱内压峰值幅度降低。
