Parres J A, Kropp K A
Department of Surgery, Medical College of Ohio, Toledo.
J Urol. 1991 Aug;146(2 ( Pt 2)):535-8. doi: 10.1016/s0022-5347(17)37846-1.
In an attempt to create continence in myelomeningocele children we performed urethral lengthening/submucosal reimplantation, a form of bladder neck reconstruction, to create a valve allowing catheterizable access to the bladder. We present the urodynamic findings of 23 patients 4 to 89 months (mean 43.1 months) after bladder neck reconstruction and enterocytoplasty to determine the continence mechanism of this 1-way valve and characteristics of the augmented bladder. Standard cystometrograms with simultaneous pressure recording of the submucosal portion of the neourethra were undertaken with a 10F, triple lumen, urethral pressure profile catheter. Baseline pressures in the submucosal neourethra were higher than in the bladder (mean 25.3 versus 13.4 cm, water, p less than 0.001). Submucosal tunnel and bladder pressures paralleled throughout filling, with mean tunnel pressures remaining greater at the time of first (53.6 versus 45.5 cm. water, p less than 0.01) and peak (62.9 versus 55.8 cm. water, p greater than 0.05) cystoplasty contractions. Bladders augmented with detubularized ileum had fewer significant contractions (greater than 40 cm. water) than other types of cystoplasties (36% versus 92%) and over-all they had first and peak contractions at greater volumes and lesser magnitude. We conclude that continence following urethral lengthening/reimplantation results from an anatomical arrangement allowing transmission of dynamic bladder pressure changes to the submucosal neourethra and that urethral pressure exceeds bladder pressure throughout filling. Additionally, our data suggest that detubularized ileum provides a large capacity, low pressure reservoir suitable for augmentation.
为了使脊髓脊膜膨出患儿实现控尿，我们实施了尿道延长/黏膜下再植术，这是一种膀胱颈重建术式，目的是创建一个瓣膜，以便能够通过导尿管进入膀胱。我们展示了23例患者在膀胱颈重建和小肠黏膜成形术后4至89个月（平均43.1个月）的尿动力学检查结果，以确定这种单向瓣膜的控尿机制以及扩大膀胱的特征。使用10F三腔尿道压力轮廓导管进行标准膀胱测压，并同时记录新尿道黏膜下部分的压力。黏膜下新尿道的基线压力高于膀胱（平均分别为25.3cm水柱和13.4cm水柱，p<0.001）。在整个充盈过程中，黏膜下隧道和膀胱压力平行，在首次（53.6cm水柱对45.5cm水柱，p<0.01）和峰值（62.9cm水柱对55.8cm水柱，p>0.05）膀胱成形术收缩时，黏膜下隧道平均压力始终更高。与其他类型的膀胱成形术相比，用去管化回肠扩大的膀胱显著收缩（大于40cm水柱）较少（36%对92%），总体而言，它们的首次和峰值收缩出现在更大的容量和更小的幅度。我们得出结论，尿道延长/再植术后的控尿是由于一种解剖结构安排，使得膀胱动态压力变化能够传递到黏膜下新尿道，并且在整个充盈过程中尿道压力超过膀胱压力。此外，我们的数据表明，去管化回肠提供了一个大容量、低压的储尿囊，适合用于扩大膀胱。
