Sethia K K, Webb R J, Neal D E
University Department of Surgery, Freeman Hospital, Newcastle upon Tyne.
Br J Urol. 1991 Mar;67(3):286-90. doi: 10.1111/j.1464-410x.1991.tb15136.x.
Enterocystoplasty is being used with increasing frequency in the treatment of patients with idiopathic detrusor instability. We have performed a prospective clinical and urodynamic study of this procedure in 11 patients using both conventional (CMG) and ambulatory monitoring techniques (AM). Nine of 11 patients were satisfied with the symptomatic outcome, but 7 relied on clean intermittent self-catheterisation (CISC) to achieve a good result. Urodynamic studies demonstrated a significant increase in residual urine volume from 48 +/- 72 ml before to 347 +/- 298 ml after operation, but there was only a small and statistically insignificant increase in cystometric capacity. Detrusor instability, present before operation in all patients, could still be demonstrated in over half of them after operation. However, a significant decrease in the severity of instability was found after operation as assessed by an increased volume at first unstable contraction. The bladder volume before operation at which the first unstable contraction occurred was smaller in those who still had persistent instability after enterocystoplasty compared with those in whom instability could not be identified after operation. These results suggest that all patients about to undergo ileocystoplasty should be trained in the use of CISC. In selected patients with idiopathic detrusor instability refractory to other treatment, this procedure can yield satisfactory results.
肠膀胱扩大术在特发性逼尿肌不稳定患者的治疗中应用越来越频繁。我们对11例患者进行了该手术的前瞻性临床和尿动力学研究，采用了传统（CMG）和动态监测技术（AM）。11例患者中有9例对症状改善结果满意，但7例依赖清洁间歇性自家导尿（CISC）以获得良好效果。尿动力学研究显示残余尿量从术前的48±72ml显著增加至术后的347±298ml，但膀胱测压容量仅略有增加且无统计学意义。所有患者术前均存在逼尿肌不稳定，术后仍有超过半数患者可检测到。然而，通过首次不稳定收缩时容量增加评估，术后不稳定严重程度显著降低。与术后未发现不稳定的患者相比，肠膀胱扩大术后仍存在持续性不稳定的患者术前首次出现不稳定收缩时的膀胱容量较小。这些结果表明，所有即将接受回肠膀胱扩大术的患者都应接受CISC使用培训。对于其他治疗无效的特发性逼尿肌不稳定的特定患者，该手术可产生满意的结果。
