Sammour Mohammed T, Ajjaj Abdulbari Bin
Department of Urology, King Abdul-Aziz National Guard Hospital, Al-Ahsa, Saudi Arabia.
Urol Ann. 2011 Jan;3(1):33-5. doi: 10.4103/0974-7796.75863.
It is a great challenge to select and perform continent mechanism in a stoma for urinary reservoir. A new technique by combining MONTI ileal conduit with the serosal lined trough in order to achieve continent catheterizable stoma to the umbilicus as a part of augmentation ileocystoplasty. We applied serosal-lined trough as a continent mechanism with MONTI ileal tube in 12 years smart girl underwent ileocystoplasty for neuropathic bladder due to meylomeningocele in whom continence failed to be achieved by using Mitrofanoff with submucosal tunnel of the bladder as continent mechanism before, also the previous operation included left to right transuretero-ureterostomy, ureterocystoplasty and reimplantation of the right ureter. The patient became completely continent; she was able to do self-catheterization easily through the umbilical stoma using 16-French catheter and was able to wash the mucous easily. The capacity of the augmented bladder was 300ccs. She became independent from her mother and stopped using diapers, anticholinergic and antibiotics. Combining MONTI conduit with serosal-lined extramural valve trough (The Ghoneim technique) is an effective continent technique and gives wider channel for catheterization and washing out the mucous.
在尿流改道的造口中选择并实施可控机制是一项巨大挑战。一种新技术是将MONTI回肠导管与浆膜内衬槽相结合,以实现经脐的可控性造口,作为扩大回肠膀胱术的一部分。我们将浆膜内衬槽作为可控机制与MONTI回肠管一起应用于一名12岁的聪明女孩,她因脊髓脊膜膨出导致神经源性膀胱而接受回肠膀胱术,此前使用带膀胱黏膜下隧道的Mitrofanoff作为可控机制未能实现控尿,且之前的手术包括左至右输尿管-输尿管吻合术、输尿管膀胱成形术和右侧输尿管再植术。该患者实现了完全控尿;她能够使用16号法国导管轻松地通过脐部造口进行自我导尿,并且能够轻松清洗黏液。扩大膀胱的容量为300cc。她变得不再依赖母亲,不再使用尿布、抗胆碱能药物和抗生素。将MONTI导管与浆膜内衬壁外瓣膜槽(戈内姆技术)相结合是一种有效的可控技术,可为导尿和冲洗黏液提供更宽的通道。