Delacroix Scott E, Winters J C
Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
Clin Colon Rectal Surg. 2010 Jun;23(2):119-27. doi: 10.1055/s-0030-1254299.
Bladder dysfunction following colorectal surgery may be related to extirpative procedures in the region of the pelvic autonomic plexus. The most common etiology is from autonomic disruption during abdominoperineal or low anterior resections. Contemporary technical modifications have allowed surgeons to achieve oncologic control while preserving the autonomic nerves that innervate the bladder and sexual organs. Although these modifications have resulted in a significant decrease in the incidence of postoperative bladder dysfunction, bladder dysfunction continues to be a source of significant morbidity after surgery. In this patient population, symptoms are not reliable for accurate diagnosis. The use of urodynamics provides objective measurements of bladder and outlet function and are paramount in providing an accurate diagnosis and in recommending treatments. Follow-up and treatment are highly individualized based on urodynamic findings, patient expectations, patient abilities, and family support. This article provides an overview of pertinent neuroanatomy, diagnosis, urodynamic interpretation, and treatment related to bladder dysfunction following pelvic colorectal surgery.
结直肠手术后的膀胱功能障碍可能与盆腔自主神经丛区域的切除手术有关。最常见的病因是腹会阴联合切除术或低位前切除术过程中自主神经的损伤。现代技术改进使外科医生在保留支配膀胱和性器官的自主神经的同时实现肿瘤控制。尽管这些改进已使术后膀胱功能障碍的发生率显著降低，但膀胱功能障碍仍是术后严重发病的一个原因。在这一患者群体中，症状对于准确诊断并不可靠。尿动力学检查可提供膀胱和出口功能的客观测量，对于准确诊断和推荐治疗至关重要。随访和治疗高度个体化，取决于尿动力学检查结果、患者期望、患者能力和家庭支持。本文概述了与盆腔结直肠手术后膀胱功能障碍相关的相关神经解剖学、诊断、尿动力学解读及治疗。
