Elfayoumy Hany, Abou-Elela Ashraf, Orban Tamer, Emran Ashraf, Elghoneimy Mohamed, Morsy Ahmed
Urology Department, Kasr Al Aini Hospitals, Cairo University, Cairo, Egypt.
ISRN Urol. 2011;2011:431951. doi: 10.5402/2011/431951. Epub 2011 Sep 14.
Objective. Although a large debate exists regarding the need for reflux prevention in ileal orthotopic neobladders, it is our policy to continue performing nonrefluxing ureteroileal anastomoses for our patients. An ideal uretero-ileal anastomosis must be simple, nonrefluxing, as well as non-obstructive. Here, we present a new antireflux mechanism for orthotopic ileal neobladders. Methods. 12 radical cystectomy patients for muscle invasive bladder cancer were candidates for orthotopic urinary diversion and underwent a non-refluxing uretero-ileal anastomosis using the flat-segment technique with a follow up of 6 to 18 months. Results. Preliminary results after the short-term followup showed that the success rate in reflux prevention was 92% and no cases of obstruction. The upper tracts were preserved or improved in all 12 patients. Operative time for neobladder creation ranged between 120-240 minutes, with a mean of 165 minutes (±36 minutes). No diversion-related complications. Conclusions. Based on our early data, we believe that the flat-segment uretero-ileal anastomosis technique for reflux prevention in orthotopic ileal bladder substitutes is simple, easy to learn and carries no additional morbidity to a standard refluxing uretero-ileal anastomosis, but has the advantage of effective reflux prevention. A longer follow-up period study with more patient numbers is ongoing.
目的。尽管对于回肠原位新膀胱是否需要预防反流存在大量争论，但我们的政策是继续为患者进行无反流的输尿管回肠吻合术。理想的输尿管回肠吻合术必须简单、无反流且无梗阻。在此，我们介绍一种用于原位回肠新膀胱的新型抗反流机制。方法。12例因肌层浸润性膀胱癌接受根治性膀胱切除术的患者为原位尿流改道的候选者，并采用平段技术进行了无反流的输尿管回肠吻合术，随访6至18个月。结果。短期随访后的初步结果显示，预防反流的成功率为92%，无梗阻病例。所有12例患者的上尿路均得以保留或改善。新膀胱创建的手术时间为120 - 240分钟，平均为165分钟（±36分钟）。无与尿流改道相关的并发症。结论。基于我们的早期数据，我们认为用于原位回肠膀胱替代物预防反流的平段输尿管回肠吻合术技术简单、易于学习，与标准的反流性输尿管回肠吻合术相比不会增加额外的发病率，但具有有效预防反流的优势。正在进行一项更大样本量、更长随访期的研究。
