Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Urol. 2012 Apr;187(4):1416-21. doi: 10.1016/j.juro.2011.12.009. Epub 2012 Feb 16.
Urothelium lined seromuscular colocystoplasty is an ideal method of augmentation cystoplasty that avoids various complications caused by the use of gastrointestinal segments. We reviewed the long-term outcomes using this technique at a single institution.
We retrospectively analyzed 34 patients who underwent urothelium lined seromuscular colocystoplasty between January 1996 and December 2007. A total of 33 patients, excluding 1 who had previously undergone artificial urinary sphincter implantation, were included in the study. Changes in urodynamic parameters, duration of anticholinergic use, incontinence and surgical complications were analyzed.
Mean±SD age at surgery was 10.0±5.7 years (range 3.0 to 26.0) and duration of followup was 6.0±2.3 years (2.7 to 13.4). A total of 17 patients (51.5%) underwent simultaneous anti-incontinence surgery and urothelium lined seromuscular colocystoplasty. Mean bladder capacity increased by a factor of 2.96 and mean percentage of expected bladder capacity for age increased by a factor of 1.96 postoperatively. Of patients who underwent anti-incontinence surgery 4 of 10 whose abdominal leak point pressure was less than 40 cm H2O required additional surgery, whereas none whose abdominal leak point pressure was 40 to 60 cm H2O required reoperation. Two of 16 patients who did not undergo anti-incontinence surgery eventually required continence surgery. A total of 13 patients (39.4%) were able to discontinue anticholinergics at 47.3 months postoperatively. There were no bladder perforations, bowel obstructions or metabolic abnormalities.
Urothelium lined seromuscular colocystoplasty can be primarily considered in patients without prior bladder mucosal injury. Constant high bladder outlet pressure to facilitate adhesion of bladder mucosa and seromuscular patch is critical for the best results. We recommend abdominal leak point pressure 60 cm H2O or less as an indication for simultaneous anti-incontinence surgery and urothelium lined seromuscular colocystoplasty.
尿路上皮衬里的肌层膀胱黏膜下囊状扩大术是一种理想的膀胱扩大术，可避免使用胃肠道段引起的各种并发症。我们在一家单中心回顾了使用该技术的长期结果。
我们回顾性分析了 1996 年 1 月至 2007 年 12 月期间接受尿路上皮衬里的肌层膀胱黏膜下囊状扩大术的 34 例患者。共纳入 33 例患者，排除 1 例先前接受过人工尿道括约肌植入术的患者。分析尿动力学参数的变化、抗胆碱能药物使用时间、尿失禁和手术并发症。
手术时的平均年龄±标准差为 10.0±5.7 岁（范围 3.0 至 26.0），随访时间平均为 6.0±2.3 年（2.7 至 13.4）。17 例患者（51.5%）同时行抗失禁手术和尿路上皮衬里的肌层膀胱黏膜下囊状扩大术。术后膀胱容量增加了 2.96 倍，年龄预期膀胱容量的平均百分比增加了 1.96 倍。行抗失禁手术的 10 例患者中，4 例腹压漏点压力<40cmH2O 需再次手术，而腹压漏点压力为 40 至 60cmH2O 的患者无一例需要再次手术。16 例未行抗失禁手术的患者中有 2 例最终需要行控尿手术。13 例患者（39.4%）术后 47.3 个月能够停止使用抗胆碱能药物。无膀胱穿孔、肠梗阻或代谢异常。
对于无先前膀胱黏膜损伤的患者，可首选尿路上皮衬里的肌层膀胱黏膜下囊状扩大术。为获得最佳效果，需保持较高的膀胱出口压力，以促进膀胱黏膜和肌层补片的黏附。我们建议将腹压漏点压力<60cmH2O 作为同时行抗失禁手术和尿路上皮衬里的肌层膀胱黏膜下囊状扩大术的指征。
