Department of Urology, University Hospital of Wales, Cardiff, UK.
Int J Urol. 2012 Dec;19(12):1099-102. doi: 10.1111/j.1442-2042.2012.03111.x. Epub 2012 Jul 31.
Detrusor myectomy is a recognized method of bladder augmentation for treating refractory detrusor overactivity. Herein we report the long-term outcomes of this procedure at the University Hospital of Wales in Cardiff, UK.
Detrusor myectomy was carried out in 33 patients (7 males, 26 females) with urodynamically proven detrusor overactivity between 1995 and 2002. The mean patient age was 33 years (range 5-62). A total of 18 patients had idiopathic detrusor overactivity, whereas 15 had neurogenic detrusor overactivity.
A total of 24 patients had a detrusor myectomy alone, whereas eight patients had a detrusor myectomy with implantation of artificial urinary sphincter. One patient had detrusor myectomy with transuretero-ureterostomy. The mean follow up was 148 months (range 108-192). A total of 10 of the 18 patients with idiopathic detrusor overactivity (55.5%) and six of the 15 patients with neurogenic detrusor overactivity (40%) showed marked improvement in symptoms. Detrusor overactivity was completely abolished in 11 patients and significantly reduced in five. Postoperatively, mean cystometric capacity improved from 290 to 458 mL, whereas mean maximum amplitude of detrusor contraction was reduced from 44 cm/H(2) O to 20 cm/H(2) O. An overall success rate of 48.5% (16/33 patients) was achieved. Intermittent self catheterization was needed to achieve bladder emptying in 12 of the 16 (75%) patients. Of the remaining 17 patients who did not improve, six had CLAM enterocystoplasty carried out and two await the operation. An ileal conduit diversion and suprapubic catheter insertion was carried out in one patient each, whereas seven patients declined any further intervention.
Detrusor myectomy offers a reasonable long-term success rate to patients undergoing surgical treatment for refractory detrusor overactivity.
逼尿肌肌切除术是治疗难治性逼尿肌过度活动的公认膀胱扩大方法。在此，我们报告了英国加的夫威尔士大学医院该手术的长期结果。
1995 年至 2002 年间，对 33 例经尿动力学证实逼尿肌过度活动的患者（7 名男性，26 名女性）进行了逼尿肌肌切除术。患者平均年龄 33 岁（5-62 岁）。共有 18 例患者为特发性逼尿肌过度活动，15 例患者为神经源性逼尿肌过度活动。
24 例患者仅行逼尿肌肌切除术，8 例患者行逼尿肌肌切除术联合人工尿道括约肌植入术。1 例患者行逼尿肌肌切除术联合输尿管-输尿管吻合术。平均随访时间为 148 个月（108-192 个月）。18 例特发性逼尿肌过度活动患者中，10 例（55.5%）和 15 例神经源性逼尿肌过度活动患者中 6 例（40%）症状明显改善。11 例患者逼尿肌过度活动完全消除，5 例患者明显减少。术后膀胱测压容量从 290 毫升增加到 458 毫升，逼尿肌收缩最大幅度从 44 厘米水柱降低到 20 厘米水柱。33 例患者中，总有效率为 48.5%（16/33 例）。16 例（75%）患者需要间歇性自行导尿排空膀胱。在其余 17 例未改善的患者中，6 例行 CLAM 肠膀胱扩大术，2 例等待手术。1 例患者行回肠造口术和耻骨上导管插入术，7 例患者拒绝进一步干预。
逼尿肌肌切除术为接受难治性逼尿肌过度活动手术治疗的患者提供了合理的长期成功率。
