Department of Urology, China Rehabilitation Research Center, Rehabilitation College of Capital Medical University, Beijing, China.
Urology. 2012 Aug;80(2):440-5. doi: 10.1016/j.urology.2012.05.010.
To assess the clinical and urodynamic results of sigmoidocolocystoplasty in patients with neurogenic bladder dysfunction.
We retrospectively reviewed 78 augmentation enterocystoplasty cases in our database from 2005 to 2011 to identify 47 patients who had undergone sigmoidocolocystoplasty alone or combined with ureter reimplantation. The indications for surgery and postoperative complications were evaluated. Renal function preservation, increased postoperative bladder capacity, decreased maximal detrusor pressure, and overall patient satisfaction were deemed successful outcomes.
The mean follow-up period was 24 months. The mean bladder capacity increased from 160.6 ± 128.3 to 468.5 ± 60.6 mL (P < .001) and the maximal detrusor pressure decreased from 31.1 ± 26.4 to 10.9 ± 4.5 cm H(2)O (P = .002). The serum creatinine level decreased from 270.3 ± 113.6 to 174.4 ± 81.3 μmol/L (P = .001). Most patients resolved the urinary incontinence using clean self-intermittent catheterization. The decrease in the mean number of incontinence episodes and pads used daily indicated a marked improvement in patients' quality of life. Postoperative complications included bowel dysfunction in 5 patients (10.6%), adhesive intestinal obstruction in 4 (8.5%), deteriorating renal function in 3 (6.4%), and vesicoureteral reflux recurrence in 2 patients (4.3%). Nearly all patients expressed satisfaction with the urologic management.
Our results suggest that sigmoidocolocystoplasty is safe and effective in treating patients with neurogenic bladder dysfunction. Concomitant ureter reimplantation will be beneficial for patients with a long history of illness.
评估神经原性膀胱功能障碍患者行乙状结肠膀胱扩大术的临床和尿动力学结果。
我们回顾性分析了 2005 年至 2011 年数据库中 78 例肠膀胱扩大术病例，确定了 47 例单独或联合输尿管再植术接受乙状结肠膀胱扩大术的患者。评估了手术适应证和术后并发症。保留肾功能、增加术后膀胱容量、降低最大逼尿肌压力和总体患者满意度被视为成功的结果。
平均随访时间为 24 个月。膀胱容量从 160.6±128.3ml 增加到 468.5±60.6ml（P<0.001），最大逼尿肌压力从 31.1±26.4cm H2O 降低到 10.9±4.5cm H2O（P=0.002）。血清肌酐水平从 270.3±113.6μmol/L 降低到 174.4±81.3μmol/L（P=0.001）。大多数患者通过清洁间歇性自我导尿解决了尿失禁问题。失禁次数和每日使用尿垫数量的减少表明患者生活质量明显改善。术后并发症包括 5 例（10.6%）肠功能障碍、4 例（8.5%）粘连性肠梗阻、3 例（6.4%）肾功能恶化和 2 例（4.3%）膀胱输尿管反流复发。几乎所有患者对泌尿外科治疗都表示满意。
我们的结果表明，乙状结肠膀胱扩大术治疗神经原性膀胱功能障碍患者是安全有效的。对于病史较长的患者，同时进行输尿管再植术将是有益的。
