Division of Urology, Oregon Health & Science University, CH10U, 3303 SW Bond Ave, Portland, OR 97239, USA.
Curr Urol Rep. 2012 Oct;13(5):389-93. doi: 10.1007/s11934-012-0271-z.
Augmentation cystoplasty and urinary diversion are no longer commonplace in the management of patients with neurogenic bladder, but remain an important surgical treatment for those with refractory LUTS who have failed neuromodulation and onabotulinum toxin treatment or who are not candidates for those treatments. Augmentation is an option in patients who can perform intermittent catheterization and is usually performed with ileum or large intestine. Some patients benefit from continent cutaneous catherizable channels. Supravesical urinary diversion may be necessary in more severe cases. Ileovesicostomies are being supplanted by indwelling suprapubic catheters, and when catheters fail conduits may be a better option. When feasible, the diverted bladder should be excised to avoid pyocystis.
增强膀胱术和尿路分流术在神经源性膀胱的治疗中已不再常见，但对于那些对神经调节和肉毒毒素治疗无效或不适合这些治疗的难治性 LUTS 患者，仍然是一种重要的手术治疗方法。对于能够进行间歇性导尿的患者，可以选择增强膀胱术，通常使用回肠或大肠。一些患者受益于可控性皮通道。在更严重的情况下，可能需要行上尿路分流术。回肠膀胱造口术正在被留置耻骨上导管所取代，当导管失败时，导管可能是更好的选择。在可行的情况下，应切除转流膀胱以避免脓毒症。
