Nielsen K K, Kromann-Andersen B, Steven K, Hald T
Department of Urology, Herlev Hospital, University of Copenhagen, Denmark.
J Urol. 1990 Aug;144(2 Pt 1):255-8; discussion 258-9. doi: 10.1016/s0022-5347(17)39426-0.
Eight women with severe intractable interstitial cystitis were treated with supratrigonal cystectomy and Mainz ileocecocystoplasty. The preoperative evaluation consisted of symptom analysis, cystometry, cystoscopy and bladder pathological findings. Seven patients had increased mast cell density. Median followup was 10 months. The symptoms resolved in 2 patients but recurred in 6 shortly after the operation. Voiding could not be established in 4 patients. Self-catheterization was difficult and painful. Ultimately, cystectomy and urinary diversion were performed in 5 patients and is scheduled in 1. The 2 cured patients had a small contracted bladder preoperatively while they were under anesthesia, while all 6 failed cases had a large bladder capacity. Postoperative biopsies from the trigone showed no difference in the amount of fibrosis, the degree of degenerative changes in the muscle and mast cell density between the 2 cured patients and the 6 who failed to improve. The mast cell density and the histological status of the trigone cannot be used as predictors of the outcome of supratrigonal cystectomy. The role of the mast cells in interstitial cystitis is reviewed. Combination of supratrigonal cystectomy and a Mainz augmentation cystoplasty cannot be recommended in patients with intractable interstitial cystitis and a large bladder capacity.
八名患有严重顽固性间质性膀胱炎的女性接受了膀胱三角上切除术和迈因茨回盲部膀胱扩大术。术前评估包括症状分析、膀胱测压、膀胱镜检查和膀胱病理检查结果。七名患者的肥大细胞密度增加。中位随访时间为10个月。两名患者症状缓解，但术后不久六名患者症状复发。四名患者无法建立排尿功能。自行导尿困难且疼痛。最终，五名患者接受了膀胱切除术和尿流改道术，一名患者计划进行该手术。两名治愈的患者在术前麻醉状态下膀胱较小且收缩，而所有六例失败病例的膀胱容量都较大。三角区的术后活检显示，两名治愈患者和六名未改善患者之间在纤维化程度、肌肉退行性变程度和肥大细胞密度方面没有差异。肥大细胞密度和三角区的组织学状态不能作为膀胱三角上切除术结果的预测指标。本文综述了肥大细胞在间质性膀胱炎中的作用。对于患有顽固性间质性膀胱炎且膀胱容量较大的患者，不建议联合进行膀胱三角上切除术和迈因茨膀胱扩大术。
