Paananen Ilkka, Ohtonen Pasi, Perttilä Ilkka, Jonsson Olof, Edlund Christer, Wiklund Peter, Ljungberg Börje, Möller-Jensen Klaus, Jonsson Eirikur, Månsson Wiking
1 Department of Urology, Oulu University Hospital , Oulu , Finland.
Scand J Urol. 2014 Feb;48(1):90-8. doi: 10.3109/21681805.2013.799225. Epub 2013 Jul 17.
The aim of this study was to evaluate enterocystometry, voiding pattern and urine leakage of four types of orthotopic bladder substitute.
At eight urological departments, 78 consecutive men were studied: 66 with an ileal neobladder [30 Studer pouches (S), 24 Hautmann pouches (H) and 12 T-pouches (T)] and 12 with a right colonic [Goldwasser type (G)] neobladder. Enterocystometry, determination of residual urine, micturition protocol and 24 h pad weight test were performed 6 and 12 months postoperatively.
Colonic neobladders had higher pouch pressure at first desire, normal desire and strong desire than ileal neobladders (except at first and normal desire at 12 months) (p < 0.02) and contraction was present more often at both 6 and 12 months (p < 0.01 and p < 0.01). Compliance was good in all types of pouch. Intermittent self-catheterization was more common in H patients at 6 months (p = 0.033). All patients with colonic neobladders used pads during the day and night. In patients with ileal pouches 32% used pads during the day and 70% during the night at 12 months. Urine leakage was higher in patients with colonic bladders at 6 and 12 months during the day (mean/median of 98/31 ml and 82/16 ml versus 10/0 ml and 4/0 ml, p < 0.001). T-pouches had excellent day-time continence, but nocturnal leakage was high.
The Hautmann pouch and the Studer pouch behaved similarly at enterocystometry and clinically, and continence was good in the majority of patients. The low number of patients with the other two types of pouch precludes definitive statements.
本研究旨在评估四种原位膀胱替代物的膀胱内压测定、排尿模式及尿失禁情况。
在八个泌尿外科科室，对78例男性患者进行了连续研究：66例采用回肠新膀胱[30例Studer袋（S）、24例Hautmann袋（H）和12例T形袋（T）]，12例采用右半结肠[Goldwasser型（G）]新膀胱。术后6个月和12个月进行膀胱内压测定、残余尿量测定、排尿方案及24小时尿垫重量试验。
结肠新膀胱在初次排尿意愿、正常排尿意愿和强烈排尿意愿时的囊袋压力高于回肠新膀胱（12个月时初次排尿意愿和正常排尿意愿除外）（p<0.02），且在6个月和12个月时收缩更为常见（p<0.01和p<0.01）。所有类型的囊袋顺应性均良好。6个月时，H组患者间歇性自我导尿更为常见（p = 0.033）。所有结肠新膀胱患者日夜均使用尿垫。回肠囊袋患者在12个月时，32%白天使用尿垫，70%夜间使用尿垫。结肠膀胱患者在6个月和12个月时白天尿失禁情况更为严重（平均/中位数分别为98/31 ml和82/16 ml，而回肠膀胱患者为10/0 ml和4/0 ml，p<0.001）。T形袋白天控尿良好，但夜间漏尿较多。
Hautmann袋和Studer袋在膀胱内压测定及临床方面表现相似，大多数患者控尿良好。其他两种类型囊袋的患者数量较少，无法得出确切结论。
