Zhang Peng, Yang Yong, Wu Zhi-jin, Zhang Ning, Zhang Chao-hua, Zhang Xiao-dong
Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Urology. 2014 Sep;84(3):697-701. doi: 10.1016/j.urology.2014.05.025.
To assess the clinical and urodynamic outcomes of patients with low-compliance neurogenic bladder who were treated with sigmoid bladder augmentation (SBA) over a long-term follow-up.
We retrospectively reviewed 52 patients with low-compliance neurogenic bladder who underwent SBA alone or with antireflux techniques in our hospital from 2006 to 2014. Clinical outcomes regarding bladder function, incontinence, medications, catheterization schedules, subsequent interventions, bowel function, and patient satisfaction were addressed.
The mean follow-up was 49 months. All patients experienced significant increases in safe cystometric capacity from 113.8 ± 65.9 mL to 373.1 ± 66.7 mL (P <.001), bladder compliance from 2.96 ± 1.55 mL/cm H2O to 14.07 ± 5.45 mL/cm H2O (P <.001), and decreases in creatinine from 88.1 ± 38.6 μmol/L to 77.1 ± 30.4 μmol/L (P <.001) compared with those before surgery. Six patients (11.5%) required anticholinergic medicine to control neurogenic detrusor overactivity, and 11 (21.1%) had recurrent febrile urinary tract infections after SBA. Among 47 prehydronephrosis patients (grade I-II in 10 and III-V in 37), 16 still had minor hydronephrosis after SBA, but the hydronephrosis had been improved significantly (all posthydronephroses were grade I-II instead). All patients reported significant improvements in constipation, and no patient had obvious metabolic acidosis or bladder perforation after SBA. All patients expressed extreme satisfaction with the operation.
SBA provided durable clinical and urodynamic improvement for patients with low-compliance neurogenic bladder and constipation. SBA alone, without ureteral reimplantation, seemed sufficient for neurogenic bladder. Furthermore, there was a high level of patient satisfaction with SBA.
通过长期随访评估接受乙状结肠膀胱扩大术（SBA）治疗的低顺应性神经源性膀胱患者的临床和尿动力学结果。
我们回顾性分析了2006年至2014年在我院单独接受SBA或联合抗反流技术治疗的52例低顺应性神经源性膀胱患者。探讨了膀胱功能、尿失禁、药物治疗、导尿计划、后续干预、肠道功能和患者满意度等临床结果。
平均随访49个月。与术前相比，所有患者的安全膀胱容量从113.8±65.9 mL显著增加至373.1±66.7 mL（P<.001），膀胱顺应性从2.96±1.55 mL/cm H2O增加至14.07±5.45 mL/cm H2O（P<.001），肌酐水平从88.1±38.6 μmol/L降至77.1±30.4 μmol/L（P<.001）。6例患者（11.5%）需要抗胆碱能药物来控制神经源性逼尿肌过度活动，11例患者（21.1%）在SBA后出现复发性发热性尿路感染。在47例术前有肾积水的患者中（10例为I-II级，37例为III-V级），16例在SBA后仍有轻度肾积水，但肾积水已显著改善（所有术后肾积水均为I-II级）。所有患者均报告便秘有显著改善，且无患者术后出现明显代谢性酸中毒或膀胱穿孔。所有患者对手术均表示极度满意。
SBA为低顺应性神经源性膀胱和便秘患者提供了持久的临床和尿动力学改善。单独的SBA，不进行输尿管再植，似乎对神经源性膀胱就足够了。此外，患者对SBA的满意度很高。
