Tayib Abdulmalik M S, Abdel-Meguid Taha A, Al-Sayyad Ahmed J, Altayloni Truki E, Khan Mohammed K, Zugail Ahmed S
Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Int J Urol. 2015 Mar;22(3):301-5. doi: 10.1111/iju.12684. Epub 2015 Jan 13.
To show the efficacy and safety of a novel modification of Studer's neobladder, herein defined as the "fez procedure."
The medical records of 21 children (mean age 9.4 ± 1.3 years) who underwent the "fez procedure" at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, to manage refractory poorly-compliant bladders and concomitantly obstructed megaureters were retrospectively reviewed. The patients had been previously managed by either preliminary cutaneous ureterostomy (17 patients) or temporary nephrostomy (four patients) to improve and stabilize the renal functions. The "fez procedure" entailed augmentation ileocystoplasty and the use of an afferent tubularized ileal loop for direct ureteroileal anastomosis. The augmented bladder together with the tubularized loop were fashioned as a "fez" with its tassel. The outcome measures were changes in cystometric capacity, bladder compliance, glomerular filtration rate, serum creatinine, technetium 99m-diethylene triamine pentaacetic acid diuretic renography (T1/2), ureteral diameter, vesicoureteral reflux, febrile urinary tract infections, continence and complications.
The mean study follow-up period was 52.5 ± 12.8 months. Means of changes of cystometric capacity (273.2 ± 60.9 mL) and bladder compliance (15.6 ± 4.2 mL/cm H2 O) were significant (P < 0.0001). Resolution of ureteral obstruction was documented with improved T1/2 and ureteral diameter (P < 0.0001, each) of all patients. The initially improved renal functions after ureterostomies or nephrostomies were maintained after "fez surgery," with non-significant changes in the improved glomerular filtration rate (P = 0.22) and serum creatinine (P = 0.18). None of the patients experienced ureteral restenosis, vesicoureteral reflux, febrile urinary tract infections, incontinence or significant complications.
The "fez procedure" represents a versatile and successful surgical option for these selected patients, as it offers improved bladder capacity/compliance, resolution of ureteral obstruction and vesicoureteral reflux, preservation of the renal function, control of urinary tract infections and urinary continence, and acceptable morbidity.
展示一种新型改良的施图德回肠新膀胱术（本文定义为“菲斯手术”）的疗效和安全性。
回顾性分析了沙特阿拉伯吉达阿卜杜勒阿齐兹国王大学医院21例接受“菲斯手术”的儿童（平均年龄9.4±1.3岁）的病历，这些儿童患有难治性顺应性差的膀胱并伴有输尿管梗阻。患者此前曾接受过初步皮肤输尿管造口术（17例）或临时肾造瘘术（4例）以改善和稳定肾功能。“菲斯手术”包括回肠膀胱扩大术和使用传入的管状回肠袢进行直接输尿管回肠吻合术。扩大的膀胱与管状袢被制成带有穗状物的“菲斯”形状。观察指标包括膀胱测压容量、膀胱顺应性、肾小球滤过率、血清肌酐、锝99m - 二乙烯三胺五乙酸利尿肾图（T1/2）、输尿管直径、膀胱输尿管反流、发热性尿路感染、控尿情况及并发症的变化。
平均研究随访期为52.5±12.8个月。膀胱测压容量（273.2±60.9 mL）和膀胱顺应性（15.6±4.2 mL/cm H2O）的变化均值具有统计学意义（P < 0.0001）。所有患者的输尿管梗阻均得到缓解，T1/2和输尿管直径均有所改善（各P < 0.0001）。输尿管造口术或肾造瘘术后最初改善的肾功能在“菲斯手术”后得以维持，肾小球滤过率（P = 0.22）和血清肌酐（P = 0.18）的变化无统计学意义。所有患者均未出现输尿管再狭窄、膀胱输尿管反流、发热性尿路感染、尿失禁或严重并发症。
“菲斯手术”是这些特定患者的一种通用且成功的手术选择，因为它能改善膀胱容量/顺应性，缓解输尿管梗阻和膀胱输尿管反流，保留肾功能，控制尿路感染和实现控尿，且发病率可接受。
