Beauval J-B, Grange C, Roumiguié M
Département d'urologie, andrologie et transplantation rénale, CHU de Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse, France.
Département d'urologie, andrologie et transplantation rénale, CHU de Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse, France.
Prog Urol. 2015 Nov;25(14):900-6. doi: 10.1016/j.purol.2015.09.016. Epub 2015 Oct 23.
Cystectomy and urinary diversion (Bricker ileal conduit or neobladder) are common modalities of care in urology requiring their attention. Oncological surgery as well as functional disorders in particular for neurogenic bladder are the main directions. The optimal decision must be multidisciplinary and requires the fundamental of stomatherapy that urology teams need to know in order to improve the management of the care plan. After cystectomy whose surgical approach depends on the cause (oncological vs other causes), urinary diversions may be non continent (cutaneous ureterostomy or Bricker ileal conduit) or continent (ileal neobladder most of the time.) The monitoring and patient's support remain two most important steps, particularly in cases of bladder diversion to monitor (protection of upper urinary tract, neobladder capacity) and patient education (learning of continence and good emptying). The choice of many surgical techniques must be adapted to the characteristics of the patient, after an informed discussion with the patient.
膀胱切除术和尿流改道(Bricker回肠膀胱术或新膀胱)是泌尿外科常见的治疗方式,需要引起关注。肿瘤手术以及特别是神经源性膀胱的功能障碍是主要方向。最佳决策必须是多学科的,并且需要泌尿团队了解造口治疗的基本知识,以便改进护理计划的管理。膀胱切除术后,手术方式取决于病因(肿瘤性与其他病因),尿流改道可分为非可控性(皮肤输尿管造口术或Bricker回肠膀胱术)或可控性(大多数情况下为回肠新膀胱)。监测和患者支持仍然是两个最重要的步骤,特别是在膀胱改道的情况下,要进行监测(保护上尿路、新膀胱容量)和患者教育(学习控尿和良好排空)。在与患者进行充分讨论后,许多手术技术的选择必须根据患者的特点进行调整。