Department of Urology, Mayo Clinic, Rochester, Minnesota.
Department of Urology, Mayo Clinic, Rochester, Minnesota.
J Urol. 2016 Nov;196(5):1478-1483. doi: 10.1016/j.juro.2016.06.009. Epub 2016 Jun 8.
To our knowledge there are no guidelines for the evaluation and management of incontinence in women with an orthotopic neobladder. We propose a treatment algorithm based on our experience with treating this patient population.
We identified women in whom orthotopic neobladder diversion and surgery for incontinence were performed from January 1, 1995 to January 1, 2014. Charts were reviewed for management, outcomes and complications within 30 days of surgery.
At this institution 12 women with orthotopic neobladder diversion were treated with surgery for incontinence between 1995 and 2014. Six women (50%) had an undiagnosed neovesicovaginal fistula, of whom 3 (50%) underwent successful fistula repair. A total of 12 bulking agent injections were performed in 6 women (50%). The outcomes were continued dryness after 1 injection (8%), transient improvement after 9 (75%), immediate failure after 1 (8%) and secondary fistula development after 1 (8%). Four transobturator slings and 4 pubovaginal slings were placed in a total of 6 patients (50%), of whom 1 (17%) was dry and 1 (17%) was improved. At a median followup of 22.9 months (IQR 11.1-46.4) 6 women (50%) were dry or improved and 6 (50%) had no improvement in leakage. Of the 6 (50%) women who were dry or improved 2 (17%) achieved planned intermittent catheterization after surgery and 2 (17%) underwent ileal conduit conversion.
Bulking agents have low long-term efficacy and carry the risk of fistula formation. The efficacy of tension-free sling placement is low and continence requires an obstructing sling. Counseling should include acceptance of multiple procedures, which may be necessary to achieve continence, and consideration of conduit diversion.
据我们所知，目前尚无针对行原位新膀胱术的女性尿失禁评估和管理的指南。我们根据治疗该患者人群的经验提出了一种治疗算法。
我们从 1995 年 1 月 1 日至 2014 年 1 月 1 日期间，确定了行原位新膀胱术和尿失禁手术的女性患者。对手术 30 天内的管理、结果和并发症进行了图表回顾。
在该机构，1995 年至 2014 年间，有 12 名女性因行原位新膀胱术而接受了治疗尿失禁的手术。6 名女性（50%）患有未确诊的新膀胱阴道瘘，其中 3 名（50%）瘘管修复成功。6 名女性（50%）共进行了 12 次膀胱内填充物注射。结果是：1 次注射后持续干燥（8%），9 次注射后暂时改善（75%），1 次立即失败（8%），1 次继发瘘管形成（8%）。6 名女性（50%）共放置了 4 个经闭孔吊带和 4 个耻骨阴道吊带，其中 1 名（17%）女性干燥，1 名（17%）女性改善。在中位随访 22.9 个月（IQR 11.1-46.4）时，6 名女性（50%）干燥或改善，6 名女性（50%）漏尿无改善。在 6 名（50%）干燥或改善的女性中，2 名（17%）在手术后计划间歇性导尿，2 名（17%）行回肠造口术。
填充物的长期疗效较低，且有瘘管形成的风险。无张力吊带放置的疗效较低，且需要阻塞性吊带才能实现控尿。咨询应包括接受多种可能需要进行控尿的程序，并考虑使用导管引流。
