Frohneberg D, Bachor R, Egghart G, Miller K, Hautmann R
Department of Urology, University of Ulm, FRG.
Eur Urol. 1989;16(4):241-9.
Since April 1986, total bladder substitution, by the ileal neobladder in cases of radical cystoprostatectomy or bladder augmentation, proved to be a reliable alternative method of urinary diversion in 81 patients. The operative technique is standardized, comparably simple and safe to prevent upper urinary tract deterioration, reflux, as well as incontinence. The neurovascular bundle can be preserved, so potency might not be compromised. As preservation of the external urethral sphincter is possible, total day and night time continence is a result of residual sphincter function and abolishment of high pressure waves of the intestinal reservoir. Follow-up of the patients is between 1 and 28 months (mean 12.2 months). 64 patients had a follow-up of more than 3 months postoperatively and the evaluation included private micturition behavior and urodynamic investigation. Stress incontinence, which has to be corrected by an artificial sphincter, was found in 3 and night time incontinence needing some external device in 2 patients. There was no perioperative mortality. The special technique of creating the ileal neobladder by folding the ileal segment 4 times with complete detubularization, besides preserving urethral sphincter function, seems to be the most important reason why total continence during the day and night is achieved in more than 90% of the patients.
自1986年4月以来，在81例患者中，经回肠新膀胱行根治性膀胱前列腺切除术或膀胱扩大术的全膀胱替代术，被证明是一种可靠的尿流改道术替代方法。手术技术标准化，相对简单且安全，可防止上尿路恶化、反流以及尿失禁。神经血管束可得以保留，因此性功能可能不会受到损害。由于可以保留尿道外括约肌，白天和夜间完全尿失禁是残余括约肌功能和肠道储尿囊高压波消除的结果。患者的随访时间为1至28个月（平均12.2个月）。64例患者术后随访超过3个月，评估包括个人排尿行为和尿动力学检查。3例患者出现需用人造括约肌纠正的压力性尿失禁，2例患者出现需用某种外部装置的夜间尿失禁。围手术期无死亡病例。通过将回肠段折叠4次并完全去管状化来创建回肠新膀胱的特殊技术，除了保留尿道括约肌功能外，似乎是90%以上的患者实现昼夜完全尿失禁的最重要原因。
