Sawant S Ajit, Tamhankar Ashwin Sunil, Kumar Vikash, Prakash W Pawar, Gaurav V Kasat, Bansal Sumit
Department of Urology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India.
Urol Ann. 2016 Oct-Dec;8(4):464-467. doi: 10.4103/0974-7796.192087.
To demonstrate the new technique of Spiral-cap ileocystoplasty for bladder augmentation and simultaneous ureteric reimplant.
Seven patients with small capacity bladder and simultaneous lower ureteric involvement operated in single tertiary care institute over the last 5 years were included in this study. Spiral-cap ileocystoplasty was used in all the patients for bladder augmentation. Proximal part of the same ileal loop was used in isoperistaltic manner for ureteric reimplantation. Distal end of this ileal loop was intussuscepted into the pouch to decrease the incidence of reflux. Detubularized distal portion of the loop was reconfigured in spiral manner to augment the native bladder. Patients were analyzed for upper tract changes, serum creatinine, bladder capacity, and requirement of clean intermittent self-catheterization in follow-up over 5 years.
There was no evidence of any urinary or bowel leak in the postoperative period. Recovery was equivalent with those treated with other methods of bladder augmentation. Follow-up ultrasonography showed good capacity bladder. Upper tracts were well preserved in follow-up. Urinary bladder and lower ureter pathologies were addressed simultaneously.
Spiral-cap ileocystoplasty is a useful technique in patients who require simultaneous bladder augmentation and ureteric reimplant.
展示用于膀胱扩大术及同期输尿管再植术的螺旋帽回肠膀胱扩大成形新技术。
本研究纳入了过去5年在一家三级医疗机构接受手术的7例膀胱容量小且合并下段输尿管受累的患者。所有患者均采用螺旋帽回肠膀胱扩大成形术进行膀胱扩大。同一回肠袢的近端以顺蠕动方式用于输尿管再植。该回肠袢的远端套叠入膀胱袋以降低反流发生率。袢的去管化远端部分以螺旋方式重新构建以扩大天然膀胱。对患者进行了5年随访，分析其上尿路变化、血清肌酐、膀胱容量以及清洁间歇性自家导尿的需求。
术后期间未发现任何尿漏或肠漏迹象。恢复情况与采用其他膀胱扩大方法治疗的患者相当。随访超声显示膀胱容量良好。随访期间上尿路保存良好。膀胱和下段输尿管病变同时得到处理。
螺旋帽回肠膀胱扩大成形术对于需要同时进行膀胱扩大和输尿管再植的患者是一种有用的技术。
