El-Helaly Hisham Abdulazim, Saifelnasr Mohamed Kamal, Mohamed Khaled Mohyeelden, Abdelaziz Alsayed Saad, Youssof Hamada Ahmed
Department of Urology, Faculty of Medicine, El-Fayoum University, El-Fayoum, Cairo, Egypt.
Department of Urology, Faculty of Medicine, Al-Azhar University, Damietta, Cairo, Egypt.
Urol Ann. 2019 Apr-Jun;11(2):204-210. doi: 10.4103/UA.UA_137_18.
Radical cystectomy with orthotopic urinary diversion is considered the gold standard for treatment of muscular invasive bladder cancer or high-risk nonmuscular invasive bladder cancer. The choice of orthotopic neobladder reconstruction depends on the clinical outcomes of it and should be planned with the patients, especially the risk of incontinence.
this study included 52 Egyptian patients underwent radical cystectomy and orthotopic neobladder reconstruction with sigmoid (25 patients) and ileal (27 patients) segments. Postoperative clinical outcomes between the sigmoid and ileal neobladder groups were compared.
In the present study, 12 intraoperative complications (6 in each group) and 19 postoperative complications (17 in sigmoid and 15 in ileal group) occurred; however, there was no significant difference in the incidence of intraoperative and postoperative complications between both groups. There were no significant differences in the continence status and spontaneous voiding between both groups. There were no significant differences in maximal flow rate and voided volume between both groups. Night voiding frequency in the ileal neobladder patients was significantly smaller than sigmoid neobladder patients. Free flowery showed a significant difference of voiding time and volume in favor of sigmoid neobladder group. Maximum urethral pressure and urethral closing pressure were significantly higher in ileal neobladder group.
Both types of neobladder reconstruction resulted in comparatively satisfactory outcomes; however, the voiding function in sigmoid neobladder group appeared to be more favorable than that in ileal neobladder group.
根治性膀胱切除术加原位尿流改道术被认为是治疗肌层浸润性膀胱癌或高危非肌层浸润性膀胱癌的金标准。原位新膀胱重建的选择取决于其临床结果，并且应该与患者共同规划，尤其是尿失禁的风险。
本研究纳入了52例接受根治性膀胱切除术并采用乙状结肠段（25例）和回肠段（27例）进行原位新膀胱重建的埃及患者。比较了乙状结肠新膀胱组和回肠新膀胱组的术后临床结果。
在本研究中，发生了12例术中并发症（每组6例）和19例术后并发症（乙状结肠组17例，回肠组15例）；然而，两组术中及术后并发症的发生率无显著差异。两组在控尿状态和自主排尿方面无显著差异。两组在最大尿流率和排尿量方面无显著差异。回肠新膀胱患者的夜间排尿频率显著低于乙状结肠新膀胱患者。自由尿流显示排尿时间和尿量有显著差异，有利于乙状结肠新膀胱组。回肠新膀胱组的最大尿道压力和尿道闭合压力显著更高。
两种类型的新膀胱重建均取得了相对满意的结果；然而，乙状结肠新膀胱组的排尿功能似乎比回肠新膀胱组更有利。
