Shen Jim K, Chan Kevin G, Warner Jonathan N
Department of Surgery, Division of Urology and Urologic Oncology, City of Hope National Medical Center, Duarte, California, USA.
Can J Urol. 2020 Feb;27(1):10093-10098.
To assess the use, complications, and outcomes of continent cutaneous ileocecal cystoplasty (CCIC) for the management of refractory bladder neck contractures and/or urinary incontinence after prostate cancer therapy.
An institutional review board approved database was reviewed for patients who underwent CCIC from January 1, 2003 to December 31, 2018. Preoperative, perioperative and postoperative factors were assessed, including complications and outcomes.
Thirteen patients were identified. Indications for CCIC included refractory bladder neck contracture (n = 3), urinary incontinence (n = 5), or both (n = 5). Median age was 69. Median follow up was 78.1 months. Seventy-seven percent of patients (10/13) had a history of radiation. The median number of procedures between initial prostate treatment and augmentation was 3. Sixty-nine percent (9/13) of patients had a bladder neck closure along with augmentation (5 transabdominal and 4 transperineal). Median operative time was 375 minutes. Median blood loss was 175 mL. The overall complication rate was 69% (9/13), with 38% (5/13) occurring within 30 days. One patient (8%) required stomal revision. Thirty-three percent (3/9) of patients with bladder neck closure required revision due to perineal fistula. All had a history of radiation therapy. At last follow up all patients were satisfied with their urinary control. Eighty-five percent of patients (11/13) were fully continent via both urethra and stoma. One patient had urethral leakage with bladder spasms controlled with medication and one had mild stomal incontinence.
CCIC is an effective means of treating refractory bladder neck contractures and/or urinary incontinence. While morbidity rates are high, subjective patient satisfaction is high.
评估可控性回肠膀胱扩大术（CCIC）在治疗前列腺癌治疗后难治性膀胱颈挛缩和/或尿失禁中的应用、并发症及疗效。
回顾了机构审查委员会批准的数据库中2003年1月1日至2018年12月31日期间接受CCIC手术的患者。评估术前、围手术期和术后因素，包括并发症和疗效。
共确定13例患者。CCIC的适应症包括难治性膀胱颈挛缩（n = 3）、尿失禁（n = 5）或两者皆有（n = 5）。中位年龄为69岁。中位随访时间为78.1个月。77%（10/13）的患者有放疗史。从最初的前列腺治疗到膀胱扩大术之间的手术次数中位数为3次。69%（9/13）的患者在膀胱扩大术同时进行了膀胱颈关闭术（5例经腹，4例经会阴）。中位手术时间为375分钟。中位失血量为175毫升。总体并发症发生率为69%（9/13），其中38%（5/13）发生在30天内。1例患者（8%）需要进行造口修复。因会阴瘘进行膀胱颈关闭术的患者中有33%（3/9）需要修复。所有患者均有放疗史。在最后一次随访时，所有患者对其尿控情况均满意。85%（11/13）的患者通过尿道和造口均能完全控制排尿。1例患者出现尿道漏，膀胱痉挛通过药物控制，1例患者有轻度造口失禁。
CCIC是治疗难治性膀胱颈挛缩和/或尿失禁的有效方法。虽然发病率较高，但患者主观满意度较高。
