Ochi Atsuhiko, Aikawa Koichi, Kimura Natsuo, Abe Hirokazu
Department of Urology, Kameda Medical Center, Chiba, Japan.
Department of Urology, Jikei University School of Medical, Tokyo, Japan.
J Endourol Case Rep. 2020 Dec 29;6(4):291-296. doi: 10.1089/cren.2020.0030. eCollection 2020.
Cutaneous vesicostomy is a urinary diversion for chronic urinary retention caused by neurogenic bladder. In this procedure, urine is drained directly from the bladder into a pouch attached to the lower abdomen, where the use of a catheter is unnecessary. Although complications of this procedure have been described, such as stoma stenosis, bladder prolapse, bladder calculi, and peristomal dermatitis, it is useful for patients who have difficulty with permanent bladder catheterization. The laparoscopy-assisted technique for cutaneous vesicostomy has not been described in the existing literature. In this report, we describe the case of an adult patient with chronic urinary retention caused by a neurogenic bladder who underwent laparoscopy-assisted cutaneous vesicostomy. A 61-year-old man with intellectual disability was referred to our department because of macroscopic hematuria and urinary retention. Abdominal ultrasonography and computed tomography images showed excessive bladder dilation and bilateral hydronephrosis. A left kidney tumor was found incidentally. We diagnosed left renal carcinoma and chronic urinary retention caused by a neurogenic bladder. We suspected that the hematuria resulted from the renal cancer or from mucosal or submucosal vessel injury caused by excessive dilation of the bladder. Because of the patient's intellectual disability, self-intermittent catheterization or management of a urethral catheter was not possible. Therefore, we performed left radical nephrectomy laparoscopically followed by laparoscopy-assisted cutaneous vesicostomy under general anesthesia. By using laparoscopy, we could construct the vesicostomy in the bladder dome with less tension, and no stomal complications had occurred at 7 months postoperatively. Laparoscopy-assisted cutaneous vesicostomy was a safe and feasible surgical technique in our adult patient with chronic urinary retention. This procedure may be considered effective for patients having difficulty with permanent urinary catheterization.
皮肤膀胱造口术是一种用于治疗神经源性膀胱引起的慢性尿潴留的尿液改流方法。在该手术中，尿液直接从膀胱引流至连接在下腹部的一个尿袋，无需使用导尿管。尽管该手术的并发症已被描述，如造口狭窄、膀胱脱垂、膀胱结石和造口周围皮炎，但对于永久性膀胱导尿困难的患者而言是有用的。现有文献中尚未描述腹腔镜辅助下皮肤膀胱造口术。在本报告中，我们描述了一例因神经源性膀胱导致慢性尿潴留的成年患者接受腹腔镜辅助皮肤膀胱造口术的病例。一名61岁的智障男性因肉眼血尿和尿潴留转诊至我科。腹部超声和计算机断层扫描图像显示膀胱过度扩张和双侧肾积水。偶然发现左肾肿瘤。我们诊断为左肾癌和神经源性膀胱引起的慢性尿潴留。我们怀疑血尿是由肾癌或膀胱过度扩张引起的黏膜或黏膜下血管损伤所致。由于患者存在智力障碍，无法进行自我间歇性导尿或管理尿道导尿管。因此，我们在全身麻醉下先进行了腹腔镜下左根治性肾切除术，随后进行了腹腔镜辅助皮肤膀胱造口术。通过使用腹腔镜，我们能够在膀胱顶部以较小的张力构建膀胱造口，术后7个月未发生造口并发症。腹腔镜辅助皮肤膀胱造口术在我们这位患有慢性尿潴留的成年患者中是一种安全可行的手术技术。对于永久性导尿困难的患者，该手术可能被认为是有效的。
