Department of Urology and Pediatric Urology, University Hospital of Muenster, Albert Schweitzer Campus 1, 48149, Muenster, Germany.
Department of Neurourology, Marienhospital Herne, Herne, Germany.
Int Urogynecol J. 2022 May;33(5):1267-1272. doi: 10.1007/s00192-022-05110-y. Epub 2022 Mar 1.
This study analyzes the long-term results of supratrigonal cystectomy and augmentation cystoplasty in patients with severe ulcerative interstitial cystitis/bladder pain syndrome (IC/BPS) and reduced bladder capacity.
Outcome data were retrospectively and prospectively collected and analyzed in women who underwent supratrigonal cystectomy and augmentation cystoplasty for ulcerative IC/BPS at Muenster University Hospital between 1991 and 2006. We used cross-tabulation and Pearson's Chi-squared test to examine how outcome is influenced by age, preoperative functional bladder volume, and choice of augmentation material.
After a median 171-month follow-up, analysis could be done in 26 of 27 patients. Persistent pain necessitated early revision in 2 patients (7.7%). Mean postoperative O'Leary Sant IC Score was 12.7 in the prospectively questioned patients. Responses to Patient Global Impression of Improvement (PGI-I) were: "very much better" in 15 cases (65.2%) and "much better" in 7 (30.4%). Twelve patients (52.2%) emptied their augmented bladder voluntarily, whereas 7 (32%) needed intermittent self-catheterization (ISC). The rate of patients requiring ISC tended to be lower when detubularized ileocecal bowel was used. All 5 patients (19.2%) with late relapse of ulcerative IC/BPS needed ISC.
Severe ulcerative IC/BPS can be curatively treated in some patients by supratrigonal cystectomy and augmentation, which is associated with a high satisfaction rate and few long-term complications even over a very long follow-up. In our analysis, the need for ISC is a risk factor for late relapse, although ileocecal augmentation could increase the proportion of patients with sufficient voluntary micturition.
本研究分析了严重溃疡性间质性膀胱炎/膀胱疼痛综合征（IC/BPS）和膀胱容量减少患者行上尿路憩室切除术和膀胱扩大术的长期结果。
回顾性和前瞻性收集了 1991 年至 2006 年间在明斯特大学医院因溃疡性 IC/BPS 而行上尿路憩室切除术和膀胱扩大术的女性患者的结果数据，并进行了分析。我们使用交叉表和 Pearson χ2 检验来检查年龄、术前功能性膀胱容量和增强材料选择如何影响结果。
在中位数为 171 个月的随访后，对 27 例患者中的 26 例进行了分析。2 例（7.7%）因持续性疼痛需要早期翻修。前瞻性询问的患者术后平均 O'Leary Sant IC 评分为 12.7。患者整体印象改善（PGI-I）的反应为：15 例（65.2%）为“非常好”，7 例（30.4%）为“好”。12 例（52.2%）患者能自主排空扩大的膀胱，而 7 例（32%）需要间歇性自我导尿（ISC）。当使用去管化回盲肠时，ISC 的需要率较低。所有 5 例（19.2%）晚期复发溃疡性 IC/BPS 的患者均需要 ISC。
上尿路憩室切除术和膀胱扩大术可治愈一些严重溃疡性 IC/BPS 患者，即使随访时间非常长，也有很高的满意度和很少的长期并发症。在我们的分析中，ISC 的需要是晚期复发的一个风险因素，尽管回盲肠增强可以增加有足够自主排尿能力的患者比例。
