Han Jang Hee, Yuk Hyeong Dong, Choi Jin Woo, Ku Ja Hyeon
Department of Urology, Seoul National University Hospital, Seoul, South Korea.
Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.
Front Surg. 2022 Apr 27;9:844588. doi: 10.3389/fsurg.2022.844588. eCollection 2022.
To show the effective and successful technical approach of percutaneous embolization for persistent urine leakage that occurred after orthotopic neobladder formation.
We retrospectively reviewed patients who underwent percutaneous embolization of N-butyl cyanoacrylate (NBCA) and lipiodol mixture after orthotopic neobladder formation at the Seoul National University Hospital (Seoul, Korea) from 1 January 2018 to 31 December 2020.
Among total of 182 patients of neobladder formation, five patients (four males and one female) were enrolled in this study, and their median age was 61.0 years (interquartile range (IQR): 42.5-69.5 years). All the patients showed persistent urine leakage at the neobladder-urethral anastomosis site and percutaneous drainage was primarily performed. The median time to perform percutaneous embolization was 40 days (IQR: 31.5-71.5 days) postoperatively. Elective two-staged embolization was performed in three cases for large diameter with a large fluid-filled cavity, while re-embolization was needed for delayed recurrence of urine leakage in two cases. Complete resolution of urine leakage was seen in all the cases and the median time to leakage closure was 55 days (IQR: 27.5-82.5 days). The median follow-up period after leakage closure was 26 months (IQR: 15.5-36.4 months), and embolization material-related bladder stone was a noticeable complication (two cases) during follow-up, which was removed endoscopically within 1 year after embolization. All patients' quality of life (EQ-5D-5L score) was well-maintained during the entire period.
Persistent urine leakage after neobladder formation can be effectively managed with percutaneous embolization of "dumbbell technique" by reinforcing the closure of leakage tract from inner opening to the outer opening even for large diameter (>1 cm).
展示经皮栓塞术治疗原位新膀胱形成术后持续性尿漏的有效且成功的技术方法。
我们回顾性分析了2018年1月1日至2020年12月31日在韩国首尔国立大学医院接受原位新膀胱形成术后经皮注射氰基丙烯酸正丁酯（NBCA）与碘油混合物栓塞治疗的患者。
在总共182例新膀胱形成患者中，5例（4例男性，1例女性）纳入本研究，他们的中位年龄为61.0岁（四分位间距（IQR）：42.5 - 69.5岁）。所有患者在新膀胱 - 尿道吻合口处均出现持续性尿漏，并首先进行了经皮引流。经皮栓塞术的中位实施时间为术后40天（IQR：31.5 - 71.5天）。3例因漏口直径大且有大的液性腔隙而进行了择期两阶段栓塞，2例因尿漏延迟复发需要再次栓塞。所有病例的尿漏均完全解决，漏口闭合的中位时间为55天（IQR：27.5 - 82.5天）。漏口闭合后的中位随访期为26个月（IQR：15.5 - 36.4个月），随访期间栓塞材料相关的膀胱结石是一个明显的并发症（2例），在栓塞后1年内通过内镜取出。所有患者的生活质量（EQ - 5D - 5L评分）在整个期间均保持良好。
原位新膀胱形成术后的持续性尿漏，即使对于直径较大（>1 cm）的漏口，通过“哑铃技术”经皮栓塞加强从内口到外口的漏道闭合，也能得到有效处理。
