Schultz A, Kristensen J K, Tvermosegaard T
Eur Urol. 1987;13(1-2):128-9. doi: 10.1159/000472751.
Urinary undiversion was performed in a 21-year-old man with a contracted flaccid bladder. The steps of the procedure were: bladder dilatation; antireflux implantation of an ileal conduit into the bladder; external sphincterotomy, and implantation of an artificial urethral sphincter. The patient is continent and has a good bladder capacity and emptying. In many patients with urinary ileal conduit diversion, upper urinary tract and stomal problems develop after some years. In these patients urinary undiversion must be considered but, so far, evaluation showing a high risk of postoperative incontinence has been regarded as a contraindication to urinary undiversion. However, the introduction of artificial urethral sphincters has made it possible to perform undiversion procedures in many of these patients in whom the bladder capacity and bladder emptying is acceptable, if a nonobstructed outlet is secured. We describe the findings and procedures in a patient undergoing urinary undiversion with implantation of an artificial sphincter 8 years after urinary diversion due to neurological disorders caused by a myelomeningocele.
一名21岁膀胱挛缩且松弛的男性接受了尿流改道术。手术步骤如下：膀胱扩张；将回肠导管抗反流植入膀胱；外括约肌切开术，以及植入人工尿道括约肌。患者控尿良好，膀胱容量和排空功能正常。许多接受回肠导管尿流改道的患者在数年后会出现上尿路和造口问题。对于这些患者，必须考虑进行尿流改道术逆转，但到目前为止，评估显示术后尿失禁风险高一直被视为尿流改道术逆转的禁忌症。然而，人工尿道括约肌的引入使得在许多膀胱容量和膀胱排空功能可接受、出口无梗阻的此类患者中进行尿流改道术逆转成为可能。我们描述了一名因脊髓脊膜膨出导致神经功能障碍而在尿流改道8年后接受人工括约肌植入进行尿流改道术逆转患者的检查结果和手术过程。
