Malone P R, Stanton S L, Riddle P R
Ann R Coll Surg Engl. 1985 Nov;67(6):349-52.
In the past 8 years at St George's Hospital, 13 women underwent urinary diversion for disabling incontinence. Seven patients had multiple sclerosis, 2 had suffered trauma to the lumbar spine and 4 had failed repeated surgery for urethral sphincter incompetence. One patient died several months postoperatively due to relapse of her multiple sclerosis. The remaining 12 were interviewed to determine the effect of the operation on their quality of life. Preoperatively, 9 patients (75%) were either housebound or only ventured out to do the shopping and none led a full social life. Postoperatively 8 patients (67%) managed a full social life and all were improved. Most managed their stomas proficiently and none regretted having the operation. The most common late complication was pyocystis. We conclude that patients with disabling incontinence can have their quality of life substantially improved by urinary diversion. The incidence of pyocystis is probably high enough to warrant vaginal vesicostomy to be performed routinely at the time of diversion, at least in those women with chronic urinary infection.
在圣乔治医院过去的8年里，13名女性因严重尿失禁接受了尿流改道术。7名患者患有多发性硬化症，2名患者腰椎受过外伤，4名患者因尿道括约肌功能不全接受多次手术均失败。1名患者术后数月因多发性硬化症复发死亡。对其余12名患者进行了访谈，以确定手术对其生活质量的影响。术前，9名患者（75%）足不出户或仅出门购物，没有人过着完整的社交生活。术后，8名患者（67%）过上了完整的社交生活，所有人的情况都有所改善。大多数患者能熟练护理造口，没有人后悔接受手术。最常见的晚期并发症是膀胱积脓。我们得出结论，严重尿失禁患者可通过尿流改道术使生活质量得到显著改善。膀胱积脓的发生率可能高到足以保证在进行尿流改道时常规施行阴道膀胱造瘘术，至少对于那些患有慢性尿路感染的女性患者应如此。
