Light J K, Flores F N, Scott F B
J Urol. 1983 Mar;129(3):548-51. doi: 10.1016/s0022-5347(17)52231-4.
Reconstruction of the urinary tract after diversion has been successful in patients with normal innervation of the lower tracts. However, the possibility of urinary incontinence after such major surgical procedures has dissuaded many surgeons from attempting urinary undiversion in patients in whom the continence status cannot be determined accurately before the operation or who were known to be incontinent before the original diversion. For this reason, the presence of neuropathic bladder dysfunction has been considered a relative contraindication to urinary undiversion unless it can be established preoperatively that the patient will obtain urinary continence. Eight patients are reported who had successful outcome with the use of the AS792 artificial urinary sphincter to control incontinence after urinary undiversion. Because of this successful experience it is now believed that patients with neuropathic bladder dysfunction or anatomically abnormal lower tracts are no longer precluded from urinary undiversion. A variety of methods has been used to reconstruct the urinary tract, including total reconstruction of the bladder and urethra with the sigmoid colon in 1 case. In the latter case the artificial sphincter was placed around the bowel segment to provide continence. The use of the artificial sphincter around a bowel segment offers many possibilities for reconstructive procedures involving bowel in the future.
对于下尿路神经支配正常的患者，改道后尿路重建已取得成功。然而，此类大型外科手术后出现尿失禁的可能性，使得许多外科医生不愿在术前无法准确确定控尿状态或已知在初次改道前就存在尿失禁的患者中尝试恢复尿路正常通道。因此，神经性膀胱功能障碍一直被视为尿路恢复正常通道的相对禁忌证，除非术前能确定患者可实现尿控。本文报告了8例患者，他们在尿路恢复正常通道后使用AS792人工尿道括约肌控制尿失禁取得了成功。鉴于这一成功经验，现在认为神经性膀胱功能障碍或下尿路解剖结构异常的患者不再被排除在尿路恢复正常通道手术之外。已采用多种方法重建尿路，其中1例采用乙状结肠对膀胱和尿道进行了完全重建。在后一例中，人工括约肌置于肠段周围以实现控尿。在肠段周围使用人工括约肌为未来涉及肠道的重建手术提供了许多可能性。
