Hasan S T, Robson W A, Ramsden P D, Essenhigh D M, Neal D E
Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK.
Br J Urol. 1995 May;75(5):592-6. doi: 10.1111/j.1464-410x.1995.tb07414.x.
To determine the clinical, symptomatic and objective urodynamic outcome of patients undergoing endoscopic bladder transection.
The study included 20 men and 30 women (mean age of 50 +/- 15 years, range 20-86) who underwent endoscopic bladder transection. Their underlying diagnoses were idiopathic detrusor instability (41), enuresis with instability (6), multiple sclerosis (2) and Parkinson's disease (1). A full-thickness endoscopic transection of the bladder was performed under general anaesthesia. Subjective assessment was performed using symptom scores (0-14 points) and a Visick grading system (group A-E). Objective assessment was carried out using urodynamic studies. The mean follow-up period was 6 years (57 +/- 22 months, range 6-85).
The mean hospital stay was 8 +/- 3 days (range 3-22). No patients died after the operation. Postoperative complications included extra-peritoneal extravasation (2), recurrent urinary tract infection (5) and urethral stricture (1). Symptom scores before and after the operation were 9 +/- 2 (range 4-14) and 8 +/- 3 (range 1-14) points respectively. The overall outcome of the procedure was satisfactory in only eight (16%) patients. The mean duration of symptomatic relief was 17 weeks (range 3-53). There was no significant difference between urodynamic results before and after the operation. Bladder instability observed in all patients before operating was demonstrated in 93% of patients after the operation.
The results of our study suggests that endoscopic bladder transection produces only a transient symptomatic relief in a few of those patients who have failed to respond to pharmacological manipulations. We do not feel that its continued role is justified.
确定接受内镜下膀胱横断术患者的临床、症状及客观尿动力学结果。
该研究纳入了20名男性和30名女性（平均年龄50±15岁，范围20 - 86岁），他们均接受了内镜下膀胱横断术。其基础诊断包括特发性逼尿肌不稳定（41例）、伴有不稳定的遗尿症（6例）、多发性硬化（2例）和帕金森病（1例）。在全身麻醉下进行膀胱全层内镜横断术。采用症状评分（0 - 14分）和Visick分级系统（A - E组）进行主观评估。通过尿动力学研究进行客观评估。平均随访期为6年（57±22个月，范围6 - 85个月）。
平均住院时间为8±3天（范围3 - 22天）。术后无患者死亡。术后并发症包括腹膜外渗血（2例）、复发性尿路感染（5例）和尿道狭窄（1例）。术前和术后症状评分分别为9±2分（范围4 - 14分）和8±3分（范围1 - 14分）。该手术的总体结果仅在8例（16%）患者中令人满意。症状缓解的平均持续时间为17周（范围3 - 53周）。手术前后尿动力学结果无显著差异。术前所有患者均观察到的膀胱不稳定在术后93%的患者中仍存在。
我们的研究结果表明，内镜下膀胱横断术仅能使少数对药物治疗无反应的患者获得短暂的症状缓解。我们认为其持续应用并不合理。
