Boyd S D, Esrig D, Stein J P, Freeman J A, Skinner D G
Department of Urology, University of Southern California, Los Angeles.
J Urol. 1994 Aug;152(2 Pt 1):334-7. doi: 10.1016/s0022-5347(17)32733-7.
This report discusses the feasibility and functional outcome of conversion to an orthotopic Kock neobladder in 11 men (average age 58 years) who underwent cystoprostatectomy and cutaneous urinary diversion an average of 7.3 years previously are discussed. Cystectomy had been performed for bladder cancer in 9 men and for multiple failed bladder reconstructions in 2. No patient had any evidence of recurrent cancer. The reasons for conversion to a Kock neobladder included complications with the current form of diversion (stomal stenosis, leakage and so forth) and dislike of a cutaneous stoma. Average followup since neobladder conversion was 36 months. The exactness of the anastomosis to the urethra and the presence of a retained apex of the prostate were major factors in the technical success of the operation, degree of continence and satisfaction of the patients. All 4 patients who had some portion of retained prostate enjoy excellent continence without anastomotic stricture. In 2 of the early undiversion patients with direct membranous urethral anastomoses anastomotic strictures occurred and they subsequently chose to resume continent cutaneous diversion. The other 5 patients with anastomoses to the membranous urethral stump did well but 2 required an artificial urinary sphincter for continence. These latter 5 patients had more extensive pelvic mobilization of the urethra for more exact anastomoses. The satisfaction level of all 9 continuing neobladder patients, even if an artificial urinary sphincter was necessary, has been exceptional.
本报告讨论了11名男性（平均年龄58岁）转为原位Kock新膀胱的可行性和功能结果，这些男性平均在7.3年前接受了膀胱前列腺切除术和皮肤尿流改道术。9名男性因膀胱癌接受了膀胱切除术，2名因多次膀胱重建失败接受了该手术。没有患者有复发性癌症的证据。转为Kock新膀胱的原因包括当前尿流改道形式的并发症（造口狭窄、渗漏等）以及对皮肤造口的厌恶。自新膀胱转换后的平均随访时间为36个月。与尿道吻合的精确性和前列腺尖部的保留情况是手术技术成功、患者控尿程度和满意度的主要因素。所有4名保留了部分前列腺的患者控尿良好，无吻合口狭窄。在2例早期未改道且直接进行膜部尿道吻合的患者中出现了吻合口狭窄，他们随后选择恢复可控性皮肤尿流改道。其他5例与膜部尿道残端吻合的患者情况良好，但有2例需要人工尿道括约肌来实现控尿。后5例患者为了更精确的吻合对尿道进行了更广泛的盆腔游离。所有9名保留新膀胱的患者，即使需要人工尿道括约肌，满意度都很高。
