Okada E, Iwatsubo E, Takehara T, Tamada K
Nihon Hinyokika Gakkai Zasshi. 1994 May;85(5):785-91. doi: 10.5980/jpnjurol1989.85.785.
A total of 68 ureteroneocystostomies performed between 1980 and 1992 in 63 patients with vesicoureteral reflux (UVR) secondary to neurogenic bladder were reviewed to elucidate factors of postoperative hydronephrosis. Urogram, cystogram, and urodynamics were analyzed, and the cases were classified into two types (areflexia, hyperreflexia) of detrusor muscle response. Occurrence or progression of hydronephrosis was demonstrated in 26 operations (complicated group). Compared with the rest (uncomplicated group), significant difference was not observed concerning proportions of vesical deformity, VUR grades, preoperative hydronephrosis, cystometric types and operative factors. In cases of hyperreflexia maximum vesical volume, maximum vesical pressure or maximum urethral pressure was not different between both groups. However, in those of areflexia maximum vesical volume of the complicated group was significantly smaller than that of the uncomplicated group (290 +/- 35 ml vs. 370 +/- 35 ml, P = 0.03), and the proportion of bladders with compliance less than 10 ml/cmH2O was significantly higher in the complicated group than in the uncomplicated group (P = 0.05) though maximum vesical pressure or maximum urethral pressure was not different. In areflex bladder deformity was observed more in the complicated group than in the uncomplicated group (P = 0.06). Relative inactiveness of detrusor muscle in areflex bladder might render such preoperative findings as vesical deformity, contracted bladder and low compliance more prognosticative of postoperative hydronephrosis than in hyperreflex bladder. During the follow up (6 to 132, mean 42 months) no case showed progression of hydronephrosis or renal deterioration, nor did any case require revisional surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
回顾了1980年至1992年间对63例神经源性膀胱继发膀胱输尿管反流（UVR）患者实施的68例输尿管膀胱吻合术，以阐明术后肾积水的相关因素。分析了尿路造影、膀胱造影和尿动力学检查结果，并将病例分为逼尿肌反应的两种类型（无反射型、反射亢进型）。26例手术（复杂组）出现了肾积水或肾积水进展。与其余病例（非复杂组）相比，在膀胱畸形比例、输尿管膀胱反流分级、术前肾积水、膀胱测压类型和手术因素方面未观察到显著差异。在反射亢进型病例中，两组的最大膀胱容量、最大膀胱压力或最大尿道压力没有差异。然而，在无反射型病例中，复杂组的最大膀胱容量明显小于非复杂组（290±35ml对370±35ml，P = 0.03），尽管最大膀胱压力或最大尿道压力没有差异，但复杂组中顺应性小于10ml/cmH2O的膀胱比例明显高于非复杂组（P = 0.05）。在无反射型膀胱中，复杂组比非复杂组观察到更多的膀胱畸形（P = 0.06）。与反射亢进型膀胱相比，无反射型膀胱逼尿肌相对不活跃可能使膀胱畸形、膀胱挛缩和低顺应性等术前表现对术后肾积水更具预后意义。在随访期间（6至132个月，平均42个月），没有病例出现肾积水进展或肾功能恶化，也没有病例需要再次手术。（摘要截断于250字）
