Chancellor M B, Erhard M J, Strup S, Tammela T L
Department of Urology, Jefferson Medical College, Philadelphia, PA.
Arch Phys Med Rehabil. 1993 Nov;74(11):1222-4.
A small capacity, poorly compliant neurogenic bladder is a difficult problem in spinal cord injured patients. Bladder augmentation with intermittent catheterization offers an alternative to indwelling catheterization. Ileum, cecum, and sigmoid colon have been most commonly used for enterocystoplasty but may, however, cause hyperchloremic metabolic acidosis in patients with impaired renal function. This can be prevented by performing a gastric augmentation. We present two cases of gastrocystoplasty in spinal cord injured patients with a small capacity, poorly compliant neurogenic bladder, impaired renal function, vesicoureteral reflux, and recurrent febrile urinary tract infections. Both patients had bilateral ureteral reimplantations during the surgery. One of the patients, a women, had a destroyed urethral sphincter secondary to long-term Foley that was repaired with a concurrent pubovaginal sling. Follow-up ranges from 12 to 18 months and both patients are continent with intermittent catheterization and have bladder capacities over 500 mL. Neither patient had deterioration in renal function or changes in serum electrolytes. Both patients maintain a slightly acidic urine and neither patient has had a clinically apparent urinary tract infection.
小容量、顺应性差的神经源性膀胱是脊髓损伤患者面临的一个难题。膀胱扩大术联合间歇性导尿为留置导尿提供了一种替代方案。回肠、盲肠和乙状结肠最常用于肠道膀胱扩大术，但对于肾功能受损的患者，可能会导致高氯性代谢性酸中毒。这可以通过进行胃扩大术来预防。我们报告了两例脊髓损伤患者行胃膀胱扩大术的病例，这些患者存在小容量、顺应性差的神经源性膀胱、肾功能受损、膀胱输尿管反流和复发性发热性尿路感染。两名患者在手术期间均进行了双侧输尿管再植术。其中一名患者为女性，长期使用Foley导尿管导致尿道括约肌受损，手术时同时进行耻骨后阴道吊带修复。随访时间为12至18个月，两名患者通过间歇性导尿均能控制排尿，膀胱容量超过500 mL。两名患者的肾功能均未恶化，血清电解质也未发生变化。两名患者的尿液均保持轻度酸性，均未发生临床上明显的尿路感染。
