Rivas D A, Karasick S, Chancellor M B
Department of Urology, Jefferson Medical College, Philadelphia, PA 19107, USA.
Paraplegia. 1995 Sep;33(9):530-5. doi: 10.1038/sc.1995.114.
The aim of this study was to investigate the efficacy and morbidity of cutaneous ileocystostomy, as an alternative to cystectomy and ileal conduit urinary diversion, for patients with end-stage neurogenic vesical dysfunction. Three male and eight female patients, mean age 41 years (range 28-59), with a mean duration of a neuropathic bladder of 8 years (range 4-17 years) underwent evaluation for ileocystostomy urinary diversion. Indications for the procedure included a bladder capacity < or = 200 ml (10 patients), recurrent febrile urinary tract infection (nine patients), and urinary incontinence despite an indwelling urethral catheter (all eight women). Each was felt to be a poor candidate for, or refused, continent urinary diversion or bladder augmentation cystoplasty. All eight females required concomitant pubovaginal sling urethral compression to eliminate urinary leakage from a patulous, non-functional urethra. Two patients required bilateral ureteral reimplantation for grade III-IV/V reflux. Effective low-pressure urinary stomal drainage was achieved without the need for chronic catheterization in all of the patients with a mean duration of follow-up of 24 months (range 6-60 months). No patient has developed pyelonephritis since the procedure. Urethral urinary leakage was eliminated in all of the female patients, whilst vesicoureteral reflux resolved in those with reflux preoperatively.
本研究的目的是探讨对于终末期神经源性膀胱功能障碍患者，作为膀胱切除术和回肠代膀胱尿流改道的替代方法，皮肤回肠膀胱造口术的疗效和发病率。3例男性和8例女性患者，平均年龄41岁（范围28 - 59岁），神经性膀胱平均病程8年（范围4 - 17年），接受了回肠膀胱造口术尿流改道评估。该手术的指征包括膀胱容量≤200 ml（10例患者）、复发性发热性尿路感染（9例患者）以及尽管留置尿道导管仍存在尿失禁（所有8例女性）。每例患者均被认为是可控性尿流改道或膀胱扩大成形术的不佳候选者或拒绝接受此类手术。所有8例女性均需要同时进行耻骨后阴道吊带尿道压迫术以消除来自扩张、无功能尿道的尿液渗漏。2例患者因III - IV/V级反流需要双侧输尿管再植术。所有患者平均随访24个月（范围6 - 60个月），均实现了有效的低压尿口引流，无需长期置管。自手术以来，无患者发生肾盂肾炎。所有女性患者均消除了尿道尿液渗漏，而术前存在反流的患者其膀胱输尿管反流得到了解决。
