Kakizaki H, Shibata T, Ameda K, Shinno Y, Nonomura K, Koyanagi T
Department of Urology, Hokkaido University School of Medicine, Sapporo, Japan.
Int J Urol. 1995 Sep;2(4):267-72. doi: 10.1111/j.1442-2042.1995.tb00470.x.
The main objectives of bladder substitution are the preservation of the upper urinary tract and maintenance of urinary continence. Orthotopic bladder substitution makes it possible to achieve urinary continence as well as normal passage of urine through the urethra. Creation of a low pressure reservoir and careful preservation of the distal sphincter mechanism are considered to be of utmost importance for the maintenance of urinary continence after orthotopic bladder substitution. However, sphincter behavior after orthotopic bladder substitution has not been fully elucidated. The purpose of this study was to evaluate the vesicourethral continence mechanism after orthotopic bladder substitution in male patients.
Urodynamic evaluation was performed in 14 male patients after cystoprostatectomy for bladder cancer and an ileocolic neobladder using a cecourethral anastomosis.
Good continence was achieved in 86% (12/14) of the patients during the day and in 79% (11/14) at night. On cystometry, maximum capacity of the neobladders was 434 +/- 21 ml (mean +/- SEM), and basal pressure at maximum capacity was 15.6 +/- 0.9 cm water. Phasic neobladder contraction with amplitudes ranging from 14 to 40 (26.6 +/- 2.7) cm water were noted in 11 of 14 patients. Sphincter electromyography demonstrated an increase in the frequency of action potentials of the external urethral sphincter during neobladder filling from empty to 80% of capacity (from 8.9 +/- 1.6 to 14.6 +/- 2.1 spikes per second; mean percentage increase, 64%, in patients with daytime continence). Maximum urethral closure pressure on urethral pressure profile was 49.9 +/- 3.5 (range, 30 to 64) cm water in patients with daytime continence, while in two patients who were incontinent during the day and at night maximum urethral closure pressure was lower (16 and 24 cm water) and the recruitment of action potentials of the external urethral sphincter during neobladder filling was impaired (percentage increase, 15% and 20%).
An ileocolic neobladder has characteristics of a low pressure reservoir with a satisfactory continence rate. The vesicourethral continence reflex is well preserved in patients with continence after orthotopic bladder substitution.
膀胱替代的主要目标是保护上尿路并维持尿失禁。原位膀胱替代使得实现尿失禁以及尿液通过尿道正常排出成为可能。创建一个低压储尿囊并仔细保留远端括约肌机制被认为对于原位膀胱替代术后维持尿失禁至关重要。然而，原位膀胱替代术后括约肌的行为尚未完全阐明。本研究的目的是评估男性患者原位膀胱替代术后膀胱尿道控尿机制。
对14例因膀胱癌行膀胱前列腺切除术后采用回肠结肠新膀胱并进行盲肠尿道吻合的男性患者进行了尿动力学评估。
86%（12/14）的患者白天控尿良好，79%（11/14）的患者夜间控尿良好。在膀胱测压时，新膀胱的最大容量为434±21 ml（平均值±标准误），最大容量时的基础压力为15.6±0.9 cm水柱。14例患者中有11例记录到新膀胱的相性收缩，幅度为14至40（26.6±2.7）cm水柱。括约肌肌电图显示，在新膀胱从空虚充盈至容量的80%期间，尿道外括约肌动作电位频率增加（从8.9±1.6增加至14.6±2.1次/秒；白天控尿患者的平均增加百分比为64%）。白天控尿患者的尿道压力分布图上最大尿道闭合压力为49.9±3.5（范围为30至64）cm水柱，而白天和夜间均失禁的两名患者最大尿道闭合压力较低（分别为16和24 cm水柱），且新膀胱充盈期间尿道外括约肌动作电位的募集受损（增加百分比分别为15%和20%）。
回肠结肠新膀胱具有低压储尿囊的特征，控尿率令人满意。原位膀胱替代术后控尿的患者膀胱尿道控尿反射保存良好。
