Nurse D E, McInerney P D, Thomas P J, Mundy A R
Department of Urology, Guy's Hospital, London, UK.
Br J Urol. 1996 May;77(5):684-7. doi: 10.1046/j.1464-410x.1996.97311.x.
To assess the aetiology of stones which occur in enterocystoplasties and continent diversions, generally attributed to the presence of foreign material, e.g. staples, or to recurrent urinary infection, in patients with augmented or substituted bladders.
The study comprised 467 patients who had undergone reconstruction of the lower urinary tract and had been followed up for at least 3 years using videourodynamics and ultrasonography.
Stones were found in 42 patients (9%); 50% were found incidentally and the remaining patients presented with symptomatic infections (27%) or deterioration in urinary continence (23%). Stones occurred in 6% of patients with augmentation, in 7% of those with substitution cystoplasty and in 22% of patients with continent diversions. Most patients with stones (88%) used clean intermittent self-catheterization (CISC). Stones were 5-10 times commoner in patients using CISC than in patients voiding spontaneously.
Urinary stasis was a more important cause of stone formation than was bacteriuria in patients with cystoplasty. The presence of mucus and bacteriuria are presumed to be contributory. To reduce the risk of stone formation, orthotopic cystoplasty and spontaneous voiding are to be preferred to continent diversion and CISC. Periodic bladder washouts may be an alternative solution.
评估在肠膀胱扩大术和可控性尿流改道中出现结石的病因，这些结石通常归因于异物（如吻合钉）的存在或膀胱扩大或替代术后患者反复发生的泌尿系统感染。
本研究纳入467例接受下尿路重建的患者，采用影像尿动力学和超声检查对其进行了至少3年的随访。
42例患者（9%）发现有结石；50%为偶然发现，其余患者表现为有症状的感染（27%）或尿失禁恶化（23%）。膀胱扩大术患者结石发生率为6%，替代膀胱成形术患者为7%，可控性尿流改道患者为22%。大多数结石患者（88%）采用清洁间歇性自家导尿（CISC）。采用CISC的患者结石发生率比自然排尿患者高5至10倍。
在膀胱成形术患者中，尿潴留是比菌尿更重要的结石形成原因。黏液和菌尿的存在被认为是促成因素。为降低结石形成风险，原位膀胱成形术和自然排尿优于可控性尿流改道和CISC。定期膀胱冲洗可能是一种替代解决方案。
