Watanabe T, Rivas D A, Smith R, Staas W E, Chancellor M B
Department of Urology, Jefferson Medical College, Philadelphia, Pennsylvania, USA.
J Urol. 1996 Dec;156(6):1926-8.
We investigated the changes in sexuality and quality of life that evolve after lower urinary tract reconstruction in neurologically impaired women previously treated with an indwelling urethral catheter.
A total of 18 neurologically impaired women treated with an indwelling urethral catheter underwent bladder reconstruction. Pubovaginal sling urethral compression was required to restore perineal dryness in 13 patients and was the only operation required in conjunction with intermittent catheterization in 3. Eight patients underwent ileocystostomy, that is creation of a "bladder chimney," and 4 underwent augmentation cystoplasty with creation of a continent catheterizable stoma. In 3 patients ileocystoplasty alone with intermittent urethral catheterization was performed. All patients were followed 6 to 40 months (mean 18) after reconstructive surgery using a 9-part questionnaire to score numerically the effect of surgical reconstruction on sexuality and quality of life issues.
On a scale of 0 (worst) to 5 (best) mean score for self-esteem improved from 1 preoperatively to 4 postoperatively, self-image from 1 to 4, sexual desire from 2 to 4 and ability to cope with disability from 1 to 4, respectively. In 4 of the 15 women who were sexually active preoperatively the frequency of sexual intercourse doubled from a mean of 3 to 6 times per month, respectively, and all 4 women reported improved sexual satisfaction. All 13 patients with pelvic pain and 5 with symptoms of autonomic dysreflexia noticed significant improvement if not complete resolution of the symptoms.
Neurogenic lower urinary tract dysfunction treated with an indwelling urethral catheter is detrimental to sexuality and quality of life in neurologically impaired women. Urinary tract reconstruction restores not only quality of life but also sexuality by improving self-image, self-esteem and the ability to cope. Indwelling catheterization as a method of long-term urinary treatment should be avoided in women.
我们研究了既往接受留置尿道导管治疗的神经功能受损女性在进行下尿路重建后性功能和生活质量的变化。
共有18例接受留置尿道导管治疗的神经功能受损女性接受了膀胱重建。13例患者需要行耻骨后阴道吊带尿道压迫术以恢复会阴部干爽，3例患者仅需此手术并结合间歇性导尿。8例患者接受了回肠膀胱造口术，即创建一个“膀胱烟囱”，4例患者接受了扩大膀胱成形术并创建了可控性造口。3例患者仅接受了回肠膀胱成形术并结合间歇性尿道导尿。所有患者在重建手术后随访6至40个月（平均18个月），使用一份9部分的问卷对手术重建对性功能和生活质量问题的影响进行数字评分。
自尊评分从术前的1分（最差）提高到术后的4分（最佳），自我形象评分从1分提高到4分，性欲评分从2分提高到4分，应对残疾能力评分从1分提高到4分，评分范围为0（最差）至5（最佳）。术前有性生活的15名女性中，4名女性的性交频率从平均每月3次增加到6次，翻倍，且所有4名女性均报告性满意度提高。所有13例盆腔疼痛患者和5例自主神经反射异常症状患者的症状即使未完全缓解也有显著改善。
使用留置尿道导管治疗神经源性下尿路功能障碍对神经功能受损女性的性功能和生活质量有害。尿路重建不仅能恢复生活质量，还能通过改善自我形象、自尊和应对能力来恢复性功能。应避免对女性采用留置导尿作为长期尿液治疗方法。
