Cortellini P, Larosa M, Ferretti S, Arena F, Frattini A
Division of Urology, Azienda Ospedaliera di Parma.
Acta Biomed Ateneo Parmense. 1995;66(6):239-42.
We report our experience with orthotopic ileal neobladder, after radical prostatocistectomy for local advanced cancer. We performed 2 reservoirs using Camey's I-II procedure, 4 Studer, 3 Hautmann, 4 VIP and 17 performed using staplers, according to Rouxel-Coadou's technique (we underline the simplicity and speed of automatic stapling devices, very important elements for surgical staff performance in this kind of surgery). Clinical and urodynamic evaluations were performed at 3,6,12,18 months and after every year (mean follow-up 18 months). All patients referred day-time continence already 3 months and 7/10 pts (70%) night-time continence too, after 24 months; the others referred moderate incontinence (1 pad for night). The urethral sphincter was well preserved in all patients (MUCP 72,4 cm H2O). At 18 months, post-void residual volume was absent, basal cystometric pressure was 10-15 cm H2O and mean neobladder capacity was 475 ml. We report 2 cases of reservoir calculosis, 2 stenosis of neobladder-urethral anastomosis and 2 pts with I-II grade hydronephrosis (in first case it's monolateral, the second is a bilateral case) owing to a stenosis of ureteral-ileal anastomosis. In short, the use of debutularizated and bended ileum allows to achieve a low pressure with an adequate capacity and continent orthotopic reservoir.
我们报告了在对局部晚期癌症进行根治性前列腺膀胱切除术后采用原位回肠新膀胱的经验。我们采用卡米氏I-II手术方法制作了2个贮尿囊，4个采用施图德手术，3个采用豪特曼手术，4个采用VIP手术，17个采用吻合器，按照鲁塞尔-科阿杜技术（我们强调自动吻合器的简便性和速度，这对于此类手术中手术人员的操作表现非常重要）。在3、6、12、18个月以及之后每年进行临床和尿动力学评估（平均随访18个月）。所有患者在3个月时均报告白天控尿良好，24个月后7/10的患者（70%）夜间也能控尿；其他患者报告有中度尿失禁（夜间使用1片尿垫）。所有患者的尿道括约肌均保存良好（最大尿道闭合压为72.4 cmH₂O）。在18个月时，排尿后残余尿量消失，基础膀胱测压压力为10 - 15 cmH₂O，新膀胱平均容量为475 ml。我们报告了2例贮尿囊结石病例、2例新膀胱 - 尿道吻合口狭窄以及2例因输尿管 - 回肠吻合口狭窄导致I-II级肾积水的患者（第一例为单侧，第二例为双侧）。简而言之，使用去管状化和弯曲的回肠能够实现低压、具有足够容量且可控的原位贮尿囊。
