Austin P, Spyropoulos E, Arango H, Fiorica J, Homsy Y, Lockhart J
Department of Surgery, University of South Florida Health Sciences Center and H. Lee Moffitt Cancer and Research Institute, Tampa, USA.
J Urol. 1997 May;157(5):1638-41. doi: 10.1016/s0022-5347(01)64817-1.
On a long-term basis patients with continent urinary diversions may have an acceptable number of complications, such as urinary incontinence. We report on a new surgical technique for treatment of the incompetent anti-incontinence segment.
Seven patients presented with a large capacity, low pressure reservoir and an incompetent anti-incontinence mechanism. The original anti-incontinence mechanism consisted of an intussuscepted reimplanted appendix (Mitrofanoff) in 2 patients, tapered ileum and reinforced ileocecal valve in 3, and tapered and reimplanted ileal segment in 2. Surgical reconstruction involved 2 stages: stage 1 - lengthening and tubularizing the cecum with the anti-incontinence segment and stage 2 - creation of the flap valve mechanism. Stage 2 required intraoperative modification when abundant peri-reservoir fibrosis, a thin-walled reservoir (cecal wrap) or an excessive thickened mesentery was encountered.
After a mean followup of 7 months 6 of 7 patients performed catheterization every 4 hours and were continent. Several patients required a concomitant procedure with the incontinence revision.
We describe a 2-stage technique for correction of a variety of untoward anatomical conditions related to a failed anti-incontinence segment with continent urinary reservoirs. Concomitant repair of other coexisting structural abnormalities related to the continent reservoir may also be necessary.
从长期来看，可控性尿流改道患者可能会出现可接受数量的并发症，如尿失禁。我们报告一种治疗抗失禁段功能不全的新手术技术。
7例患者存在大容量、低压储尿囊及抗失禁机制功能不全。原抗失禁机制包括2例患者采用套叠式再植阑尾（米氏法），3例采用锥形回肠和加强的回盲瓣，2例采用锥形并再植回肠段。手术重建分两个阶段：第一阶段——将盲肠与抗失禁段延长并管状化，第二阶段——构建瓣阀机制。当遇到储尿囊周围大量纤维化、薄壁储尿囊（盲肠包裹）或肠系膜过度增厚时，第二阶段需要在术中进行调整。
平均随访7个月后，7例患者中有6例每4小时进行一次导尿且保持控尿。部分患者在进行尿失禁修复时需要同时进行其他手术。
我们描述了一种两阶段技术，用于纠正与可控性尿储器抗失禁段功能失败相关的各种不良解剖状况。可能还需要同时修复与可控性储尿囊相关的其他并存结构异常。
