N'Dow J, Leung H Y, Marshall C, Neal D E
Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom.
J Urol. 1998 May;159(5):1470-4; discussion 1474-5. doi: 10.1097/00005392-199805000-00015.
Bowel function may be disturbed after intestinal segments are used in urinary reconstruction. The etiology of this condition and its incidence in different patient groups is unclear. We studied the incidence of bowel disturbance in patients who underwent bladder replacement, continent diversion, enterocystoplasty for idiopathic detrusor instability and ileal conduit diversion.
We evaluated 71 patients after ileal conduit diversion and 82 after bladder reconstruction, including clam enterocystoplasty for detrusor instability in 28, neurogenic bladder dysfunction in 26 and nonneuropathic conditions in 28. We noted the severity of symptoms, such as frequency of defecation, nocturnal diarrhea, flatus leakage, fecal urgency, fecal incontinence and explosive diarrhea, as well as quality of life.
Of the patients who underwent bladder reconstruction 24% had symptoms of bowel dysfunction preoperatively and 42% of those who were asymptomatic preoperatively described new bowel symptoms postoperatively. These symptoms were most common and severe in 54% of patients after clam enterocystoplasty for detrusor instability compared to 26% with neuropathy, 14% with a nonneuropathic condition and 15% with an ileal conduit. Compared to those in other groups patients who underwent enterocystoplasty for detrusor instability had a significantly higher incidence of nocturnal bowel movements (18 versus less than 4%, p <0.01), flatus leakage (29 versus less than 8%, p <0.01), fecal urgency (39 versus less than 12%, p <0.001) and fecal incontinence (32 versus less than 16%, p <0.001). The length of ileum used for clam enterocystoplasty was only slightly greater than that used for ileal conduit operations (25 versus 18 cm.). Of the patients who underwent enterocystoplasty for detrusor instability 29% regretted undergoing the procedure due to subsequent bowel symptoms.
After enterocystoplasty for detrusor instability patients are at risk of significant bowel symptoms. The development of new bowel symptoms was associated with poor patient satisfaction.
在尿路重建中使用肠段后，肠道功能可能会受到干扰。这种情况的病因及其在不同患者群体中的发生率尚不清楚。我们研究了接受膀胱替代、可控性尿流改道、针对特发性逼尿肌不稳定的肠膀胱扩大术和回肠膀胱术的患者中肠道功能紊乱的发生率。
我们评估了71例行回肠膀胱术的患者和82例行膀胱重建术的患者，其中包括28例行针对逼尿肌不稳定的夹心法肠膀胱扩大术、26例行神经源性膀胱功能障碍手术以及28例行非神经病变手术的患者。我们记录了症状的严重程度，如排便频率、夜间腹泻、排气泄漏、排便紧迫感、大便失禁和暴发性腹泻，以及生活质量。
在接受膀胱重建术的患者中，24%术前有肠道功能障碍症状，术前无症状的患者中有42%术后出现了新的肠道症状。与26%的神经病变患者、14%的非神经病变患者和15%的回肠膀胱术患者相比，这些症状在54%接受针对逼尿肌不稳定的夹心法肠膀胱扩大术的患者中最为常见和严重。与其他组相比，接受针对逼尿肌不稳定的肠膀胱扩大术的患者夜间排便发生率显著更高（18%对低于4%，p<0.01）、排气泄漏发生率显著更高（29%对低于8%，p<0.01）、排便紧迫感发生率显著更高（39%对低于12%，p<0.001）以及大便失禁发生率显著更高（32%对低于16%，p<0.001）。用于夹心法肠膀胱扩大术的回肠长度仅略长于用于回肠膀胱术的回肠长度（25厘米对18厘米）。在接受针对逼尿肌不稳定的肠膀胱扩大术的患者中，29%因随后出现的肠道症状而后悔接受该手术。
在接受针对逼尿肌不稳定的肠膀胱扩大术后，患者有出现严重肠道症状的风险。新肠道症状的出现与患者满意度低有关。
