Awad S A, Al-Zahrani H M, Gajewski J B, Bourque-Kehoe A A
Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada.
Br J Urol. 1998 Apr;81(4):569-73. doi: 10.1046/j.1464-410x.1998.00549.x.
To assess the long-term (3-9 years) results of augmentation ileocystoplasty for non-neurogenic female urge incontinence in terms of continence, the need for intermittent self-catheterization and the need for additional or auxiliary treatment, to define the long-term complications and to assess the patients' satisfaction with the outcome.
The study comprised 51 women who underwent augmentation ileocystoplasty for non-neurogenic urge incontinence between November 1987 and December 1993; 27 patients had associated interstitial cystitis. All patients had exhausted conservative methods, with an unsatisfactory outcome. All patients were interviewed about the results of the procedure, and their charts reviewed and updated with relevant information.
Within a mean (range) follow-up of 75.4 (36-109) months, 27 patients (53%) were completely continent, 13 (25%) had occasional leaks and nine (18%) continued to have disabling urge incontinence frequently requiring pads. Regular self-catheterization was needed by 20 (39%) patients while the rest emptied adequately with no or minimal residual volumes. Additional pharmacotherapy had to be used by 12 (24%) patients. Three patients later developed stress urinary incontinence and were managed with fascial sling procedures. The patch was revised in two patients and excised from four others because they had high residual volumes and uncontrollable infections. Two patients had an ileal conduit diversion for persistent incontinence. The most common complication was recurrent urinary tract infections, seen in 22 patients using intermittent self-catheterization. Mucus retention occurred regularly in 10 patients, six had chronic diarrhoea, four had latent bowel obstruction, one developed a bladder stone, one an incisional hernia and one developed patch necrosis and perforation. Twenty-seven patients (53%) were happy with the outcome of the procedure while 20 (39%) were not; four patients were unsure whether a change had occurred.
Augmentation ileocystoplasty is a valuable alternative for women with intractable urge incontinence. However, these patients and their physicians should be aware of its limitations, specifically the possibility that incontinence may persist and the high probability of the need for self-catheterization, with potential subsequent urinary tract infection.
评估回肠膀胱扩大术治疗非神经源性女性急迫性尿失禁的长期（3 - 9年）效果，包括控尿情况、间歇性自我导尿的必要性以及额外或辅助治疗的必要性，明确长期并发症，并评估患者对治疗结果的满意度。
本研究纳入了1987年11月至1993年12月期间接受回肠膀胱扩大术治疗非神经源性急迫性尿失禁的51名女性；27例患者合并间质性膀胱炎。所有患者均已用尽保守治疗方法，但效果不佳。对所有患者进行了关于手术结果的访谈，并查阅其病历，用相关信息进行更新。
平均（范围）随访75.4（36 - 109）个月，27例患者（53%）完全控尿，13例（25%）偶尔漏尿，9例（18%）仍有严重的急迫性尿失禁，频繁需要使用尿垫。20例（39%）患者需要定期自我导尿，其余患者排尿充分，残余尿量无或极少。12例（24%）患者需要额外的药物治疗。3例患者后来出现压力性尿失禁，接受了筋膜吊带手术治疗。2例患者对补片进行了修复，4例患者的补片被切除，因为他们残余尿量高且感染无法控制。2例患者因持续性尿失禁进行了回肠导管改道。最常见的并发症是反复发生的尿路感染，22例使用间歇性自我导尿的患者出现此情况。10例患者经常出现黏液潴留，6例有慢性腹泻，4例有潜在肠梗阻，1例发生膀胱结石，1例发生切口疝，1例出现补片坏死和穿孔。27例患者（53%）对手术结果满意，20例（39%）不满意；4例患者不确定是否有改善。
回肠膀胱扩大术是治疗顽固性急迫性尿失禁女性的一种有价值的选择。然而，这些患者及其医生应意识到其局限性，特别是尿失禁可能持续存在的可能性以及自我导尿的高必要性，以及随之而来的潜在尿路感染。
