Lee K T, Li M K, Cheng W S, Foo K T
Department of Urology, Sultanah Aminah Hospital, Johore Bahru, Johore, Malaysia.
Br J Urol. 1998 May;81(5):705-8. doi: 10.1046/j.1464-410x.1998.00586.x.
To evaluate the impact of the modified ileal neobladder reconstruction on lifestyle, voiding habits and functional outcome in Asian patients.
Twenty-seven Asian patients (25 men and two women, mean age 59 years, range 41-76) underwent modified ileal neobladder reconstruction after radical cystectomy for carcinoma of the bladder. The mean (range) follow-up was 21 (3-75) months. All patients were evaluated retrospectively using case notes, reviews, interviews and voiding charts; 18 patients underwent urodynamic studies.
Twenty-five patients (93%) achieved diurnal and 23 (85%) nocturnal continence within 6 months. Of the 19 patients who were in employment before surgery, 15 continued to be economically active afterward; 26 patients (96%) reported no change in their daily living activities. Of 16 men who reported being potent pre-operatively only four retained some residual erectile function. Twenty-three patients were interviewed about their voiding habits and satisfaction with the outcome of surgery. Fourteen patients had no sensation of reservoir fullness and of the 21 men, 13 had to squat or sit to void effectively. The mean (range) voiding frequency was 5 (4-8) during the day and 2 (0-4) during sleep. Twenty-two patients were satisfied with the overall outcome.
The modified ileal bladder provides a high urinary continence rate with minimal changes in daily living activities and occupational status. The functional outcome was very satisfactory and accepted well, despite some changes in reservoir sensation, voiding posture and erectile function. The method is a viable option for reconstruction after cystectomy in Asian patients.
评估改良回肠新膀胱重建术对亚洲患者生活方式、排尿习惯及功能结局的影响。
27例亚洲患者（25例男性，2例女性，平均年龄59岁，范围41 - 76岁）因膀胱癌行根治性膀胱切除术后接受改良回肠新膀胱重建术。平均（范围）随访时间为21（3 - 75）个月。所有患者均通过病历记录、复查、访谈及排尿图表进行回顾性评估；18例患者接受了尿动力学检查。
25例患者（93%）在6个月内实现日间控尿，23例（85%）实现夜间控尿。术前就业的19例患者中，15例术后仍保持经济活动能力；26例患者（96%）报告日常生活活动无变化。术前报告有性功能的16例男性中，仅4例保留了一些残余勃起功能。对23例患者进行了排尿习惯及手术结局满意度的访谈。14例患者无储尿囊充盈感，21例男性中，13例需蹲或坐才能有效排尿。日间平均（范围）排尿频率为5（4 - 8）次，夜间为2（0 - 4）次。22例患者对总体结局满意。
改良回肠膀胱术具有较高的尿失禁率，对日常生活活动及职业状态影响极小。尽管在储尿囊感觉、排尿姿势及勃起功能方面有一些变化，但功能结局非常令人满意且患者接受度良好。该方法是亚洲患者膀胱切除术后重建的一个可行选择。
