Two types of micturitions of ileal neobladder

Abstract

回腸新膀胱による禁制型尿路変向術を再発性表在性膀胱腫瘍8例に被膜下前立腺摘出下膀胱摘出後に施行し, 術後の排尿状態を検討した.患者は平均55.3歳, サントリニー静脈叢を結紮切除せず順行性に膀胱を切除後, 前立腺は膀胱頸部より2cm末梢側で切除し被膜下前立腺摘出した.1例で代用膀胱と尿道の間に3cmの腸管部分を残し, その蠕動運動のため排尿が著明に遷延し, 再手術を要した.他7名は脱管腔化した新膀胱を直接前立腺被膜に縫合し, 排尿は良好であった.内圧-尿流検査を7名に施行し, fast bladderとintermittent flowが見られ, 後者は排尿筋・括約筋協調不全様所見がみられた

Eight patients were evaluated clinically, radiologically, and urodynamically to determine the outcome of continent urinary diversion with ileal neobladder performed to treat the recurrent superficial bladder cancer after cystectomy with subcapsular prostatectomy. The mean age of the patients was 55.3 years. After descending dissection of the urinary bladder without ligation or dissection of Santorini's plexus, the prostate was cut to the bladder neck distally for 2 cm under the subcapular prostatectomy. One patient who had a short 3 cm intestinal segment between the pouch and the urethra, had severely prolonged micturition with peristalsis in this short segment, and required a re-operation. Micturition was good in the other seven patients, all with detubularized neobladder directly to the prostate capsule in anastomosis. Pressure flow studies performed on these seven patients revealed two types of micturition; "fast bladder" and "intermittent flow", the latter resembling detrusor sphincter dyssynergia.