Orthotopic ileal neobladder reconstruction using a modified Goodwin method: functional outcome in 37 patients

Abstract

小腸を50cm, 回盲弁より20cmの部位で切離する.小腸ループをU字に置く.排尿機能は, 排尿パターン, 尿禁制及びウロダイナミックスタディにて評価した.平均follow-up期間の中央値は17ヵ月(3～64ヵ月).安静時最大新膀胱内圧は6ヵ月で15cm水柱, 12ヵ月で12cm水柱, 24ヵ月で7cm水柱.最大尿道閉鎖内圧は6ヵ月で52cm水柱, 12ヵ月で51.7cm水柱, 24ヵ月で66cm水柱.最大尿流量率は6ヵ月で16.2ml/秒, 12ヵ月で17.6ml/秒, 24ヵ月で20.8ml/秒.新膀胱の最大容量は6ヵ月で300ml, 12ヵ月で302ml, 24ヵ月で382ml.30例の昼夜問わず尿禁制が保たれていた.3例は夜間のみ尿失禁がみられたが, 使用パッド数は1枚であった.4例が日中も尿失禁が認められ, 使用パッド数は, 1日2枚であった.Goodwin法を応用した方法が膀胱全摘術後の回腸新膀胱造設術において, 素晴らしい方法である

Since 1996, we have been using a modified Goodwin technique for orthotopic ileal neobladder replacement. We report on the surgical technique and the voiding function of ileal neobladder in 37 patients. A small bowel segment, 50 cm in length, was resected 20 cm proximal to the ileocecal valve. The small bowel loops were then arranged in a U shape. Vodiing function was evaluated in terms of voiding pattern, continence and urodynamic study. The mean follow-up period was 18 months (range 3 to 64). The mean maximum neobladder pressure in the storage phase was 15 cm water at 6 months, 12 at 12 months, and 7 at 24 months. The mean maximal urethral closed pressure was 52 cm water at 6 months, 51.7 at 12 months, and 66 at 24 months. The mean maximal urinary flow rate was 16.2 ml per second at 6 months, 17.6 at 12 months, and 20.8 at 24 months. The mean maximal neobladder capacity was 300 ml at 6 months, 302 ml at 12 months, 382 ml at 24 months. Among the 37 patients, 30 remained completely dry day and night. Three patients were incontinent only during the nighttime, and required only one pad. Four patients were wet day and night, and required 2 pads daily. Our results indicate that the modified Goodwin method appears to be an excellent technique for ileal neobladder replacement following cystectomy and seems successful in producing balanced voiding dynamics.