膀胱全摘除術後の尿路再建 : 自然排尿可能な回腸代用膀胱3例の手術経験

Abstract

We constructed an ileal neobladder in three patients using Hautmann's technique. The patients were men 51 and 67 years old with invasive bladder cancer and a 45-year-old woman with intractable hemorrhagic cystitis induced by cyclophosphamide. The urethral catheter was removed on the 21st postoperative day. At 2 to 5 months following operation, 3 patients had a vesical capacity of 270 to 500 ml and the maximum volume of urine excreted at one voiding was 130 ml to 400 ml. Voiding cystography disclosed no vesico-ureteral reflux. Two patients required abdominal straining at urination and another patient complained of a slight degree of nocturnal incontinence. Intravesical pressure was retained below 10 cm in hydrostatic height in two patients. On the other hand, it gradually increased as the neobladder was extended in another one. No uninhibited contraction was demonstrated by cystometric examination. The serum chloride level indicated almost the maximum normal value in all patients. Neither hydronephrosis nor residual urine was seen on drip infusion pyelography. The postoperative results indicate that the ileal neobladder using Hautmann's technique may become a very useful way to reconstruct the urinary tract.