膀胱全摘出術後の新しい尿路再建術 : Colon Bladder Replacementの経験

Abstract

7例の膀胱癌患者と, 1例の直腸癌患者に尿路再建術としてColon bladder replacementを行った.1)全例, 尿道からの排尿が可能であるが, 1例のみself catheterizationが必要であった.2)尿流量測定では, 平均最大尿流量は16 ml/secと良好で, 残尿は認められなかった.3) 8例中5例は完全な尿禁制を得たが, 3例には週1～2回の軽度の夜間遺尿があった.4)全例, VURや上部尿路の拡張などの異常所見を認めなかった

Although ileal conduit diversion is widely accepted in the treatment of the patients undergoing radical cystectomy, many patients would prefer other alternatives which allow continence. and urination through the urethra. We describe a new procedure in which a segment of detuburalized right colon is used as a continent reservoir. Eight patients, 7 after radical cystectomy for bladder cancer and one after total exenteration for rectal cancer, have undergone colon bladder replacement. New created bladder had a capacity of 300 to 600 ml. All patients could pass urine through the urethra but one is on self-catheterization. Five of the 8 patients had no residual urine. Three months after operations 4 were totally continent and 3 were satisfactorily dry during daytime but slightly enuretic. Excretory urography showed no abnormalities in their upper urinary tract. Considering the "quality of life' of a patient, this procedure can be an ideal option for selected patients.