脱管腔化しない輸入脚をもつ低圧型回腸代用膀胱を形成した2例

Abstract

膀胱全摘除術後に回腸利用による代用膀胱形成術を施行した2症例について報告した。術後2年経過した現在, 腎機能などの異常は認めないものの自己導尿を施行中である。より自然な代用膀胱の作製のためにはさらなる検討が必要と思われた

We anastomosed the ileal reservoir to the membranous urethra in 2 male bladder cancer patients accepted for total cystectomy. Construction of the reservoir was performed according to Studer et al. (Br J Urol 63: 43-52, 1989). The procedure entails the use of 60 cm of ileal segment. The proximal segment, 15 cm, was left tubular to act as the inflow urinary tract. Anastomosis of the ureters to a tubular afferent ileal limb was carried out by end to side without anti-reflux method. The renal function was not changed by the operation. More than one year after the operation, urodynamic evaluation showed the reservoir to be low pressure with a capacity that increased to more than 400 ml. In both cases, however, about 300 ml residual urine was observed. Now both patients are performing intermittent self-catheterization and are continent night and day. When considering quality of life, this procedure is suitable whenever the urethra can be preserved after total cystectomy. For making a more "natural" bladder substitute, however, some modification of the operative procedure including anti-reflux system may be required.