神経因性膀胱に対する改良型回腸開放弁膀胱固定術による排泄機能改善に関する研究

Abstract

Between 1978 and 1985, 72 patients with urinary and defecatory dysfunction due to neurogenic bladder associated with myelodysplasia (57), spinal cord injury (11), and other causes (4) were treated with modified sero-muscular ileal flap fixation to the bladder (modified IFFB). They were followed from 1 to 88 months (mean: 36.3 months). This operative procedure was attempted to recover urinary and defecatory function. Sixty-four patients underwent urodynamic studies before and after the modified IFFB. On urodynamic evaluation, bladder capacity was not decreased, voiding time was diminished, and average urine flow rate was significantly improved after the modified IFFB. Patients who were followed at least 6 months after the modified IFFB showed the following results. Urinary substitute sensation appeared in 57 out of 59 patients (96.6%) and fecal substitute sensation in 34 (57.6%). Urinary incontinence improved in 38 out of 42 patients (90.5%), disappearing completely in 19 (45.2%). Constipation improved in 26 of 59 patients (44.1%). The upper urinary tract improved in 22 renal units, remained unchanged in 90 renal units, and deteriorated in 6 of the 118 renal units. Operative complications were encountered in 6 out of 72 patients (8.3%). The modified IFFB procedure does not appear to be suitable for the low compliance bladders with high grade VUR or for young women who desire pregnancy in the future.