| Background and ObjectiveThroughout the urinary system,bladder neoplasms are the most common tumors.With the continuous development of China’s industrialization and the rising number of smokers,the incidence of bladder cancer has risen year after year.According to the histological classification of the tumor,bladder tumors can be divided into the following categories:bladder carcinoma、non-epithelial tumor of urinary bladder、miscellaneous tumor、epithelial cell abnormalities、tumor-like lesion,and so on.Bladder epithelial tumors are the most common tumors.Bladder cancer can directly threaten the patient’s life and health.Clinically,the main performance of bladder cancer is mainly painless gross hematuria,or microscopic hematuria.Another common clinical manifestation of bladder cancer is bladder irritation: frequency,urgency,urine pain,which is usually caused by tumor tissue necrosis,ulcers,or concurrent infection,which hints bladder cancer has progressed to the late period.The clinical stage of bladder cancer is TNM staging,which can be subdivided into muscle-invasive bladder cancer and non muscle-invasive bladder cancer.For different stage of bladder cancer,the clinical treatment is also different.For tumors at Ta,T1 stage,transurethral resection of bladder tumor with bladder perfusion chemotherapy is appropriate;For tumors at T2-T4 a,N0-X,M0 stage,radical cystectomy and urinary diversion is the golden standard.There is no unified standard of urinary diversion methods at present.Ileal conduit has been a classic operation because of its simple operation,less postoperative complications.However,postoperative patients need to wear abdominal wall urine collection device,which reduces the quality of life of patients and bring a lot of inconvenience to the patient’s social activities.On the contrary,people who accept orthotopic bladder substitution do not need to wear abdominal wall urine collection device.The new bladder,which is restored in the operation,is respectively anastomosed with ureter and residual urethral.Thus urine is temporarily stored in the new bladder.When a certain capacity is reached,the patient discharges the urine by increasing the abdominal pressure and relaxing the pelvic floor muscles.Because orthotopic bladder surgery can simulate the way of normal urination,many medical centers have adopted orthotopic bladder surgery as a preferred way of urinary diversion.In the clinical work,patients undergoing orthotopic bladder surgery need to take long-term and continuous urodynamic follow-up to observe the functional characteristics of the new bladder.Urodynamics is mainly based on the basic principles and methods of fluid mechanics and electrophysiology to detect the uroflowmetry,pressure of urinary tract and activity of bioelectricity.There are so many different types of orthotopic neobladder that it is particularly important to do urodynamic follow-up of different types of new bladder.In this study,an early continuous urodynamic follow-up was performed on the modified Studer neobladder,investigating the changes of urodynamic characteristics and function in the early stage of the modified Studer neobladder.MethodsThere have been a retrospective analysis of the urodynamic results of bladder cancer by the same surgical group improved Studer ileal bladder surgery and early postoperative(third month,sixth month and twelfth month)regular(at least 2 times)follow-up Urodynamic results of 2014 to 2015 in the Southwest Hospital.A total number of 49 patients were included in the study,of which the average age is(56.7?7.9).There were 33 males and 16 females,and 21 cases completed third times urodynamic examination.All patients underwent preoperative CT urography and bladder tumor biopsy were showed as bladder cancer and tumor clinical stage in T2-T3 b,N0 ~ Nx,M0.The urodynamic data were collected using the DantecM enuet and Duet Urogenics(Danish),including measuring the free urinary flow rate,the filling bladder pressure and the static outflow tract pr essure.Results49 patients(33 males,16 females)regularly finished at least two follow-ups during one year after the operation,among them 21 patients regularly finished three follow-ups.1.Comparing the 3-month、6-month and 12-month follow-up data of urodynamic changes: the maximum bladder capacity(274.0±88.3vs.296.7±91.3vs.350.5±98.0)m L,maximum bladder pressure during filling(31.1±13.9vs.27.8±20.2vs.19.6±12.8)cmH20,bladder capacity when neobladder occurs contraction during filling(139.0±71.0vs.150.5±85.5vs.210.1±76.9)m L,significant difference was found when 12 months were compared with 6 months(P <0.05);but there were no significant differences in the maximum flow rate(9.1±5.1vs.8.5±4.8vs.8.6±5.5)m L/s 、 residual urine content(22.5±53.8vs.36.1±80.0vs.21.0±46.2)m L、maximum urethral closure-pressure(59.8±26.2vs.69.6±42.2vs.71.7±46.7)cmH20 and functional urethral length(31.5±8.5vs.32.1±9.9vs.30.5±9.8)mm at 3 months、6 months and 12 months(P >0.05).2.Male and female postoperative urodynamic follow-up data: statistical analysis showed that the maximum bladder capacity of the new bladder was significantly greater in the postoperative 12-month than 6-month(P <0.05)for male.For female,the new bladder capacity was significantly greater in the postoperative 12-month than 6-month(P <0.05),the maximum bladder pressure in the postoperative 12-month was significantly lower than 3-month(P <0.05).3.Compared with 12-month follow-up data,male maximum urethral closure-pressure(88.6±54.5)cmH20、functional urethral length(34.6±9.5)mm have significant differences from female maximum urethral closure-pressure(49.1±22.3)cm H20、functional urethral length(24.0±6.4mm)(P <0.05).ConclusionsThe modified Studer ileal neobladder,which has a appropriate capacity、low-pressure reservoir and favorable compliance,is a comparatively ideal urinary diversion.Besides,the function of this neobladder is gradually improving. |
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