| Urinary diversion and reconstruction of bladder are important tasks faced with after radical cystectomy on the management of bladder carcinoma. The type of urinary diversion will decide the life quality of patients if there is no recurrence and transference of tumour. Before the 1980's,the ileal conduit was the standard urinary diversion after radical cystectomy. During the last decade the time honored conduit has given way to the ileal neobladder, which has fewer complications and provides the easiest adjustment of patient's life-style. The proportion of patients who undergo cystectomy and receive a neobladder has increased from 50% to 90% at some overseas medical centers. Yet, with relative lagging medical knowledge, a majority of urologists in our country consider subjectively that ileal neobladder is more complex and has more complications. They are more willing to make a ileal conduit so as that the ileal neobladder get no wide development. This study is aim to illustrate the fewer complications and high continence rates and surgical techniques and lessons of ileal neobladder and popularize the ileal neobladder through effect evaluation and experience summarization of 10-year's patients who underwent cystectomy and received a neobladder at theFirst Affiliated Hospital of Medical College of Zhejiang University.CLINIC DATA & METHODWe collected 60 cases who underwent cystectomy and receive a ileal neobladder in the urologic department of the First Affiliated Hospital of Medical College of Zhejiang University from March 1993 to July 2002.We reviewed their clinic data and followed up 56 cases triumphantly (48 males and 8 females) with a mean age of 59.5 years, ranged form 28 to 78 years old at the operative time. Out of 56 cases, 53 were bladder carcinomas, while 2 were cystitis glandularis and I was sigmoid carcinoma which involved the bladder. Surgeries were carried out with retrograde total cystecnomy and W-shape ileal neobladder modified by Cai Songliang et al. The follow approaches include telephone investigation, mailing questonaire and direct examination. All examinations include blood assay,urine assay, renal function, chest film, B ultrasound, IVU, cystography and cystoscopy. 20 patients were evaluated by urodynamics examination, including uroflowmetry, post-void residual urine volume measurement, enterocystometry and resting urethral pressure profilemetry, meanwhile cystourethrography.RESULTSThe median follow-up was 38.8 months(range 10 to 120). Median operative time was 151 minutes. Two perioperative death occurred. Vesicoileal fistula occurred in three patients and one had the neobladder resected one month after operation. One patient had the neobladder and urethra resected five years after operation because of the urethral recurrence. Three repeated operations for strictures of urethra-intestinal anastomosis. One repeated operation for intraperitoneal hernia one month after operation. Two had indirect hernia and one had incisional hernia. Neobladder stones were found in one patient. Left renal carcinoma was found in one patient when followed up. Unilateral slight upper urinary tract dilatation caused by ureteral-intestinal anastomosis were present in four patients, which were proved by IVU. Early and latereoperation rates were 5. 4% and 12. 5%. Thereinto 3. 6% and 3. 6% were related to the neobladder. Daytime and nocturnal continence rates were 96. 16% and 88. 5%. No metabolic and renal functional normalities were found. No ureter reflux was found. Urodynamic examination showed the average maximum pouch capacity was 492. 9ml.The average full resting pressure was 32. lcmH20. The average maximum urethral pressure was 69. 8 cmH20. The average maximum free flow rate was 12ml/s. The average residual volume was 33. 1ml.The urine flow curve showed two types:continual shape and intermittent shape.CONCLUTIONSL. The ileal neobladder is a nice surgery of urinary diversion for those undergo cystectomy, which shall improve the patients' life quality and increase their survival rate.
|
PDF Full Text Request