| Objective:To evaluate the surgical method and postoperative efficacy of laparoscopic cystectomy for contracture of tuberculous bladder with ileal neocystoplasty.Methods:The data of 11 patients with tuberculous bladder contracture admitted to the Department of Urology from February 2014 to August 2020 were retrospectively analyzed.All patients underwent Laparoscopic tuberculous contracture Cystectomy and Augmented Ileocystoplasty.Postoperative follow-up was detailed.Data including maximum bladder volume,single urination interval,hydronephrosis,creatinine value CREA,ureteral reflux grade,quality of life score(SF-36),pain score,urodynamic and video-urodynamic evaluation and postoperative complications were mainly recorded and collected.After the normality test,the paired t test,paired rank sum test and other methods were used for statistical analysis of the target data,and P<0.05 was taken as the difference,and the surgical effect was observed and analyzed.Results:Among the 11 patients with bladder contracture,7(63.64%)were males and 4(36.36%)were females.All patients underwent Laparoscopic tuberculous contracture Cystectomy and Augmented Ileocystoplasty,and 6 patients underwent ureter reimplantation due to grade 4 or greater ureteral reflow before surgery.Follow-up of 6-72 months,6 months follow-up data:the maximum bladder capacity(X Pre-op=31.18 ml,X Post-op=322.27 ml);Single urination time interval(X pre-op=24.9 min,X post-op=169.10 min).The degree of hydronephrosis(X Preop=4.03 cm,X Post-op=1.45 cm).Preoperative serum creatinine CREA values(X Pre-op=135.00 umol/L,X Post-op=123.28 umol/L);Quality of life score SF-36(X Pre-op=36.08 points,X Post-op=89.25 points).Micturition pain score(X Pre-op=33.77 points,X Post-op=60.95 points).The grade of ureteral reflux decreased significantly.Urodynamic examination at the 6th month after the operation showed that 6 of the 11 patients showed low bladder compliance,6 patients showed slightly poor contractible force of new bladder,assisted urination with intra-abdominal pressure during urination,and good performance of other indicators.The maximum follow-up time was 72 months,and no urinary incontinence occurred in all patients after surgery,and the common postoperative complications were urine accompanied by mucous flocculent,which decreased or disappeared with the extension of time.There was no urinary fistula,intraperitoneal or intestinal complications,stone formation or operation-related electrolyte disturbance in all patients except 1 patient who developed incomplete intestinal obstruction 2 weeks after surgery.Statistical analysis showed that bladder volume,time between single urination,hydronephrosis,SF-36 score,pain score and ureteral reflux grade had statistically significant differences before and after operation(P<0.05),while serum creatinine value had no statistically significant differences before and after surgery(P>0.0.5).Conclusion:1.Early diagnosis,timely treatment and control of tuberculosis are of great value in preventing or treating tuberculous contractures of the bladder;2.Laparoscopic tuberculous contracture Cystectomy and Augmented Ileocystoplasty is safe and feasible for the treatment of contractures of the bladder with tuberculosis;3.Severe bladder contracture requires subtotal or partial bladder contracture resection and Ilealcystoplasty;4.Laparoscopic tuberculous contracture Cystectomy and Augmented Ileocystoplasty can significantly increase bladder volume,single urination interval;improve patients’quality of life score;relieve patients’ urination pain,hydronephrosis and ureteral reverse flow;5.The long-term follow-up results of bladder storage function after operation are good;6.Postoperative bladder function evaluation should be combined with clinical symptoms,imaging examination and urodynamic examination;Individual follow-up strategy should be developed for postoperative management of bladder. |
