An urodynamic study on neobladder function

对8例膀胱癌根治性切除术后新膀胱术患者的尿流动力学进行了分析。1999年，我们计划分析与上尿路损伤发生相关的因素，如肾积水和膀胱输尿管返流。尿流动力学检查包括压力-流率检查和外括约肌肌电检查，同时进行尿路造影术和排尿膀胱尿路造影术作为放射学检查。中位随访2年零5个月，无1例患者排尿困难，无法确定与排尿疗效相关的因素。但有1例残余尿量较大的患者，除直接括约肌损伤和纤维化外，怀疑为盆腔神经损伤，主要表现为尿路括约肌损伤。压力-流量分析结果显示，新膀胱术后排尿效果与新膀胱术的形状、吻合口的位置及灵活性有关。1例患者排尿时无尿路松弛，提示医源性括约肌协同功能障碍。到目前为止，还没有出现上尿路损伤的病例。然而，根据这些发现，我们理解仔细长期随访的重要性，因为上尿路威慑治疗通常是多因素的，进展缓慢。

Eight cases with neobladder after radical cystectomy for bladder cancer were analyzed regarding their urodynamic status. In 1999, we planned to analyze factors which correlated with the occurrence of upper urinary tract damage such as hydronephrasis and vesicoureteral reflux in the follow-up terms. Urodynamics included pressure-flow study and electromyography of the external urethral sphincter, while urography and voiding cystourethrography were also performed as radiological assessments. After a median follow-up of 2 years and 5 months, there are no patients who are unable to void, therefore, we could not identify the factors which relate to the efficacy of micturition. However, one case with large amount of residual urine had both daily and nocturnal incontinence, thus has been suspected of intrapelvic nerve damage which dominates the urinary sphincter other than direct sphincter injury and the fibrosis. As results of pressure-flow analysis, we found it important for voiding efficacy a shape of neobladder, position of urethroileal anastomosis and its flexibility. In 1 case, iatrogenic sphincter dyssynergia was suggested since he showed no urethral relaxation during voiding. There have been no cases with upper urinary tract damage so far. With these findings, however, we empathize the importance of careful long-term follow-up since upper urinary tract deteriration is generally multifactorial and slow to progress.