An urodynamic study on neobladder function

本文分析了8例膀胱癌根治性膀胱切除术后新膀胱患者的尿动力学状况。1999年，我们计划在随访中分析与肾积水、膀胱输尿管反流等上尿路损害发生相关的因素。尿动力学包括压力流研究和外尿道括约肌肌电图，同时也进行尿路造影和排尿膀胱尿道造影作为放射学评估。中位随访2年5个月后，没有患者排尿困难，因此，我们无法确定与排尿效果相关的因素。但有1例大量残尿同时出现日尿失禁和夜尿失禁，怀疑除直接损伤和纤维化外，以尿括约肌为主的盆腔内神经损伤。通过压力-流量分析，我们发现新膀胱的形状、尿道-尿道吻合口的位置及其灵活性对排尿效果有重要影响。1例患者排尿时未见尿道松弛，提示医源性括约肌协同障碍。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，我们认识到仔细长期随访的重要性，因为上尿路检测通常是多因素的，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.