两端膨大式尿道记忆支架在神经源性排尿障碍的临床应用

Implantation of urethral stent with amphi-oncoides in patients with neurogenic voiding dysfunction

目的制备个体化两端膨大式尿道支架治疗神经源性下尿路功能障碍患者,对其疗效作评估。方法对21例神经源性损伤致下尿路功能性梗阻患者采用个体化两端膨大式尿道支架,经尿道支架置入器植入后尿道(支架置于膀胱颈与尿道外括约肌之间)。对术前、术后的排尿量、剩余尿量、尿动力学指标、肾积水程度、血清肌肝及尿素氮等项指标作比较,评估疗效。结果获得随访的19例中,平均排尿量由234.3ml增至385.4ml,平均剩余尿量由327.3ml降至45.2ml,平均逼尿肌漏尿点压由63.1cmH2O降至32.4cmH2O,最大排尿压由126.0cmH2O降至76.0cmH2O,最大尿流率由6.3ml/s升至16.5ml/s,肾积水程度及血清肾功能指标有改善(P<0.05),未有严重尿失禁及支架移位,1例有结石形成。结论应用个体化两端膨大式尿道记忆支架能减少了尿失禁和支架移位,明显改善患者的排尿功能,减少膀胱剩余尿量,保护患者的肾功能,提高患者的生活质量,是治疗神经源性下尿路功能障碍的一种较好方法。

Objective To introduce an improved implantation for urethral stent with amphi-oncoides in patients with neurogenic voiding dysfunction and to evaluate its curative effect. Methods Totally 21 cases with infrasaeral neurogenic voiding dysfunction were treated by implanting individualized urethral stents with amphi- oneoides. The urethral stent was implanted between the bladder neck and the urethral external sphincter muscle by transurethral operation. The following preoperative parameters were used to evaluate the outcome by comparing with those postoperatively： urinary output, urine residual volume （URV）, urodynamic tests, renal hydronephrosis degree, and blood serum inosine and urea nitrogen. Results In the 19 patients with follow-up, the parameters were improved significantly after operation. The average urinary output volume was increased from 234.3 ml up to 385.4 ml. The average urine residual volume was decreased from 327.3 ml down to 45.2 ml. The average detrusor leak point pressure was decreased from 63.1 cmH2O to 32.4 cmH2O. The average max voiding pressure was declined from 126.0 cmH2O to 76.0 cmH2O. The average Qmax was elevated from 6. 3 ml/s up to 16.5 ml/s. Renal hydronephrosis degree, and blood serum inosine and urea nitrogen were improved significantly （ P 〈 0.05 ）. No case has serious urinary incontinence or stent displacement. Urethral stone was found in one case. Conclusion This procedure is effective in treating neurogenic lower urinary tract dysfunction with no urinary incontinence and stent displacement. It protects the function of upper urinary tract and improves the life quality of those patients.