原位新膀胱术后新膀胱尿道吻合口狭窄的诊断和治疗

Diagnosis and treatment of neovesical-urethral anastomotic stricture after orthotopic neobladder substitute

目的探讨根治性膀胱切除原位新膀胱术后新膀胱尿道吻合口狭窄的诊断和治疗效果。方法回顾性分析416例男性膀胱尿路上皮癌行根治性膀胱切除原位新膀胱术患者的临床资料,分析新膀胱尿道吻合口狭窄的发生率及其诊断和治疗。结果本组共15例(3.6%)发生新膀胱尿道吻合口狭窄,Ⅰ级狭窄(17F^22F)5例,Ⅱ级狭窄(<17F)8例,Ⅲ级狭窄(针尖)2例。9例表现为排尿困难,3例表现为尿潴留,2例表现为泌尿系感染,1例表现为初发的充盈性尿失禁。7例初始行尿道探子或尿道镜扩张,其中2例无效改行经尿道狭窄钬激光或冷刀切开术,均恢复排尿通畅;3例初始即行经尿道狭窄钬激光或冷刀切开术,均恢复正常排尿;5例初始行单次或多次经尿道瘢痕切除术,4例能排空新膀胱,1例无效行新膀胱腹壁造瘘术。所有患者治疗后均定期随访,平均随访56个月,14例完全排空新膀胱,无患者出现新发的尿失禁。结论原位新膀胱术后新膀胱尿道吻合口狭窄发生率较低,主要表现为排尿困难,尿道扩张和腔内治疗是有效的微创治疗手段,大部分患者能获得满意的疗效。

Objective To evaluate the incidence,manifestation,treatment and outcomes of neoves-ical-urethral anastomotic stricture （NUAS）after orthotopic neobladder substitute. Methods We retro-spectively analyzed the data of 41 6 male patients who received neobladder reconstruction following radical cystectomy due to bladder urothelial carcinoma.The clinical characteristics,management and outcomes information were collected from all patients with NUAS. Results Of 41 6 patients 1 5 （3.6%）developed NUAS.Five NUASs were classified as Grade Ⅰ （1 7-22 F）,eight as Grade Ⅱ（〈1 7 F）and two as Grade Ⅲ （pinpoint）.Nine of the 1 5 patients presented with voiding difficulties, three with complete retention,two with urinary tract infection,and one with new-onset filling urinary in-continence.Seven patients were initially subjected to urethral dilation with the probe or urethro-scope,but 2 of them had to receive transurethral incision （TUI）with a cold knife or holmium laser due to the failure of dilation and finally achieved complete neobladder emptying.A single TUI with a cold knife or holmium laser was initially performed in 3 cases successfully.A single or multiple TUR of the stricture was performed in 5 patients.Finally,only 1 patient with a multiple TUR needed to undergo neobladder fistulation.All the 1 5 patients were scheduled in regular follow-up after the treatments of NUAS .At the last follow-up,14 patients achieved complete neobladder emptying. No patient developed denovo incontinence. Conclusions Incidence of NUAS is low in the patients un-dergoing orthotopic neobladder substitute,with most patients presenting with voiding difficulties.Ure-thral dilation and endoscopic treatment are effective minimal invasive therapy.Most patients recover＆amp;nbsp;complete neobladder emptying.