骨盆惡性腫瘤治療後引發膀胱功能異常之處理流程圖--某醫院之短期報告
盧致誠 范文宙
奇美醫療財團法人柳營奇美醫院 外科部 泌尿外科
Postulated algorithm for urinary bladder dysfunction of patients after pelvic malignancy treatment--short term report of a local hospital
Chih-Cheng Lu, Wen-Chou Fan
Division of Urology, Department of Surgery, Chi Mei Medical Center, Liouying, Tainan
Purpose:
The primary function of urinary bladder is for urine storage and voiding. Treatment for pelvic organ malignancy may deteriorate the originally normal bladder function. The aim of this study is to postulate a clinical steps for managing bladder dysfunction of the patients who had treatment for pelvic malignancy.
Materials and Methods:
A retrospective chart review study was performed. From the urodynamic studies records, patients with pelvic organ malignancy after treatment (surgery or radiation) were enrolled. Patients’ gender, age, causes of malignancy, were recorded and analyzed. Patients receiving urodynamic studies with benign causes were excluded. A possible flow chart to manage the bladder dysfunction was proposed by reviewing literature.
Results:
From January 2014 to Marchl 2014, there were 77 patients eligible for urodynamic analysis. Pelvic organ malignancies included prostatic (31/77), bladder (18/77), colonic (21/77), and cervical (7/77) origin. The urodynamic studies were demonstrated by uroflowmetry and cystometry. In uroflowmetry (53 cases), maximal urine flow rate ranged from 6 to 17 ml/sec (mean 11.8 ). In cystometry (27 cases), most of the bladder contractility showed detrusor areflexia(11/27) followed by detrusor hyper-reflexia (7/27), hyper-reflexia (5/27) and normoreflexia (4/27). Several methods were postulated. Behavioral therapy, weight loss and pelvic muscle exercise, might improve neurogenic dysfunction. Medications consist of antimuscarinic agents and newly developed B3-adrenergic agonist. Monotherapy or combined medications is based on the improvement of the patients. Side effects of B3-adrenergic agonist include hypertension, cardiac arrhythmia, and urinary retention. After refractory to prior management, invasive procedures including treatments with onabotulinumtoxin A botox, percutaneous tibial nerve stimulation, and sacral neuromodulation are available options.
Conclusion:
This is a short term report. An algorithm will be drawn for clinical application. Further study for longer and larger scale is needed.