神經性膀胱患者接受膀胱擴大手術的長期追蹤
吳書雨、郭漢崇
花蓮慈濟醫院 泌尿科
Does augmentation enterocystoplasty really benefit patients with neurogenic lower urinary tract dysfunction? -- a real world practice report
Shu-Yu Wu, Hann-Chorng Kuo
Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University Hualien, Taiwan
Purpose: To investigate the real treatment outcome after augmentation enterocystoplasty (AE) in patients with refractory neurogenic lower urinary tract dysfunction.
Materials and Methods: A total of 79 patients were included in this retrospective follow-up investigation in a single center. The video urodynamic data, renal function, incontinence grade before and after AE, voiding pattern and management, clinical outcome, and complications were evaluated.
Results: Seventy-nine patients including 62 men and 17 women were included. The mean age at operation was 39.4 ± 11.6 years and the mean follow-up period was 128.4 ± 85.2 months. At follow-up, 5 (6.7%) patients had spontaneous voiding, 60 (80%) had to perform clean intermittent catheterization (CIC), and 10 (13.3%) chose to keep the indwelling urethral catheter or cystostomy. The catheter depending rate was 93.3% and complete catheter dependent rate was 76%. The renal function did not show much deference after AE. Three patients developed end-stage renal disease and 4 patients had renal function decreased for more than 20% during the follow-up period. The incontinence grade showed much improved in symptom as 2.58 ± 0.95 preoperatively vs. 0.39 ± 0.81 postoperatively (p = 0.000). Among all patients 41.8% experienced recurrent urinary tract infection needing medical treatment and 21.5% of patients suffered from chronic diarrhea. Overall, 45.6% patients had experienced complications needing surgical interventions, most of them were urinary tract stones. Life-threatening complications like bowel obstruction, bladder cancer were also noted in some patients. The majority (86.8%) of patients reported moderate to excellent satisfaction with the outcome of AE.
Conclusions: AE is a procedure with long-term durability and high rates of patient satisfaction. However, several bothersome complications might happen and affect life quality. Both patients and doctors need to think carefully before perform the operation.