潰瘍型間質性膀胱炎女性施行膀胱部分切除及膀胱擴大整形術後長期滿意度及併發症
王脩仁、郭漢崇
花蓮慈濟醫院 泌尿部
Long-term satisfaction and complications in women with ulcer type interstitial cystitis undergoing partial cystectomy and augmentation enterocystoplasty
Hsiu-Jen Wang, Hann-Chrong Kuo
Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
Purpose: Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic syndrome characterized by chronic pelvic pain (> 6 months) with lower urinary tract symptoms. Current consensus suggests the patients with IC/BPS could be subdivided into two types, ulcerative and non-ulcerative IC. Among all medical and surgical treatments for IC/BPS, partial cystectomy (PC) and augmentation enterocystoplasty (AE) is considered a treatment of last resort which may be used just when other therapy such as Intravesical injection of botulinum toxin A or cystoscopy with hydrodistension cannot meet the expectations. The aim of our study is to investigate the long-term satisfaction and complications of the patients undergoing AE which may inspire the pros and cons in treating for refractory IC/BPS.
Materials and Methods: The medical records of fifteen IC/BPS patients (12 ulcer type and 3 non-ulcer type) undergoing AE in single medical center by a single operator (HCK) during 2010 through 2016 were retrospectively reviewed in this study. All patients had been initially treated conservatively but failed. The clinical symptoms and urodynamic study results before operation were recorded. The long-term satisfaction were evaluated by the global response assessment (GRA) and the symptoms which affect the quality of life such as bladder pain, dysuria, frequency and urinary tract infections (UTI) which were graded on a 4-point scale (2: much improved, 1: mild improved, -1: mild worse, and -2: much worse).
Results: The average age was 58.7±12.7 years (range 34~76) and average follow-up period was 36.9±23.1 months. The significant difference between ulcer and non-ulcer IC groups on the clinical symptoms and urodynamic study results before operation were FSF, FS, Capacity and Qmax (Table 1.). The complications related with AE was bladder stone in 3 patients who underwent cystolithotripsy (2 ulcer,16.7%, and 1 non-ulcer, 33.3%). Patients with ulcer type IC/BPS underwent AE reported a better outcome on GRA and quality of life compared with non-ulcer type IC/BPS (Table 2. and Table 3.)..
Conclusions: TAP1 gene codon 333 polymorphism was associated with the calcium oxalate urolithiasis in Taiwanese. The “A” allele had a higher incidence of calcium oxalate urolithiasis. There was lack of association of TAP2 gene polymorphism between calcium oxalate urolithiasis and healthy subjects in Taiwan.