Orthotopic urinary diversion in women

摘要

To investigate the therapeutic effects of orthotopic urinary diversion in women.Methods From September 1995 to December 2003,34 female patients (mean age,58 years;ranging,53-64 years) with bladder cancer were included.Of them,30 cases were of primary tumors and 4,of recurrent ones.Pathology showed transitional cell carcinoma in 30 cases,bladder adenocarcinoma in 3 and squamous cell carcinoma in 1.Radical cystectomy was performed in all the 34 cases; and the technique of cystectomy with nerve-sparing was performed in 24 of them.Intraoperative frozen section of the distal urethra surgical margin showed no evidence of tumor,and ileal neobladder was formed in all.The clinical therapeutic effects were analyzed retrospectively.Results The mean operative time was 360 min (ranging,280-420 min),and mean blood transfusion was 600 ml(ranging,300-1000 ml).Thirty cases were followed up for a mean of 61 months (ranging,6-108 months).At 6 months after surgery the continence rate was 90% (27/30) during the day and 86% (26/30) at night.Twenty-three cases could empty the neobladder one time and 2 needed intermittent catheterization due to hyper-continence;the other 5 needed pushing the abdomen to empty the neobladder.Twenty-three patients had good urodynamic findings;the vesical capacity ranged 300-520 ml and maximum intravesical pressure were <23 cm H2O;functional urethral length ranged 2.6-3.5 cm and the residual urine volume ranged 0-38 ml.IVU showed that all the neobladders were ball-shaped with no ureteral stenosis,but reflux in 1 case and mild hydroureter and hydronephrosis in another 1.Renal function and electrolyte metabolism were normal in the 30 cases.No one suffered from urethral recurrence or neobladder tumor.Conclusion The results of orthotopic urinary diversion in women are satisfactory and this surgical technique can be preferred in selected women with bladder cancer after radical cystectomy.14 refs.