Study on substitution of wedge-shaped stomach for urinary bladder

摘要

To study the indications,effects and complications of substitution of wedge-shaped stomach for urinary bladder.Methods From May 1992 to December 2003 reconstruction of bladder with wedge-shaped stomach was performed in 61 bladder cancer patients who had undergone total cystectomy.All the patients had urethral urination.Postoperatively,urine continence,urethral urination and complications were observed,and urodynamic studies,imaging examinations,laboratory tests and cystoscopy were performed.Results All the 61 patients were followed up for 5 months to 12 years (mean,6 years).Of them 43 (70.49%) had normosthenuria.The urination interval was 2.0-4.5 h (mean,3 h).The urine volume was 280-520 ml (mean,385 ml).Qmax was 13-25 ml/s (mean,17 ml/s).The bladder capacity was 300-550 ml (mean,375 ml).The maximum urethral pressure was 20-60 cm H2O (mean,48 cm H2O,1 cm H2O=0.098 kPa).The filling bladder pressure was 5-14 cm H2O (mean,11 cm H2O).The maximum bladder pressure was 40-65 cm H2O (mean,55 cm H2O); and it was 25-60 cm H2O (mean,45 cm H2O) during urination.Six cases (9.84%) had urethral anastomotic stoma stricture,which was corrected by electro-resection.In 12 cases whose bladder necks were resected,postoperative incontinence occurred in 12 (100%,12/12),and incontinence was gradually remitted 3-6 months after surgery.Six cases (9.84%) had pain and ulcer of urethral meatus.Nine cases (14.75%) had left uroureter.Forty of 49 cases (81.63%) had residual urine (1-125 ml;mean,30 ml).Retention of urine occurred in 2 cases;urinary tract infection,in 5; hematuria-dysuria syndrome,in 10;aciduria (pH 4.5-7.0),in 61 (100%);epididymitis,in 1.No pyloric sphincter muscle spasm occurred.At 12 months after surgery anastomotic stoma tumor developed in 1,who underwent tumor resection.Nine cases died of tumor metastasis in 1-5 years after surgery.Postoperatively,cystoscopy showed that gastrocystic mucosa was even and smooth in white color without ulcer.Over 1 year gastrocystic mucosa was taken from 15 cases for microscopic and electron microscopic examination.There was gastrocystic mucosal interstitial infiltration of acidophils and lymphocytes.Blood,electrolyte tests and arterial blood gas analysis showed no obvious abnormality.BUN and Cr values were within normal range.Conclusion The operation of substitution of wedge-shaped stomach for bladder has satisfactory effect with less complications.For bladder cancer patients who undergo total cystectomy and cannot keep the urethral sphincter,substitution of wedge-shaped stomach for bladder with urethral urination should not be adopted.8 refs.