CLINICAL OUTCOME AND QUALITY-OF-LIFE FOLLOWING ENTEROCYSTOPLASTY FOR IDIOPATHIC DETRUSOR INSTABILITY AND NEUROGENIC BLADDER DYSFUNCTION

被引:64
作者
HASAN, ST
MARSHALL, C
ROBSON, WA
NEAL, DE
机构
[1] FREEMAN RD HOSP,DEPT UROL,NEWCASTLE TYNE NE2 4HH,TYNE & WEAR,ENGLAND
[2] UNIV NEWCASTLE UPON TYNE,SCH MED,DEPT SURG,NEWCASTLE TYNE NE1 7RU,TYNE & WEAR,ENGLAND
来源
BRITISH JOURNAL OF UROLOGY | 1995年 / 76卷 / 05期
关键词
DETRUSOR INSTABILITY; ENTEROCYSTOPLASTY; BLADDER RECONSTRUCTION; QUALITY OF LIFE; OUTCOME;
D O I
10.1111/j.1464-410X.1995.tb07777.x
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Objective To study the long-term outcome of patients undergoing enterocystoplasty. Patients and methods The study comprised 48 patients (17 men and 31 women; mean age 46 years) who underwent enterocystoplasty for idiopathic detrusor instability (DI, 35 patients) or neurogenic bladder dysfunction (13 patients). Symptoms were scored from 0 to 14 and the overall outcome and generic quality of life were assessed using a Visick grading system (groups A to E) and the Nottingham Health Profile (NHP), These assessments were carried out before, 3 months after operation and at the final follow-up (38 +/- 18 months, range 13-78). Urodynamic studies were performed before and after operation. Results No patient died after operation and there was minimal early morbidity. Late complications (>30 days) included incisional hernia (3), anastomotic perforation (Ij, calculus formation (1) and urethral stricture (1). Clean intermittent self-catheterization (CISC) was performed by 36 (75%) patients. Early symptomatic outcome was good in 40 (83%) patients, moderate in seven (15%) and unsatisfactory in one (2%) patient, The mean symptom scores before and 3 months after surgery were 10 (range 2-14) and 3 (range 2-14), respectively (P<0.001). There was a significant increase in total bladder capacity (307 +/- 140 to 588 +/- 217 mL; P<0.001) and bladder compliance (37 +/- 50 to 169 +/- 162 mL/cm H2O; P<0.001), DI persisted in 15 (31%) patients. NHP scores revealed significant improvements in all domains. Final assessment showed a less satisfactory situation, with recurrent urinary tract infection (UTI) in 17 (37%) patients, a need for long-term antibiotic therapy in seven (15%) and a change in bowel habit in 15 (33%) (13 DI, two with neurogenic bladder dysfunction). CISC was performed by 39 (85%) patients. The long-term outcome was good or moderate in 12 patients (92%) with neurogenic bladder dysfunction and good or moderate in only 19 patients (58%) with DI. Conclusion Clam enterocystoplasty remains an effective management option in some patients with DI, but most patients with neurogenic bladder dysfunction do well. The procedure is, however, associated with longterm complications such as disturbance of bowel habit and recurrent UTIs, which impair the outcome in the long-term in patients with DI despite general improvements in irritative bladder symptoms.
引用
收藏
页码:551 / 557
页数:7
相关论文
共 24 条
[1]   PERFORATION OF THE AUGMENTED BLADDER [J].
BAUER, SB ;
HENDREN, WH ;
KOZAKEWICH, H ;
MALONEY, S ;
COLODNY, AH ;
MANDELL, J ;
RETIK, AB .
JOURNAL OF UROLOGY, 1992, 148 (02) :699-703
[2]   THE CLAM CYSTOPLASTY [J].
BRAMBLE, FJ .
BRITISH JOURNAL OF UROLOGY, 1990, 66 (04) :337-341
[3]   THE TREATMENT OF ADULT ENURESIS AND URGE INCONTINENCE BY ENTEROCYSTOPLASTY [J].
BRAMBLE, FJ .
BRITISH JOURNAL OF UROLOGY, 1982, 54 (06) :693-696
[4]   NUTRITIONAL CONSEQUENCES OF BOWEL SEGMENTS IN THE LOWER URINARY-TRACT [J].
CANNING, DA ;
PERMAN, JA ;
JEFFS, RD ;
GEARHART, JP .
JOURNAL OF UROLOGY, 1989, 142 (02) :509-511
[5]   ANALYSIS OF PRESENTING SYMPTOMS IN PROSTATISM [J].
FRIMODTMOLLER, PC ;
JENSEN, KME ;
IVERSEN, P ;
MADSEN, PO ;
BRUSKEWITZ, RC .
JOURNAL OF UROLOGY, 1984, 132 (02) :272-276
[6]   CLAM ILEOCYSTOPLASTY [J].
GEORGE, VK ;
RUSSELL, GL ;
SHUTT, A ;
GACHES, CGC ;
ASHKEN, MH .
BRITISH JOURNAL OF UROLOGY, 1991, 68 (05) :487-489
[7]   SPONTANEOUS PERFORATION OF AN AUGMENTED BLADDER [J].
GLEESON, MJ ;
CUNNANE, G ;
GRAINGER, R .
BRITISH JOURNAL OF UROLOGY, 1991, 68 (06) :655-655
[8]   BLADDER AUGMENTATION - EXPERIENCE WITH 129 CHILDREN AND YOUNG-ADULTS [J].
HENDREN, WH ;
HENDREN, RB .
JOURNAL OF UROLOGY, 1990, 144 (02) :445-453
[9]   COMPLICATIONS OF ENTEROCYSTOPLASTY [J].
KHOURY, JM ;
TIMMONS, SL ;
CORBEL, L ;
WEBSTER, GD .
UROLOGY, 1992, 40 (01) :9-14
[10]   TUBULOVILLOUS ADENOMA ARISING 30 YEARS AFTER ILEOCYSTOPLASTY [J].
KING, PH ;
OSBORN, DE ;
MACKAY, EH .
JOURNAL OF CLINICAL PATHOLOGY, 1992, 45 (10) :928-929