Of the 63 patients with neurogenic bladder who underwent ureteroneocystostomy for the treatment of reflux in the Spinal Injuries Center of the Labour Welfare Corporation, 50 cases where patients had been followed up by urogram for more than 1 year postoperatively were reviewed. The Politano-Leadbetter technique had been used in 3 patients (4 ureters), the Cohen technique had been used in 46 patients (62 ureters), and simple anastomosis had been used in one patient (1 ureter) because of an unsuccessful Cohen technique. Reflux was resolved in 40 (80.0%) of these 50 patients initially, but finally became resolved in 46 patients (92.0%) after subsequent treatment, such as clean intermittent catheterization, anticholinergic agents, transurethral surgery, or re-antireflux surgery. Contralateral reflux occurred postoperatively in 2 (6.1%) of 33 patients who underwent unilateral reimplantation. Reflux was resolved in 11 (64.7%) of 17 patients who underwent bilateral reimplantation, in 29 (87.9%) of 33 patients who underwent unilateral reimplantation, in 18 (72.0%) of 25 patients who had underactive detrusor function, and in 17 (89.5%) of 19 patients who had overactive detrusor function. Vesical compliance was 10 or more than 10 ml./cm. water in 11 of these 25 patients who had underactive detrusor function, 5 to 9.9 in 9, and less than 5 in 5. Reflux was resolved in 10 (90.9%) of these 11 patients, in 6 (66.7%) of these 9 patients, and in 2 (40.0%) of these 5 patients, respectively. Our experience with the 10 patients in whom reflux reappeared suggested that inadequate length (less than 2 cm.) of the submucosal tunnel and/or lower vesical compliance (<10 ml./cm. water) caused the reappearance of reflux. These results indicate that the improvement of vesical compliance is recommended preoperatively and postoperatively, and that ureteroneocystostomy with an adequate length of submucosal tunnel should be performed.
|ジャーナル||Nishinihon Journal of Urology|
|出版ステータス||出版済み - 1 1 1994|
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