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Continent urinary tract reconstruction - the Lund experience.

机译：尿路重建-隆德经验。

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The Department of Urology in Lund, Sweden, has a long association with innovations in reconstructive urology. The authors from that department describe their experience over a long period with orthotopic bladder substitution and continent cutaneous urinary diversion. They conclude that continent urinary tract reconstruction is associated with a high incidence of early and late complications. They also found that for storage and emptying, their Lundiana pouch was superior to the Goldwasser neobladder. OBJECTIVE: To assess the early and late complications and functional results in patients undergoing continent reconstruction of the urinary tract, i.e. orthotopic bladder substitution (OBS) or continent cutaneous diversion (CCD). PATIENTS AND METHODS: The medical records of all patients undergoing OBS (Goldwasser technique) or CCD ('Lundiana' technique) for malignant or benign disease during 1987-1999 and followed to December 2001 were reviewed. There were 67 patients with neobladders, 77 with a Lundiana pouch who had undergone radical cystectomy and 22 with a Lundiana pouch operated for benign disorders. RESULTS: Early complications requiring reoperation occurred in 12% of the cystectomy group, with no difference with type of reconstruction, and in 10% with benign diseases. Four patients (3%) undergoing radical cystectomy died from early cardiovascular complications, two after surgery for intra-abdominal complications. Intestinally related complications and wound dehiscence requiring re-operation occurred in nine and six patients, respectively. The incidence of late complications requiring open surgery was 22% and 23% after cystectomy with OBS and CCD, respectively. The value in patients with benign diseases undergoing CCD was also 23%. Stone formation in the pouch was common, occurring in 12% in patients with OBS and in 10% after CCD. The pouch perforated or ruptured in four patients. The incidence of uretero-intestinal stricture using the Le Duc technique was 2.4% and renal function was well preserved. Theincidence of revisional surgery of the Lundiana pouch outlet for incontinence was low and all patients but four were continent. The functional outcome in patients with OBS was less good; some needed pouch augmentation or an artificial urinary sphincter. Most patients used incontinence products and many needed clean intermittent self-catheterization. CONCLUSION: Continent urinary tract reconstruction is associated with a high incidence of early and late complications. For storage and emptying, the CCD Lundiana pouch is superior to the OBS of Goldwasser.
机译：瑞典隆德的泌尿外科系与重建泌尿外科的创新有着长期的联系。该部门的作者描述了他们在原位膀胱替代术和大陆性皮肤尿流改道方面的长期经验。他们得出的结论是，大陆尿路重建与早期和晚期并发症的高发生率有关。他们还发现，对于储存和清空，他们的Lundiana袋优于Goldwasser新膀胱。目的：评估接受尿路大陆重建术（即原位膀胱替代术（OBS）或大陆皮肤转移术（CCD））的患者的早期和晚期并发症以及功能结果。病人和方法：回顾了1987-1999年至2001年12月期间接受OBS（Goldwasser技术）或CCD（'Lundiana'技术）恶性或良性疾病的所有患者的病历。有67例新膀胱患者，其中77例行了根治性膀胱切除术的Lundiana袋，以及22例因良性疾病而手术的Lundiana袋。结果：膀胱切除术组中需要手术的早期并发症发生率为12％，重建类型无差异，良性疾病为10％。接受根治性膀胱切除术的4例患者（3％）因早期的心血管并发症而死亡，其中2例因腹腔内并发症而死。肠道相关并发症和需要再次手术的伤口裂开分别发生在9例和6例患者中。进行OBS和CCD膀胱切除术后，需要进行开放手术的晚期并发症发生率分别为22％和23％。接受CCD的良性疾病患者的价值也为23％。眼袋中的结石很常见，OBS患者中占12％，CCD后占10％。该小袋在四名患者中穿孔或破裂。使用Le Duc技术进行的输尿管-肠狭窄的发生率为2.4％，并且肾功能得到很好的保存。 Lundiana袋式尿失禁的翻修手术发生率低，除四名外其余全部患者。 OBS患者的功能预后较差;一些需要的袋囊扩张术或人工尿道括约肌。大多数患者使用失禁产品，许多患者需要清洁的间歇性自我导尿。结论：持续尿路重建与早期和晚期并发症的高发生率有关。对于存储和清空，CCD Lundiana袋优于Goldwasser的OBS。

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