신경인성방광에서 요관방광성형술의 임상경험

Abstract

Purpose: The ureter can be a very effective tissue for bladder augmentation, but the indications for ureterocystoplasty are still evolving, with the main problem being the limited number of patients with a nonfunctioning or poor functioning kidney. Recently, ureterocystoplasty, with preservation of ipsilateral renal function, has been reported by several authors. We reported our experience and follow-up results of ureterocystoplasty. Materials and Methods: Between December 2000 and February 2003, 4 girls, aged 3 to 13 (mean age 7.2), with a low capacity, poorly compliant bladder underwent ureterocystoplasty using a single dilated ureter. Three patients had a dilated ureter due to high grade VUR (vesicoureteric reflux) and the other due to bilateral reflux. An urodynamic study showed an areflexic neurogenic bladder, with low compliance, in all patients. The technique was performed intraperitoneally using a midline abdominal incision. The distal parts of both detubularized magaureters were used for augmentation. The dilated proximal ureter was anastomosed to the longitudinally incised contralateral ureter, in an end to side fashion. Results: The mean follow-up was 21 months (6-41). In a video-urodynamic study, the mean preoperative bladder capacity and post operative volume were 140cc (67-23) and 223cc (140-320), respectively, with an average increase of 17 to 113% (mean 71). The postoperative bladder compliance was normalized in all cases. Postoperative cystography showed excellent bladder configuration, with no vesicoureteral reflux. There were no surgical complications, such as bladder perforation, stone formation and bowel problem. The serum creatinine levels remained stable in all cases (0.3 to 0.6mg/dl). Conclusions: Although an increase in bladder capacity is not always optimal with the use of a distal ureter, it is good enough to ensure a good clinical outcome and allow an adequate catheterization interval, with a low complication rate.