The choice of surgical treatment of patients with contracted urinary bladders of tubercular etiology

Chibirov K.H., Semenov S.A., Gorbunov A.I., Semchenko A.F., Komyakov B.K., Kurenkov A.V.

Introduction. Tuberculosis of the urinary bladder leads to its contraction and irreversible decrease in volume, which is defined as a stable aberration of its reservoir function and significant decrease in the quality of life. Augmentation ileocystoplasty and cystectomy combined with orthotopic ileocystoplasty are the standard methods of treating patients with contracted bladders of tubercular etiology. Today, there is the necessity of a more thorough examination and comparison of functional results obtained from these methods of treatment.

Materials and methods. Two groups were formed during the study. The first one consisted of 15 patients after bladder resection (with the trigonum vesicae kept intact) and the subsequent augmentation ileocystoplasty. The second group consisted of 8 patients undergoing cystectomy and orthotopic ileocystoplasty (the Studer's technique). 1-6 years after the operation, the patients underwent urodynamic examination.

Results. The reservoir function of the bladder did not significantly differ among the patients from both groups (p ≥ 0.05) and was within normal limits. After the surgery, 10 patients from the first group (66.6%) and all patients from the second group were able to urinate independendly. 13 patients from the first group (86.6%) and one patient from the second group (12.5%) had the indications for intermittent self-catheterization. In the second group, the volumetric urinary flow was higher; as well as the volume of urine excreted. The volume of residual urine was significantly higher in patients from the first group, which indicates chronic urinary retention. Detrusor opening pressure, detrusor pressure and abdominal pressure were comparable among patients from both groups (p ≥ 0.05). The mean opening time was 51.8 ± 25.6 s in the first group, in comparison with 3.8 ± 2.2 s in the second group, which indicates the statistically significant difference between both groups (p ≤ 0.09).

Conclusion. Augmentation ileocystoplasty and orthotopic ileocystoplasty enable to create a urinary reservoir, whose reservoir function would be satisfactory. However, evacuation of the bladder after augmentation ileocystoplasty was significantly worse, in comparison with orthotopic ileocystoplasty

Authors declare lack of the possible conflicts of interests.

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bladder tuberculosis, "small bladder", expansive ileocystoplasty , orthotopic ileocystoplasty, urodynamic examination, functional results

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