Ortotopska ilealna neobešika kreirana po originalnoj hirurškoj metodi “Belgrade pouch”– desetogodišnje iskustvo
Sažetak
Uvod/Cilj. Princip kontinentnih urinarnih derivacija je zasnovan na kreiranju arteficijalnog rezervoara za urin, što sličnijeg mokraćnoj bešici, adekvatnog kapaciteta, visokog stepena kontinencije, niskog pritiska i što manje resorptivne površine, u cilju sprečavanja pojave metaboličkih komplikacija. Metode. Prospektivnom i delom retrospektivnom studijom obuhvaćeno je 148 bolesnika koji su u periodu od 10 godina bili operisani zbog tumora mokraćne bešike ograničenog na organ sa invazijom mišićnog sloja (pT2), i kojima je nakon radikalne cistektomije originalnom hirurškom tehnikom Belgrade pouch kreirana neobešika od kratkog segmenta ileuma u obliku slova „U“, prosečne dužine 30 cm. Period praćenja posle operacije iznosio je tri godine. Rezultati. Kod 126 muškaraca i 22 žene operisanih tehnikom kreiranja neobešike Belgrade pouch, posle tri godine prosečna zapremina neobešike bila je 477 (330–659) mL, zapremina rezidualng urina je bila klinički beznačajna [52 (0–92) mL], a prosečna frekvencija 24-časovnog mokrenja iznosila je pet puta na dan. Dnevnu kontinenciju je imalo 90% operisanih, a noćnu 88%. Kod 7% bolesnika utvrđena je blaga acidoza, a kod 3% nedostatak vitamina B12. Zaključak. Neobešika kreirana po metodi Belgrade pouch pokazala je odlične rezultate, uporedive sa standardnim tehnikama obezbeđujući odličan kapacitet, visok stepen kontinencije, dobru 24-časovnu frekvenciju mokrenja, beznačajan rezidualni urin i značajno nižu stopu metaboličkih komplikacija u trogodišnjem periodu praćenja.
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