Zusammenfassung
Bei neurogenen "Low-compliance-Harnblasen" werden häufig chirurgische Verfahren wie die Blasenaugmentation notwendig. Wenn möglich, sollte man vermeiden, Fremdgewebe wie beispielsweise Darm in den Harntrakt einzubringen, sondern der Blasenaugmentation mit Eigenureter den Vorzug geben. Bei diesem Verfahren erfolgt die transperitoneale Nephrektomie der funktionslosen Niere unter Erhaltung des Nierenbeckens und des Megaureters, eine Detubularisierung dieser Strukturen und ihre Einbeziehung in die eröffnete Harnblase.
Anhand von 4 Patienten (2 Jungen und 2 Mädchen, Alter 6–13 Jahre) konnten wir zeigen, dass mit diesem Verfahren eine gute Rehabilitation des unteren Harntrakts erreicht werden kann. Die Speicherfunktion der Harnblase wird signifikant verbessert und der verbliebene Anteil des oberen Harntrakts geschützt. Mit Komplikationen, wie beispielsweise einer partiellen Harnleiternekrose, muss gerechnet werden, wenn die Durchblutung des verwendeten Ureters kompromittiert ist, beispielsweise durch vorangegangene wiederholte Antirefluxplastiken.
Abstract
Surgical procedures such as ileal augmentation cystoplasties are often necessary in neurogenic low-compliance bladders. Whenever possible one should avoid using segments of the GI tract in the urinary tract and preferably use the patient's own ureter for augmentation cystoplasty. This procedure includes transperitoneal nephrectomy of a nonfunctioning kidney with preservation of the renal pelvis and the megaureter, followed by detubularization of the ureter and its integration into the opened urinary bladder.
We performed this procedure on four patients, two boys and two girls (aged 6–13 years). In the long-term follow-up they all had good rehabilitation results for their lower urinary tracts with an increase of the storage volume and normalization of their reduced compliance. No deterioration of the remaining upper urinary tract was found. Complications such as partial ureteral necrosis have to be taken into consideration when the vascularization of the ureter is compromised, for example, by multiple prior antireflux procedures.
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Haferkamp, A., Melchior, D., Schumacher, S. et al. Ureteraugmentation der Harnblase. Urologe [A] 42, 954–959 (2003). https://doi.org/10.1007/s00120-003-0316-5
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DOI: https://doi.org/10.1007/s00120-003-0316-5