Bladder transection

Children over 3 years old have no neurological and urinary systemic lesions, and unconsciously urinate for enuresis after falling asleep at night. Usually with age, most children with enuresis can heal themselves. Those who still have the above symptoms after the age of 16 are called adult enuresis. In addition to nocturnal enuresis, there are still frequent urination, urgency and urgent urinary incontinence during the day called enurotic syndrome. 1. Diagnosis First, urinary retention and urinary incontinence caused by urinary tract obstruction, inflammation, etc. should be excluded by urography and urodynamics. Secondly, through the neurological examination and various auxiliary examinations, urinary retention and urinary incontinence caused by neurological diseases are excluded. The diagnosis is then determined based on the patient's age and clinical symptoms. 2. Treatment (1) General treatment: reduce the mental stress of the patient and the troubles in life, do not fight, should be positively encouraged; avoid excessive daytime, reduce the amount of drinking water before dinner and bedtime, develop the habit of urinating before going to bed; Use an alarm clock to wake up urination; during the day, encourage patients to extend the interval between urination to increase bladder capacity. (2) drug treatment: adult enuresis can be awakened with ephedrine, imipramine and chlorate. The enuresis syndrome can be treated with isoprozin, probufen and detrusitol. (3) Acupuncture therapy: acupuncture points on both sides of Sanyinjiao and Bladder Yu. (4) nerve block therapy: enuresis syndrome can be used for pudendal nerve or radial nerve block. (5) Surgical treatment: sacral nerve resection can cause constipation in women, and erectile dysfunction in men, should be used with caution. The use of bladder transection for the treatment of adult enuresis and enuresis syndrome with ineffective non-surgical treatment, the cure rate is 50% to 90%, the effect of adult enuresis is better than enuresis syndrome. Treating diseases: enuresis Indication 1. Age Because of the chance of self-healing in patients with enuresis from 16 to 21 years old, this operation is suitable for patients over 21 years old. 2. Drugs and other non-surgical treatments are ineffective. 3. There is no organic disease in the urinary system and nervous system. 4. The bladder capacity is normal under anesthesia. Preoperative preparation Preoperative urethral indwelling catheter. Prepare 2 ureteral catheters. Surgical procedure 1. Incision The midline incision in the lower abdomen 2. Bladder incision and ureteral catheter free front and side of the bladder. The anterior wall of the bladder was cut at a distance of 2 cm from the neck of the bladder. The bladder cavity was probed. The ureteral orifice of the ureter was inserted into the ureteral catheter and fixed in the triangle of the bladder to prevent the catheter from coming out. 3. Transversely cut the posterior wall of the bladder and cut the entire posterior wall of the bladder from the inside of the bladder 2 cm from the ureter. Be careful not to damage the two ureters. The incision was extended to both sides and connected to the incision of the anterior wall of the bladder to completely stop bleeding. 4. After the bladder is transected, the cutting edges on both sides and the posterior wall should be free of more than 1 cm. 5. After suturing the bladder and removing the two ureteral catheters, the whole layer or the muscle layer of the bladder was sutured continuously from the posterior wall of the bladder with a 2-0 absorbable line. The 3-0 absorbable line was used to suture the muscle layer. The mucosal layer was sutured continuously. A F26 sputum catheter was placed at the top of the bladder, and the upper and lower tubes were sewn with absorbable wires. About 200 ml of isotonic saline was injected from the stoma tube to observe whether there was leakage at the suture of the bladder. If there is any leakage, the seam will not be leaked. 6. Place a drainage tube behind the pubic symphysis and place a rubber tube for drainage. The abdominal incision is sutured layer by layer. Secure the stoma tube with skin sutures. complication 1. Bleeding is mainly due to the incomplete bleeding of the bladder margin. The treatment was performed by placing the urethra into a catheter, and isotonic saline or hemostatic drug for continuous bladder irrigation. More bleeding can stop on its own. Blood transfusion if necessary. 2. The leaking of the wound is mainly due to the tightness of the bladder suture or the poor healing due to infection. As long as the bladder mouth tube is kept open, the urine is fully drained, and the anti-infective measures are strengthened. The wound can heal and the urine leakage can be stopped. 3. Ureteral injury is mainly caused by accidental injury when the posterior wall of the bladder is cut. Prevention When cutting the posterior wall, you must first find out the position of the ureteral catheter, and use the method of cutting, touching, and watching. If the injury has been accidentally, the ureteral stent tube should be sutured immediately and placed for 2 to 3 weeks.