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Abstract：
BACKGROUND: Chronic catheterization remains the only attractive option in specific circumstances, especially in neurologically impaired patients. Complications produced by the indwelling catheters, like patulous urethra and bladder neck destruction, usually lead to severe incontinence and significant nursing difficulties. Here, we describe a rare case, a urinary bladder opening representing massive and extensive destruction of the urethra and bladder sphincter due to an indwelling catheter.
METHODS: We present a 46-year-old paraplegic woman complaining of recurrent febrile urinary tract infections and severe urinary incontinence. She suffered from persistent malodorous urine and skin breakdowns from constant urine leakage. The vaginal examination revealed extensive destruction of the urethra and a 10 cm opening permitting the urinary bladder wall to prolapse into the vagina. The patient underwent a combined surgical approach; a transvaginal bladder closure with anterior colporrhaphy and a Mitrofanoff procedure to ensure a continent stoma for future clean intermittent self-catheterization (CISC). The patient is compliant with CISC and, remains continent twelve years after surgery.
CONCLUSIONS: This case demonstrates that in the era of CISC, there are still neurologically impaired females suffering from rare but critical adverse effects of indwelling catheters. The urethra and bladder neck erosion represent a demanding treatment assignment. The Mitrofanoff procedure for continent stoma and the transvaginal closure of urinary bladder opening produced a lifesaving potential treatment.
METHODS: We present a 46-year-old paraplegic woman complaining of recurrent febrile urinary tract infections and severe urinary incontinence. She suffered from persistent malodorous urine and skin breakdowns from constant urine leakage. The vaginal examination revealed extensive destruction of the urethra and a 10 cm opening permitting the urinary bladder wall to prolapse into the vagina. The patient underwent a combined surgical approach; a transvaginal bladder closure with anterior colporrhaphy and a Mitrofanoff procedure to ensure a continent stoma for future clean intermittent self-catheterization (CISC). The patient is compliant with CISC and, remains continent twelve years after surgery.
CONCLUSIONS: This case demonstrates that in the era of CISC, there are still neurologically impaired females suffering from rare but critical adverse effects of indwelling catheters. The urethra and bladder neck erosion represent a demanding treatment assignment. The Mitrofanoff procedure for continent stoma and the transvaginal closure of urinary bladder opening produced a lifesaving potential treatment.
摘要：
背景：在特定情况下，慢性导管插入术仍然是唯一有吸引力的选择，尤其是在神经系统受损的患者中。留置导管产生的并发症，就像尿道和膀胱颈破坏一样,通常会导致严重的尿失禁和严重的护理困难。这里,我们描述了一个罕见的案例，膀胱开口，由于留置导尿管而造成尿道和膀胱括约肌的大量和广泛的破坏。
方法：我们介绍了一名46岁的截瘫妇女，抱怨复发性高热尿路感染和严重尿失禁。她患有持续的恶臭尿液和皮肤因持续的尿液渗漏而破裂。阴道检查显示尿道广泛破坏，开口10厘米，使膀胱壁脱垂到阴道中。患者接受了联合手术方法；经阴道膀胱闭合术和前阴道修补术和Mitrofanoff手术，以确保大陆造口，以便将来进行清洁的间歇性自我导管插入术（CISC）。患者符合CISC，手术后十二年仍然是大陆。
结论：该案例表明，在CISC时代，仍然有神经系统受损的女性患有罕见但严重的留置导尿管的不良反应。尿道和膀胱颈糜烂代表了苛刻的治疗任务。用于大陆造口的Mitrofanoff手术和经阴道关闭膀胱开口产生了挽救生命的潜在治疗方法。
方法：我们介绍了一名46岁的截瘫妇女，抱怨复发性高热尿路感染和严重尿失禁。她患有持续的恶臭尿液和皮肤因持续的尿液渗漏而破裂。阴道检查显示尿道广泛破坏，开口10厘米，使膀胱壁脱垂到阴道中。患者接受了联合手术方法；经阴道膀胱闭合术和前阴道修补术和Mitrofanoff手术，以确保大陆造口，以便将来进行清洁的间歇性自我导管插入术（CISC）。患者符合CISC，手术后十二年仍然是大陆。
结论：该案例表明，在CISC时代，仍然有神经系统受损的女性患有罕见但严重的留置导尿管的不良反应。尿道和膀胱颈糜烂代表了苛刻的治疗任务。用于大陆造口的Mitrofanoff手术和经阴道关闭膀胱开口产生了挽救生命的潜在治疗方法。
